bluuebunny/crossref_metadata_2025 huggingface dataset:
Current practice of coronary CT: indications and results - real world data
Authors: Almeida I , Mendonca T , Ramos R , Cruz Ferreira R
Published: June 2024

Introduction

Current indications for coronary artery disease (CAD) evaluation through computed tomography (CT) are well established.

Purpose

To evaluate the real world experience regarding indications to coronary CT, results and subsequent patient management.

Material and methods

Single center retrospective analysis of patients´ admitted to perform a coronary CT during 2023. Demographic and clinical characteristics of patients, indications for the CT, exam data and management were recorded.

Results

484 patients were included (mean age 67.5 years, 52.2% male). In the first group, 283 (58.4%) patients presented with chest pain and no known CAD. Of these, 47.7% had positive ischemia tests, ventricular repolarization or echocardiographic wall motion abnormalities. The other 52.3% were referred due to chest pain only or despite negative ischemia tests. In the second group, 110 (22.8%) patients were referred to exclude CAD in the presence of other cardiac conditions: valvular heart disease (18.2%), ventricular ectopic beats (22.8%), heart failure (30.0%), cardiac transplantation (10.9%), acute conditions (10%) and congenital heart disease (8.2%). The exams´ results were divided in the following categories: absence of CAD, non-obstructive CAD (stenosis <50%), obstructive CAD (stenosis >50%) or inconclusive (non-assessable left main and/or proximal anterior descending artery or elevated atherosclerotic burden precluding contrast injection). In the first group, 81.6% presented none or non-obstructive CAD, 8.8% obstructive CAD and 9.6% were inconclusive. In the second group, 85.5% presented none or non-obstructive CAD, 7.3% obstructive CAD and 6.9% were inconclusive. Depending on medical decision, some patients with obstructive and inconclusive CAD were referred to coronary angiography (CA). At the present time, 10 patients performed CA, of which 3 was submitted to percutaneous intervention. In the third group, 91 (18.8%) patients were referred to coronary CT to evaluate coronary artery anomalies (CAA) (9.9%) and known CAD, namely, coronary stents (11%), coronary artery bypass grafts (CABG) (69.2%) and to decide surgical revascularization based on an occluded artery in CA (9.9%). Regarding CAA, only 1 patient was diagnosed with a malignant course and submitted to an unroofing procedure. Regarding previously revascularized patients: coronary stents and CABG were adequately evaluated in all proposed patients (only 1 and 2, respectively, presented cclusive lesions and were referred to CA). Of the patients presented with a coronary occlusion on CA, 5 (55.6%) had a good distal vessel so they were referred to surgical revascularization.

Conclusion

Our data is in accordance with current published studies and guidelines showing that coronary CT is a well stablished exam to safely exclude CAD in a low-intermediate risk population as well as some previously revascularized patients.
Role of coronary CT angiography (CCTA) in the prepartecipation screening (PPS) of apparently healthy master athletes
Authors: Moliterno E , Giarletta L , Brancasi A , Rovere G , Natale L , Marano R
Published: June 2024

Background

Pre-participation screening (PPS) of athletes aged over 35 years (master athletes, MA) is a major concern in Sports Cardiology. In this population, exercise-related sudden cardiac death (SCD) is rare but primarily due to coronary atherosclerosis (cATS)[1] often resulting from acute plaque rupture/erosion or complication of severe stenosis in most cases, making mandatory the need for early detection of apparently healthy competitive mature athletes. Despite its excellent negative predictive value [2], the possible role of Coronary CT Angiography (CCTA) in this context has yet to be clearly defined [3].

Purpose

To evaluate the contribute of CCTA for the sport suitability and clinical management of MA assessed in course of PPS with risk factors, symptoms and/or positive/equivocal stress-test ECG.

Methods

We retrospectively enrolled MA who underwent CCTA in our hospital in the last 12 years, analyzing symptoms, stress-test ECG, cardiovascular risk profiles (SCORE) and CCTA findings.

Results

The study population included 167 MA (143 males, 24 females, mean age 53±10 and 54±9 years, respectively). Among the whole enrolled population, 153 (91.6%) MA underwent CCTA for equivocal/positive stresstest ECG with/without symptoms, 13 (7.8%) just for clinical symptoms, 1 (0.6%) for the family history. The CCTA showed the presence of cATS in 69 MA (41.3%), congenital coronary anomalies (anomalous origin or deep myocardial bridge) in 8 (4.8%), both in 7 (4.2%). A negative CCTA was observed in 83 MA (49.7%). The risk-SCORE (age, hypertension, hypercholesterolemia, smoking) was a good indicator for the presence of moderate/severe cATS on CCTA. However, mild/moderate cATS was present in 17.2% of MA clinically stratified at a low risk-SCORE.

Conclusion

While invasive angiography is more indicated in MA with positive stress-test ECG if symptomatic and/or with high/very high risk-SCORE, in our experience CCTA may be helpful in the PPS of MA (males/postmenopausal females) with an abnormal stress-test ECG and/or clinical symptoms engaged in competitive sports with a high cardiovascular involvement. Age, gender, presence of symptoms and clinical risk-SCORE assessment may help sports physicians and cardiologists to decide whether to request a CCTA or not.Flow-Charts  CCTA
Cancer treatment including radiotherapy reduces residual inflammatory risk in women with breast cancer
Authors: Kotanidis C P , Jacob S , Jimenez G , Lapeyre M , Halborg T , Tomlins P , Thomas S , Xie C , Channon K , Neubauer S , Antoniades C
Published: June 2024

Background

Radiotherapy is believed to induce vascular injury in patients with cancer. However, the link between radiation therapy and cardiovascular risk remains unclear, particularly in women with breast cancer where the coronary arteries are directly radiated.

Purpose

To explore the direct impact of cancer treatment including radiotherapy (RT) on coronary inflammation and the residual inflammatory risk in women with breast cancer.

Methods

This prospective study included 101 breast cancer patients from the BACCARAT study treated with RT without chemotherapy. CCTA images were taken at baseline (before RT) and two years following RT. Coronary inflammation was measured in each coronary artery using the perivascular Fat Attenuation Index (FAI) Score, an established quantitative metric of coronary inflammation, corrected for age and gender. The residual inflammatory risk was quantified using the CaRi-Heart prognostic model that integrates FAI Score with clinical risk factors (diabetes, smoking, hyperlipidaemia, and hypertension) and coronary plaque burden, as previously described.

Results

Two years after RT, 83 patients had a complete set of paired analysable CCTAs. There was a marked parallel reduction of vascular inflammation at follow-up, as captured by the significant reduction in FAI score percentiles across all epicardial coronaries (p<0.0001 for RCA, p=0.031 for LAD, p=0.009 for LCX, a-c). Despite the increase in coronary calcification (p<0.001, d), the predicted 8-year risk for fatal cardiac events (CaRi-Heart Risk) was reduced by 14% in this population two years after radiotherapy (p=0.014, e). No change was observed in total epicardial adipose tissue (EpAT) volume (p=0.17), while there was no significant association between coronary inflammation and the amount of radiation exposure of the heart (f). Importantly, there was a meaningful risk reclassification 2 years after radiotherapy, with 45.9% of the high-risk patients reclassified to lower risk categories, and a parallel expansion of the "low" risk population from 8.5% to 24.4% (g).

Conclusion

This study demonstrates that cancer treatment including radiotherapy decreases baseline coronary inflammation and leads to significant reduction of the residual inflammatory risk in women with breast cancer, two years after treatment (h). The parallel increase of coronary calcification suggests plaque stabilization as coronary inflammation is reduced, and supports that vascular inflammation triggered by the tumour itself, rather than the radiotherapy, may partly explain increased cardiovascular risk in these women.
Imaging Approaches for Patients with Gastrointestinal Uptake During Myocardial Perfusion Imaging: Impact on Image Quality
Authors: Wong A P C , Teng X F , Koh A S , Keng F Y J , Tan H T
Published: June 2024

Background/Purpose

Extra-cardiac uptake particularly related to increased radiotracer uptake in the gastrointestinal (GI) organs during myocardial perfusion imaging (MPI) is a common problem that reduces image quality. Traditional methods aimed at reducing GI uptake such as consumption of food and water may not be appropriate for patients with heart or renal failure, digestive disorders or naso-gastric tube feeding. Few studies have investigated the impact of upright position imaging. With the advances in gamma camera technology, newer approaches such as upright position imaging may be useful for separating GI activity away from myocardial activity.

Methods

In this work, among a large contemporary cohort of patients referred for clinically indicated MPI studies in our laboratory, we studied the impact of three different approaches for MPI scans with significant gastrointestinal uptake, using gamma cameras. The three approaches include delayed image reacquisition, re-imaging by thallium and upright imaging. Image quality was ranked as poor, fair, good, and excellent.

Results

Between January 2021 to December 2023, we identified n=780 patients with images that showed significant GI activity. Most patients were male (66%), mean age 68±11 years, and non-obese (mean body mass index 23±4 kg/m2). For stress imaging, delayed and upright imaging achieved highest scores for fair to good (70% and 81%) to excellent (29% and 19%) image quality, compared to thallium imaging (0% for good and excellent). For rest imaging, delayed and upright imaging achieved highest scores for fair to good (69% and 80%) to excellent (29% and 20%) image quality, compared to thallium imaging (0% for good and excellent).

Conclusion

We show that delayed image reacquisition in supine position is a useful approach to improving image quality for scans with significant GI uptake but also demonstrate growing potential for upright imaging. Upright imaging may be useful for patients who cannot tolerate supine positions (heart failure).
Prognosis variables to overall mortality in patients with systemic sclerosis: pilot cohort study
Authors: Aguirre E , Guillen Del Castillo A , Palomar Munoz A , Cardozo-Saavedra A , Aguade-Bruix S , Cuellar-Calabria H , Pizzi M N , Roque A , Simeon Aznar C P , Romero-Farina G
Published: June 2024

Background

It is widely acknowledged that patients with systemic sclerosis (SSc) experience elevated rates of cardiovascular mortality and morbidity over the course of their lives.

Purpose

The aim of this exploratory pilot study is to examine the prognostic variables for all-cause mortality detected in patients with SSc detected by nuclear imaging and cardiac CT.

Methods

Prospective cohort study. During a period of 4 years (2012 to 2016), 62 (age 56.8 ± 12.9 years, men 12.9%) patients with SSc referred from the Medicine Service for a cardiological evaluation. These patients underwent gated Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging (gSPECT-MPI) stress-rest and also underwent coronary computed tomography angiography (CCTA). Cox regression analysis (STATA 18, StataCorp, College Station, TX, USA) was employed for statistical analyses to evaluate independent predictive variables, with adjustments made for age and gender.

Results

During a long follow-up of 7.6 ± 2.3 years post gSPECT and CCTA, 12 deaths (9 non-cardiac deaths and 3 cardiac deaths) (0.025 exitus/patients/years) was observed. In the univariate Cox regression analysis, previous cardiac event (myocardial infarction, heart failure, unstable angina, coronary revascularization, syncope) (HR: 6.1, p=0.005), coronary artery disease (stenosis > 10%) (HR:8.2, p=0.003), significant coronary artery disease (CAD) ≥ 50% (HR: 3.9, p=0.036), calcium score ≥ 200 AU (HR: 3.2, p=0.045), METs ≤ 5 (HR: 5.3, p=0.007), cold test resistance ≤ 1 minute (HR: 10, p=0.027), summed thickening score at rest (HR: 1.12, p=0.016) and diastolic dysfunction (TPFR: Time to Peak Filling Rate > 250 mseg) (HR: 4.9, p=0.010), were significant. All these variables were used for multivariate Cox analysis, and the final predictive model for all-cause mortality adjusted by age and gender (Harrell’s = 0.905, Somers’ D = 0.809) was (Results Table):

Conclusion

In this pilot cohort study with long follow-up in patients with SSc a significant CAD, the exercise capacity, the cold test resistance and the diastolic disfunction emerged as the most crucial variables in predicting all-cause mortality, demonstrating good accuracy.
Diagnostic strategies including cardiac SPECT/CT for women with known or suspected coronary artery disease. Data from Latvian cardiac SPECT/CT registry
Authors: Vitola B , Mintale I , Trusinskis K , Kalnina M , Erglis A
Published: June 2024

Introduction

Myocardial perfusion imaging with cardiac SPECT/CT is an important and widely used non-invasive cardiac imaging test for the diagnosis and quantification of myocardial ischemia. The diagnostic algorithm for detection of coronary artery disease (CAD) should be applied individually for every patient group.

Purpose

To analyze the diagnostic strategies including cardiac SPECT/CT for women with suspected CAD in Latvia and to investigate prescribed further diagnostic approaches to establish the diagnosis and appropriate treatment.

Methods

For women included in Latvian cardiac SPECT/CT registry the cardiac SPECT/CT was performed in a single University Hospital from 2018 till 2023. For all of them the previous exercise stress test was performed. The patients were divided into 2 groups: normal myocardial perfusion and true myocardial perfusion defect, defined as area of ischemia ≥ 10% of the left ventricle myocardium. Patients with perfusion defect were analyzed according to prescribed further diagnostic test or treatment option.

Results

Totally 910 women with known or suspected CAD were analyzed. True myocardial perfusion defect was detected in 173 patients (19.0%). The previous exercise stress test was positive in 92 (53.2%) women with significant perfusion defect in SPECT/CT. As further diagnostic approach in 40 (23.1%) cases cardiac computed tomography angiography (CTA) was suggested and the invasive coronary angiography (ICA) - in 130 (75.1%) cases. The patients without performed further diagnostic tests were excluded. Analyzing results of all performed CTAs’ (n=32), stenosis in epicardial coronary arteries were found in 2 cases (6.25%) and patients were referred to percutaneous coronary intervention (PCI). Of all performed ICA (n=110), in 69 (62.7%) women atherosclerosis in main coronary arteries was not observed and INOCA (ischemia with non-obstructive coronary arteries) as a primary diagnosis was suspected. In 32(29.1%) patients the significant stenosis in epicardial coronary arteries was present and PCI was performed, of whom 12 (37.5%) women were primarily diagnosed. 2 patients (1.8%) underwent coronary artery bypass surgery (CBP).

Conclusion

The diagnostic algorithm including cardiac SPECT/CT is relevant and highly recommended for the diagnostics of CAD. Knowing the relatively low specificity of exercise stress test for women, the cardiac SPECT/CT should be performed as an initial diagnostic test for women with intermediate and high pre-test probability. In symptomatic patients with significant perfusion defect, but non-obstructed coronary arteries – the invasive testing of intracoronary physiology should be performed to assess microvascular function.
Assessment of myocardial perfusion with cardiac SPECT/CT for women with known coronary artery disease, prior myocardial infarction or percutaneous coronary intervention
Authors: Vitola B , Mintale I , Trusinskis K , Kalnina M , Erglis A
Published: June 2024

Introduction

Women with high cardiovascular risk are often underdiagnosed and subsequently undertreated leading to higher mortality. The cardiac SPECT/CT is recommended for risk stratification of symptomatic patients with known coronary artery disease (CAD) if the localization and area of ischemia may influence the clinical decision making. In patients with previous myocardial infarction (MI) or frequently after percutaneous coronary intervention (PCI), exercise ECG test is considered sub-optimal, since the possibility of ischemia is higher, and MI often makes the ST segment response more difficult to assess.

Purpose

To analyze the accuracy of cardiac SPECT/CT for symptomatic women with known CAD, prior MI or PCI.

Methods

For women included in Latvian cardiac SPECT/CT registry the cardiac SPECT/CT was performed in a single University Hospital from 2018 till 2023. True myocardial perfusion defect was defined as area of ischemia ≥ 10% of the left ventricle myocardium. Patients with perfusion defect were analyzed according to prescribed treatment option.

Results

Totally 365 patients with previously known CAD were analyzed, of whom 318 (87.1%) have had prior PCI and 114 (31.2%) – prior MI. True myocardial perfusion defect was detected in 55 patients (15.1%). The patients without performed further diagnostic tests were excluded.

In patient group with prior MI, the significant perfusion defect was detected in 25 (21.9%) cases and in 15 women (60.0% form all positive cardiac SPECT/CTs in this group) repeated PCI was performed. Of patients with prior PCI, the significant perfusion defect was detected in 47 (14.8%) cases and in 24 women (51.0% form all positive cardiac SPECT/CTs in this group) repeated PCI was performed. In patients without prior PCI or MI (n=47), but with intermediate stenosis in coronary arteries, the primary PCI was performed in 17 (36.2%) cases.

Conclusion

A non-invasive imaging test with cardiac SPECT/CT is recommended to assess perfusion defect in patients with new or worsening cardiac symptoms; as a follow-up after myocardial infarction; with undergone prior PCI or CABG and to evaluate the impact on perfusion of intermediate stenosis in epicardial coronary arteries. In patients with significant perfusion defect and non-obstructive new stenosis regardless of prior MI or PCI, the diagnosis of coronary microvascular dysfunction and / or vasospasm should be considered.
Adverse events profile of regadenoson in patients with end-stage lung disease candidates for lung transplantation
Authors: Salgado C , Ruiz-Reina A , Romero-Fernandez P , Sanchez-De-Mora E , Del Pozo-Rivas R , Jimenez-Heffernan A
Published: June 2024

Background

Regadenoson is a selective agonist of A2A adenosine receptors, and thus the risk of bronchoconstriction due to the activity through the A2B and A3 receptors is much lower, and several studies support its use in patients with mild to severe chronic obstructive pulmonary disease (COPD).

Purpose

We aim to assess the safety of regadenoson, combined with low-level exercise in patients with end-stage lung disease (ELD) who were considered candidates for lung transplantation (LT), referred for myocardial perfusion imaging (MPI).

Methods

We studied prospectively 14 patients (71.4% male, mean age: 55.5± years, range: 35-62 years) with ELD who met LT criteria. Stress was 4 minutes of low-level exercise with bolus injection of regadenoson (0.4 mg) at minute 1.5, followed by 99mTc-MPI agent injection. Type of ELD, pulmonary function test (forced vital capacity (FVC), forced expiratory volume in 1 seconds (FEV1), FEV1/FVC, diffusing capacity (DLCO), and carbon monoxide transfer coefficient (KCO)), respiratory treatment, adverse events, oxygen saturation (SatO2), changes in systolic blood pressure (SBP), and heart rate (HR), were registered.

Results

The primary diagnoses included idiopathic pulmonary fibrosis (n=7), severe COPD GOLD IV (n=5), and diffuse interstitial lung disease (n=2) (50.0%, 35.7% and 14.3%, respectively). 64.3% showed a restrictive spirometric pattern (33.3% mild, moderate and severe grades, respectively) and 35.7% a mixed obstrucitve pattern (80% severe, 20% moderate). The observed adverse events profile of regadenoson was self-limiting: Dyspnea (50.0%), fatigue (35.7%), nausea (14.3%), dizziness and feeling hot (7.1%, respectively). One patient needed additional oxygen (4 L/min) because of severe dyspnea. 28.6% of patients did not report any symptom. We observed no significant changes in SBP (139.9 mmHg ± 16.5 vs 149.0 mmHg ± 26.1; p=0.15). Mean HR increased significantly from baseline (77 b.p.m. ± 10 vs 114 b.p.m. ± 14; p<0.05).

Conclusions

Regadenoson combined with low-level exercise is safe in patients with ELD who can benefit from coronary revascularization before lung transplantation.
Evaluation of the feasibility of utilizing the H/CL ratio with HMDP/HDP cardiac amyloid imaging
Authors: Lico I , Dejesus M , Muco E , Leborgne D , Mcmahon S R , Nadig V , Arora S , Duvall W L
Published: June 2024

Background

Repetitive PYP shortages in the US have many labs alternating between Tc-99m labelled PYP and HDP for the diagnosis of cardiac amyloid. Studies have not identified a cutoff for the H/CL ratio with HDP when used to diagnose ATTR cardiac amyloid due to issues with soft tissue HDP uptake.

Purpose

We sought to assess the use of the commonly used H/CL ratio cutoff of 1.5 with HDP in the diagnosis of ATTR cardiac amyloid.

Methods

In a retrospective study, consecutive patients undergoing cardiac amyloid imaging with HDP were assessed. All were imaged and interpreted utilizing planar, SPECT, and CT imaging at 2 hours post injection. Patients were divided into positive and negative studies based on grade 2 or 3 myocardial uptake on fused SPECT/CT images. A final clinical diagnosis of ATTR cardiac amyloidosis, including testing for monoclonal gammopathy, was confirmed by chart review. Planar images were analyzed for counts in the heart and contralateral lung to calculate a H/CL ratio.

Results

A total of 274 patients were imaged with HDP during the study period. A total of 44 positive studies (16.1% of the total) (mean age 81.3 years, 75% male) and 66 negative studies (mean age 73.4 years, 59% male) were analyzed. The mean H/CL ratio for positive HDP studies was 1.9 ± 0.38 and 1.09 ± 0.12 for negative studies (p<0.0001). 100% (66/66) of the negative studies had a H/CL ratio below 1.5 and 43/44 (97.7%) of positive studies had a H/CL ratio above 1.5. The one outlier had a H/CL ratio of 1.45 (88 yo female with moderate LVH, heart failure with mild LV dysfunction, LBBB, and paroxysmal atrial fibrillation).

Conclusion

Utilization of a H/CL ratio on HDP planar imaging with a similar cut-off to PYP would also seem to be reasonable as the vast majority of positive ATTR patients had a H/CL ratio above 1.5 with HDP. Quantification of HDP would seem to be feasible and accurate.Heart/Contralateral Lung Ratio
Septal myocardial perfusion and blood flow are rarely affected by left bundle branch block when measured with rubidium-82 positron emission tomography
Authors: Keating F , Zhou T , Mumtaz S
Published: June 2024

Introduction

Patients with left bundle branch block (LBBB) have a high rate of apparent septal perfusion defects on single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). This is thought to be mediated by the heterogeneous electrical and mechanical activation of the septal and lateral walls of the left ventricle resulting in uneven myocardial workload. Positron emission tomography (PET) MPI with rubidium-82 (82Rb) has overall improved diagnostic accuracy when compared to SPECT.

Purpose

To compare the prevalence of perfusion defects in patients with LBBB in SPECT and PET MPI, and to assess septal myocardial blood flow (MBF) in patients with LBBB using 82Rb PET.

Methods

Among all patients with LBBB who underwent vasodilator (regadenoson) nuclear stress testing at a single center from December 2022 to January 2024, 27 patients undergoing PET and 25 undergoing SPECT who did not have any non-septal perfusion defects as per final interpretation were studied. Software-generated intensity scores of defects in the septal segments (2, 3, 8, 9, 14 on the AHA 17 segment model) were added to yield a septal summed stress score (SSS) and summed rest score (SRS). For PET MPI, absolute global and segmental rest and stress MBF and myocardial flow reserve (MFR) were recorded.

Results

Septal perfusion defects with an SSS or SRS ≥ 2 were less likely in PET in comparison to SPECT. SRS ≥ 2 was observed in 20/25 patients undergoing SPECT compared to 4/27 patients undergoing PET (p<0.001). SSS ≥ 2 was observed in 21/25 patients undergoing SPECT and 6/27 patients undergoing PET (P<0.001). Quantitative rest and stress MBF and regional MFR of patients undergoing PET MPI showed no significant difference between septal and non-septal regions of the myocardium (MFR, 2.53 +/- 0.71 for septal, 2.26+/- 0.58 for non-septal region, p=0.47).

Conclusion

While a reduction in septal uptake due to LBBB is well described in SPECT MPI, it appears that LBBB rarely produces a septal perfusion defect or septal changes in absolute MBF or MFR as assessed by 82Rb PET MPI. The etiology of this difference deserves further study. If confirmed, PET MPI should be a superior imaging modality for patients with LBBB.
Deep learning quantification of hypermetabolism in cardiac sarcoidosis
Authors: Shanbhag A , Miller R O B E R T , Michalowska A N N A , Struble H E L E N , Kransdorf E V A N , Lemley M A R K , Kavanagh P A U L , Liang J O A N N A , Builoff V A L E R I , Dey D A M I N I , Berman D A N I E L , Slomka P I O T R
Published: June 2024

Background

Cardiac sarcoidosis is an inflammatory cardiomyopathy characterized by non-caseating granuloma formation. Diagnosis of cardiac sarcoidosis can be challenging, but 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging plays a critical role by identifying abnormal hypermetabolism in myocardium from inflammatory cells. Quantification of myocardial hypermetabolism plays an important role in diagnosis and risk stratification but currently is associated with observer variability due to subjective placement of regions of interests and varied uptake of the FDG in the myocardium. We evaluated a fully automated method for quantifying FDG PET activity using deep learning segmentation of the coregistered CT attenuation maps.

Methods

We identified 63 patients with suspected cardiac sarcoidosis who underwent FDG PET/CT, including only the first study for each patient. A foundational deep learning model was used to automatically segment all myocardial chambers and left ventricular myocardium from computed tomography (CT) attenuation imaging. Those segmentations were transferred to FDG PET images to automatically quantify maximal standardized uptake values (SUVmax) in myocardium, target to background (left atrium) ratio (TBR), volume of inflammation (VOI) and cardiometabolic activity (CMA) (Figure 1 A). We evaluated the diagnostic accuracy of these measures for cardiac sarcoidosis, with diagnosis based on Japanese Ministry of Health and Wellness criteria.

Results

A total of 63 patients were included, with mean age 56.7 ± 13.5 and 39 (61.9%) male patients. Cardiac sarcoidosis was present in 24 (38.1%) patients. Fully automated quantification was performed in ~16 seconds per patient. Patients with cardiac sarcoidosis had higher median SUVmax (7.0 vs 4.3, p=0.001), TBR (2.7 vs 1.3, p<0.001), VOI (45 mL vs 1mL, p<0.001), and CMA (203 vs 0, p<0.001). VOI (0.910, 95% CI 0.841 – 0.979, p=0.016) and CMA (0.908, 95% CI 0.837 – 0.979, p=0.011) had significantly higher area under the receiver operating characteristic curve compared to SUVmax (0.740, 95% CI 0.599 – 0.882) (Figure 1B).

Conclusions

We demonstrate that fully automated quantification of FDG PET for cardiac sarcoidosis based on segmentation of CT attenuation maps is feasible, rapid, and has high diagnostic accuracy. This approach could be applied to provide objective and reproducible measurements of cardiac hypermetabolism to aid in diagnosis or follow response to therapy.
Regional neuroinflammation-mediated cardiac sympathetic activity contributes to impaired cardiac function after cerebral stroke
Authors: Wroblewski V , Barca C , Willmann M , Gutberlet M , Ross T , Bengel F , Thackeray J
Published: June 2024

Background

Ischemic stroke has been shown to be associated with an elevated risk of heart failure development. Activation of the immune system and sympathetic nervous system may be potential mediators for this brain-heart crosstalk. Molecular imaging may provide mechanistic insights.

We hypothesized that neuroinflammation-driven sympathetic activation contributes to cardiac dysfunction after stroke such that selective beta-1 adrenoreceptor inhibition could spare cardiac function.

Methods

C57BL/6N mice underwent surgical cerebral stroke by transient 30min middle artery occlusion (MCAo, n=14) or sham surgery (n=8). MCAo mice were randomized to receive beta-1-adrenoceptor blocker metoprolol (10 mg/kg/d, p.o.) starting from the day of MCAo (n=7) or vehicle (n=7). Positron emission tomography (PET) using translocator protein (TSPO) ligand 18F-GE-180 measured brain inflammation at 1d, 7d and 21d after stroke. Stroke size and cardiac function were assessed by magnetic resonance imaging at 1 and 3 weeks after injury.

Results

TSPO PET imaging revealed an increased neuroinflammation in the injured brain hemisphere at 7d after MCAo compared to sham (4.6±1.0 vs 2.6±0.7% injected dose (ID)/g, p<0.001) and contralateral hemisphere (4.6±1.0 vs 3.6±0.4%ID/g, p=0.05). This elevation was preserved and comparable between metoprolol- and vehicle-treated mice (3.9±0.4 vs 4.6±1.0%ID/g, p=0.16). TSPO signal remained comparable between metoprolol-treated and untreated mice (p=0.91) 3 weeks after MCAo but there was no difference in TSPO signal between injured and contralateral hemisphere (Untreated: 2.7±0.4 vs 2.9±1.0%ID/g, p>0.99; Metoprolol: 2.5±0.6 vs 2.5±0.6%ID/g, p=0.89). Likewise cardiac TSPO signal, reflecting an amalgam of cardiomyocyte mitochondria and inflammatory cells, was similar between metoprolol and vehicle treated MCAo mice (5.0±1 vs 4.2± 0.6%ID/g, p=0.23). MCAo evoked a moderate decline in left ventricular ejection fraction (LVEF) compared to sham mice (49.9±2.5 vs 66.1±3.5%, p<0.001). Treatment with metoprolol tended to spare cardiac function 3 weeks after MCAo compared to vehicle (54.0±3.3 vs 49.9±2.5%, p=0.058).

Conclusion

MCAo induced neuroinflammation in the injured cerebral region, declining over 3 weeks. Concurrently, we observed a decline in cardiac function. Blockade of beta-1-adrenoceptors partially spared cardiac function, supporting the contribution of sympathetic neuronal activity to cardiac dysfunction after stroke. Imaging of regional neuroinflammation after stroke may identify susceptibility to sympathetic overactivity in the heart and guide intervention to mediate this brain-heart crosstalk.PET imaging and MRI of MCAo  Comparison of cardiac function
The impact of lifestyle on cardiovascular risk in patients with gout: a population-based cohort study
Authors: Jung Seung Min , Jung Sang-Hyuk , Lee Su-Nam , Choi Jin A , Kim Dokyoon , Won Hong-Hee , Kim Ki-Jo , Yun Jae-Seung
Published: June 2024

Aims

Gout is associated with a significant burden of cardiovascular disease. The aim of this study was to evaluate the impact of a favourable lifestyle on incident cardiovascular events in patients with gout.

Methods

We identified 9 110 patients with gout from the UK Biobank cohort based on self-report and/or hospital diagnostic codes. Lifestyle behaviours, including smoking status, physical activity, obesity, and diet, were categorized into three patterns: favourable (three to four healthy factors), intermediate (two healthy factors), and unfavourable (zero to one healthy factor). The cardiovascular risk of participants with and without gout was estimated based on their serum uric acid levels and lifestyle patterns.

Results

Among 9 110 patients with gout and 457 596 participants without gout, the median follow-up duration was 8.9 years. The incidence rate of cardiovascular disease was significantly higher in the gout population than in the non-gout population (11.38 vs. 5.49 per 1000 person-years). The gout population consistently exhibited a high cardiovascular risk, irrespective of uric acid levels, whereas a positive correlation was observed between uric acid levels and cardiovascular risk in the non-gout population. Adopting a favourable lifestyle pattern was associated with a lower risk of cardiovascular disease in both gout and non-gout populations. Across all categories of uric acid, a favourable lifestyle was found to reduce cardiovascular risk in patients with gout.

Conclusion

Patients with gout remain at high risk of developing cardiovascular disease despite having normal uric acid levels. Lifestyle modifications may represent an effective and cost-efficient therapeutic approach for preventing cardiovascular events in this population.
A chromosome-scale Mytilus edulis genome assembly for aquaculture, marine ecology, and evolution
Authors: Regan Tim , Hori Tiago S , Bean Tim P
Published: June 2024

The smooth-shelled blue mussel, Mytilus edulis is part of the Mytilus species complex, encompassing at least three putative species: M. edulis, Mytilus galloprovincialis, and Mytilus trossulus. These three species occur on both sides of the Atlantic and hybridize in nature, and both M. edulis and M. galloprovincialis are important aquaculture species. They are also invasive species in many parts of the world. Here, we present a chromosome-level assembly of M. edulis. We used a combination of PacBio sequencing and Dovetail's Omni-C technology to generate an assembly with 14 long scaffolds containing 94% of the predicted length of the M. edulis genome (1.6 out of 1.7 Gb). Assembly statistics were as follows: total length = 1.65 Gb, N50 = 116 Mb, L50 = 7, and L90 = 13. BUSCO analysis showed 92.55% eukaryote BUSCOs identified. AB-Initio annotation using RNA-seq from mantle, gills, muscle, and foot predicted 47,128 genes. These gene models were combined with IsoSeq validation resulting in 45,379 full CDS protein sequences and 129,708 isoforms. Using GBS and shotgun sequencing, we also sequenced several eastern Canadian populations of Mytilus to characterize single-nucleotide as well as structural variance. This high-quality genome for M. edulis provides a platform to develop tools that can be used in breeding, molecular ecology and evolution to address questions of both commercial and environmental perspectives.
Genomic structural variation in Barramundi Perch Lates calcarifer and potential roles in speciation and adaptation
Authors: Campbell Matthew A , Hale Matthew C
Published: June 2024

Advancements in genome sequencing and assembly techniques have increased the documentation of structural variants in wild organisms. Of these variants, chromosomal inversions are especially prominent due to their large size and active recombination suppression between alternative homokaryotypes. This suppression enables the 2 forms of the inversion to be maintained and allows the preservation of locally adapted alleles. The Barramundi Perch (BP; Lates calcarifer) is a widespread species complex with 3 main genetic lineages located in the biogeographic regions of Australia and New Guinea (AUS + NG), Southeast Asia (SEA), and the Indian Subcontinent (IND). BP are typically considered to be a protandrous sequential hermaphrodite species that exhibits catadromy. Freshwater occupancy and intraspecific variation in life history (e.g. partially migratory populations) exist and provide opportunities for strongly divergent selection associated with, for example, salinity tolerance, swimming ability, and marine dispersal. Herein, we utilize genomic data generated from all 3 genetic lineages to identify and describe 3 polymorphic candidate chromosomal inversions. These candidate chromosomal inversions appear to be fixed for ancestral variants in the IND lineage and for inverted versions in the AUS + NG lineage and exhibit variation in all 3 inversions in the SEA lineage. BP have a diverse portfolio of life history options that includes migratory strategy as well as sexual system (i.e. hermaphroditism and gonochorism). We propose that the some of the life history variabilities observed in BP may be linked to inversions and, in doing so, we present genetic data that might be useful in enhancing aquaculture production and population management.
Tracing the color: quantitative trait loci analysis reveals new insights into red-flesh pigmentation in apple (Malus domestica)
Authors: Bouillon Pierre , Fanciullino Anne-Laure , Belin Etienne , Hanteville Sylvain , Muranty Hélène , Bernard Frédéric , Celton Jean-Marc
Published: June 2024

Red-flesh color development in apple fruit is known to depend upon a particular allele of the MdMYB10 gene. While the anthocyanin metabolic pathway is well characterized, current genetic models do not explain the observed variations in red-flesh pigmentation intensity. Previous studies focused on total anthocyanin content as a phenotypic trait to characterize overall flesh color. While this approach led to a global understanding of the genetic mechanisms involved in color expression, it is essential to adopt a more quantitative approach, by analyzing the variations of other phenolic compound classes, in order to better understand the molecular mechanisms involved in the subtle flesh color variation and distribution. In this study, we performed pedigree-based quantitative trait loci (QTL) mapping, using the FlexQTL™ software, to decipher the genetic determinism of red-flesh color in five F1 inter-connected families segregating for the red-flesh trait. A total of 452 genotypes were evaluated for flesh color and phenolic profiles during 3 years (2021–2023). We identified a total of 24 QTLs for flesh color intensity and phenolic compound profiles. Six QTLs were detected for red-flesh color on LG1, LG2, LG8, LG9, LG11, and LG16. Several genes identified in QTL confidence intervals were related to anthocyanin metabolism. Further analyses allowed us to propose a model in which the competition between anthocyanins and flavan-3-ols (monomer and oligomer) end-products is decisive for red-flesh color development. In this model, alleles favorable to high red-flesh color intensity can be inherited from both white-flesh and red-flesh parents.
Development of Two Green and High-Throughput Microwell Spectrometric Platforms for Determination of Reboxetine, the First FDA-Approved Selective Noradrenaline Reuptake Inhibitor Antidepressant Drug
Authors: Darwish Ibrahim A , Alsalhi Mohammed S
Published: June 2024

Background

Reboxetine (RBX) is the first FDA-approved antidepressant drug of the selective noradrenaline reuptake inhibitors class. There is a serious need for a convenient analytical tool for the quantitation of RBX in its dosage form.

Objective

This study aims toward the development and validation of two green and high-throughput microwell spectrometric platforms for the pharmaceutical analysis of RBX.

Methods

The two platforms, abbreviated as MW-AB and MW-FL, involved microwell-based analysis assisted with a multifunction microplate plate reader for measuring absorbance and fluorescence signals, respectively. The MW-AB and MW-FL platforms involved the formation of colored and fluorescent derivatives upon the reaction of RBX with oxidized pyrocatechol reagent (OPC) and tetracyanoquinodimethane (TCNQ), respectively. The absorbance of colored RBX-OPC derivative at 520 nm, and the fluorescence of RBX-TCNQ charge transfer complex at 283 and 484 nm for excitation and emission, respectively. The optimum conditions of both reactions were established, their molar ratios were determined, and reaction mechanisms were postulated.

Results

Both platforms were optimized and validated according to the guidelines of the International Council on Harmonization. The limits of quantitation were 19.6 µg/mL and 27 ng/mL for MW-AB and MW-FL, respectively. Both platforms were applied with excellent reliability to the quantitation of RBX content in Edranox® tablets and their drug uniformity. The greenness levels of both platforms were assessed by two comprehensive tools, and the results confirmed the high level of greenness for both platforms.

Conclusions

Both platforms involved one-step reactions, adapted microwell analysis, and simultaneous handling of large number of samples. Therefore, they have the advantages of greenness and high-throughput analysis.

Highlights

The proposed two platforms are valuable tools for the rapid quantitation of RBX.
Uncommon orbital metastasis in ductal breast carcinoma: a rare presentation 12 years after treatment
Authors: Horache Kenza , Jidal Manal , Sidki Kenza , Omor Youssef , Latib Rachida , Amalik Sanae
Published: June 2024

Orbital metastasis originating from breast carcinoma, particularly ductal carcinoma, represents a rare clinical entity, with lobular carcinoma usually being more common. Long-term surveillance in breast cancer patients is crucial for early detection of metastasis. Herein, we present a case of a 70-year-old woman with a history of left ductal breast carcinoma, diagnosed and treated 12 years ago. She then developed left eye vision loss, diplopia, enophthalmos, and chemosis in October 2024. Imaging revealed orbital metastasis involving the left superior and lateral rectus extraocular muscles. Biopsy confirmed the diagnosis of orbital metastases arising from ductal breast carcinoma. This case underscores the significance of long-term surveillance in breast cancer patients, as metastasis can manifest years after the initial diagnosis. Despite its rarity, orbital metastasis warrants consideration in the differential diagnosis of ocular symptoms in patients with a history of breast carcinoma. Treatment primarily aims at palliation and preserving visual function, with prognosis typically poor.
Delayed Pressure Urticaria Associated With Altitude Chamber Training Responsive to Cyclosporine and Omalizumab
Authors: Alix Veronica C , Weiss Samuel L , White Kevin M
Published: June 2024

Delayed pressure urticaria (DPU) is a subset of chronic inducible urticaria. It is characterized by the formation of wheals anytime between 30 minutes and 24 hours after stimulus exposure of localized pressure application. In this case report, we discuss a military flight crew member with no significant past medical history who developed DPU following rapid decompression in an altitude chamber. The chamber training included an uneventful ascent to 45,000 feet, higher than he had been previously, and a rapid decompression. About 16 hours later, he developed pruritic swelling of his hands and feet, along with diffuse deep nodular swelling, erythematous plaques, and erythematous nodules. His DPU was refractory to monotherapy treatment with antihistamines, and he continued to develop lesions in weight-bearing areas. Control of symptoms was achieved through combination treatment of a second-generation antihistamine, a leukotriene receptor antagonist, and an immunosuppressant (cyclosporine). His waiver to return to flight status was denied while on cyclosporine. He was transitioned to a monoclonal antibody that binds free immunoglobin E (omalizumab) with resolution of symptoms and was cleared to return to active duty.
An embarrassment of richnesses: the PFC isn’t the content NCC
Authors: Kozuch Benjamin
Published: June 2024

Recent years have seen the rise of several theories saying that the prefrontal cortex (PFC) is a neural correlate of visual consciousness (NCC). Especially popular here are theories saying that the PFC is the ‘content NCC’ for vision, i.e. it contains those brain areas that are not only necessary for consciousness, but also determine ‘what’ it is that we visually experience (e.g. whether we experience green or red). This article points out how this “upper-deck” form of PFC theory is at odds with the character of visual experience: on the one hand, visual consciousness appears to contain copious amounts of content, with many properties (such as object, shape, or color) being simultaneously represented in many parts of the visual field. On the other hand, the functions that the PFC carries out (e.g. attention and working memory) are each dedicated to processing only a relatively small subset of available visual stimuli. In short, the PFC probably does not produce enough or the right kind of visual representations for it to supply all of the content found in visual experience, in which case the idea that the PFC is the content NCC for vision is probably false. This article also discusses data thought to undercut the idea that visual experience is informationally rich (inattentional blindness, etc.), along with theories of vision according to which “ensemble statistics” are used to represent features in the periphery of the visual field. I’ll argue that these lines of evidence fail to close the apparently vast gap between the amount of visual content represented in the visual experience and the amount represented in the PFC.
Early prognostication of overall survival for pediatric diffuse midline gliomas using MRI radiomics and machine learning: A two-center study
Authors: Liu Xinyang , Jiang Zhifan , Roth Holger R , Anwar Syed Muhammad , Bonner Erin R , Mahtabfar Aria , Packer Roger J , Kazerooni Anahita Fathi , Bornhorst Miriam , Linguraru Marius George
Published: June 2024

Background

Diffuse midline gliomas (DMG) are aggressive pediatric brain tumors that are diagnosed and monitored through MRI. We developed an automatic pipeline to segment subregions of DMG and select radiomic features that predict patient overall survival (OS).

Methods

We acquired diagnostic and post-radiation therapy (RT) multisequence MRI (T1, T1ce, T2, and T2 FLAIR) and manual segmentations from 2 centers: 53 from 1 center formed the internal cohort and 16 from the other center formed the external cohort. We pretrained a deep learning model on a public adult brain tumor data set (BraTS 2021), and finetuned it to automatically segment tumor core (TC) and whole tumor (WT) volumes. PyRadiomics and sequential feature selection were used for feature extraction and selection based on the segmented volumes. Two machine learning models were trained on our internal cohort to predict patient 12-month survival from diagnosis. One model used only data obtained at diagnosis prior to any therapy (baseline study) and the other used data at both diagnosis and post-RT (post-RT study).

Results

Overall survival prediction accuracy was 77% and 81% for the baseline study, and 85% and 78% for the post-RT study, for internal and external cohorts, respectively. Homogeneous WT intensity in baseline T2 FLAIR and larger post-RT TC/WT volume ratio indicate shorter OS.

Conclusions

Machine learning analysis of MRI radiomics has potential to accurately and noninvasively predict which pediatric patients with DMG will survive less than 12 months from the time of diagnosis to provide patient stratification and guide therapy.