bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention of Coronavirus Disease 2019 (COVID-19) by mRNA-Based Vaccines Within the General Population of California
Authors: Andrejko Kristin L , Pry Jake , Myers Jennifer F , Jewell Nicholas P , Openshaw John , Watt James , Jain Seema , Lewnard Joseph A ,   California COVID-19 Case-Control Study Team, Samani Helia , Li Sophia S , Barbaduomo Camilla M , Walas Nikolina , Wan Christine , Fang Anna T , Ho Timothy , Tran Vivian H , Xavier Erin , Javadi Mahsa H , Poindexter Diana J , Dabbagh Najla , Spinosa Michelle M , Birkett Nozomi , Frost Paulina M , Dong Zheng N , Saretha Shrey , Cornejo Adrian F , DeGuzman Jennifer L , Bermejo Miriam I , Park Hyemin , Lam Amanda
Published: July 2021

Background

Estimates of coronavirus disease 2019 (COVID-19) vaccine effectiveness under real-world conditions, and understanding of barriers to uptake, are necessary to inform vaccine rollout.

Methods

We enrolled cases (testing positive) and controls (testing negative) from among the population whose SARS-CoV-2 molecular diagnostic test results from 24 February to 29 April 2021 were reported to the California Department of Public Health. Participants were matched on age, sex, and geographic region. We assessed participants’ self-reported history of mRNA-based COVID-19 vaccine receipt (BNT162b2 and mRNA-1273). Participants were considered fully vaccinated 2 weeks after second dose receipt. Among unvaccinated participants, we assessed willingness to receive vaccination. We measured vaccine effectiveness (VE) via the matched odds ratio of prior vaccination, comparing cases with controls.

Results

We enrolled 1023 eligible participants aged ≥18 years. Among 525 cases, 71 (13.5%) received BNT162b2 or mRNA-1273; 20 (3.8%) were fully vaccinated with either product. Among 498 controls, 185 (37.1%) received BNT162b2 or mRNA-1273; 86 (16.3%) were fully vaccinated with either product. Two weeks after second dose receipt, VE was 87.0% (95% confidence interval: 68.6–94.6%) and 86.2% (68.4-93.9%) for BNT162b2 and mRNA-1273, respectively. Fully vaccinated participants receiving either product experienced 91.3% (79.3–96.3%) and 68.3% (27.9–85.7%) VE against symptomatic and asymptomatic infection, respectively. Among unvaccinated participants, 42.4% (159/375) residing in rural regions and 23.8% (67/281) residing in urban regions reported hesitancy to receive COVID-19 vaccination.

Conclusions

Authorized mRNA-based vaccines are effective at reducing documented SARS-CoV-2 infections within the general population of California. Vaccine hesitancy presents a barrier to reaching coverage levels needed for herd immunity.
Elevated triglycerides and low HDL cholesterol predict coronary heart disease risk in patients with stable angina
Authors: Caselli C , De Caterina R , Smit JEFF , El Mahdiui M , Ragusa R , Clemente A , Sampietro T , Clerico A , Liga R , Pelosi G , Rocchiccioli S , Parodi O , Scholte A , Knuuti J , Neglia D
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The EVINCI study was supported by a grant from the European Union FP7-CP-FP506 2007 project (GA 222915). The SMARTool study was supported by a grant from the European Union H2020-PHC-30-2015 (GA 689068). This study was also partially supported by a grant from AMGEN (Protocol N. 20167781, 2017).

Background. High triglycerides (TG) and low high-density lipoprotein cholesterol  (HDL-C) characterize an atherosclerotic cardiovascular disease (CAD) risk condition defined as atherogenic dyslipidemia.

Aim. To assess whether atherogenic dyslipidemia defined by TG/HDL-C ratio predicts CAD related outcomes in patients with stable angina, independently of other risk factors and treatments.

Methods. We studied 355 patients (60 ± 9 y, 211m) with stable angina from the EVINCI Outcome study. Patients were characterized for clinical, bio-humoral and imaging profiles, managed clinically, and followed for 4.5 ± 0.9 years. A computed tomography angiography (CTA) coronary risk score was obtained at baseline in all patients, and at follow-up in 154 of them. The primary composite outcome was all-cause mortality and non-fatal myocardial infarction. CTA scan was repeated at follow-up in 154 patients to assess CAD progression.

Results. The median value of TG/HDL-C ratio was 2.095 (2.079IQR). At baseline, the proportion of males, smoking, diabetes and metabolic syndrome, as well as circulating bio-markers of abnormal glucose metabolism and myocardial damage progressively increased across quartiles of TG/HDL-C ratio. The CTA score was significantly higher in the IV quartile of the TG/HDL-C ratio and both were the only independent predictors of the primary (CTA Score: HR 1.06, 95%CI 1.03-1.09, p = 0.001; TG/HDL-C IV quartile: HR 2.85, 95%CI 1.30-6.26, p < 0.01). In the 154 patients re-evaluated at follow-up, TG/HDL-C ratio associated cardio-metabolic disorder, systemic inflammation and CTA risk score progressed over time despite increased use of lipid-lowering drugs, anti-diabetics and other cardioactive medications and reduction in LDL-C levels.

Conclusions. In patients with stable angina, the TG/HDL-C ratio expresses a cardio-metabolic atherogenic disorder which is progressive over time and is associated with CAD related outcomes independently of LDL-C levels and treatments.
The presence of adverse atherosclerotic coronary plaque features is associated with diabetes
Authors: Hahn V , Simon J , Kolossvary M , Szilveszter B , Kardos AS , Boussoussou M , Vattay B , Merkely B , Maurovich Horvat P
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The grant was given to the Bioimaging field of Semmelweis University by the Excellence Program of the Ministry of Innovation and Technology in Hungary.

On Behalf of

Cardiovascular Imaging Research Group (CIRG)

Introduction

Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. However, there is a lack of data about the prevalence of high-risk coronary artery plaques in patients with DM.

Purpose

In our study we aimed to compare the prevalence of adverse atherosclerotic coronary artery plaque features between patients with and without DM.

Methods

We have analyzed the data of patients who underwent coronary computed tomography angiography (CCTA) between October 2012 and December 2020. Our exclusion criteria were coronary anomaly, congenital or other structural heart disease, previous revascularization or heart transplantation, non-diagnostic image quality and no available data on the presence of DM. Patients were divided into two groups based on the presence of DM.

Results

In total, 11357 patients (47.6% men) were included in our study. Prevalence of DM was 14.5%. There were significant differences in age (63.2 ± 9.5 vs 58.1 ± 12.2 years, p < 0.001) and major cardiovascular risk factors such as hypertension, dyslipidemia and smoking between the two groups (all p < 0.05). We have measured higher coronary artery calcium score in patients with DM vs. without DM  (424.3 ± 744.0 vs 174.2 ± 794.6, p < 0.001). Luminal stenosis >70% was more frequent in the DM group (24.6% vs 10.5%, p < 0.001). While 29.6% of patients without DM had at least one high risk plaque, this rate was 38.9% in those with DM (positive remodeling: 19.6% vs 26.1%, low attenuation: 7.6% vs 10.2%, spotty calcium: 16.9% vs 21.6%, napkin-ring sign: 1.7% vs 2.6%, all p < 0.05).

Conclusions

The prevalence of severe coronary artery stenosis and coronary plaques with adverse characteristics was higher in patients with DM.
Cardiac computed tomography: beyond ischemic heart disease and preTAVI studies. Experience during a year in a second level hospital
Authors: Sanz Ortega I , Sadaba Sagredo M , Armendariz Tellitu K , Velasco Del Castillo S , Quintana Raczka O , Cacicedo Fernandez De Bobadilla A , Ullate De La Torre A , Salcedo Arruti A
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac disease is generally evaluated by non-ionizing imaging exams, as echocardiogram or magnetic resonance (MRI) and cardiac computed tomography (cCT) is seldom performed due to radiation concerns, but this exam has some advantages as better spatial resolution or better assessment of calcifications. Depending on different cardiac procedures, radiation exposure to the patients varies. Published values ranged from 4 mSv approx. for coronary angiography alone to 15 mSv approx. if stenting and ventriculography are added. Apart from coronary angiography, cCT is usually performed to plan transaortic valve implantation (TAVI) but other indications exit.

Methods

we reviewed cCT performed during a year and selected those not performed to assess coronary stenosis or previous to TAVI procedure.

Results

There were 18 exams, 50% women, mean age 62.8 years (range 17 to 82). There were no inconclusive exams. There were 10 exams with diagnostic purpose, not for measuring different structures. Among them, suspected diagnosis was confirmed in 2 cases. Reasons to choose cCT were: better assessment of calcium (6 cases), better spatial resolution (11), contraindications to MRI (3: 1 due to claustrophobia, 2 due to intracardiac device). 3 exams had 2 reasons (better spatial resolution+ assessment of calcium). 4 exams were performed without contrast, only to assess calcification: 1 case the pericardium, 3 cases the aortic valve. In the rest, contrast was used, assessing coronary anatomy as well in 5 of them. Among them, calcification was also assessed in other 2 cases (pericardium in constrictive pericarditis and mitral annulus in a woman with previous coronary artery by-pass grafting in whom a new mitral intervention was planned). Mean Radiation exposure was 5.5 mSv (range 0.3 to 15.3). There were 9 prospective cases (4 women), with a mean age of 61.6 years (17 to 82 years). Radiation exposure was 1.9 mSv (0.3 to 5.9). Mean age in retrospective studies was 63.8 years (53 to 81). 5 women underwent a retrospective study. Radiation exposure in retrospective studies was 8.7 mSv (3.9 to 15.3). There were no complications. We can see images from the prospective and retrospective studies in figures 1 and 2 respectively.

Conclusions

Although is seldom performed, cCT can be used safely to assess different cardiac structures. In different cases in which other imaging techniques is not enough, cCT is a good option to evaluate different structures or ventricular function. Several structures can be assessed in the same exploration.
The volume of left atrium measured by multi-detector computed tomography can predict of long term outcome in catheter ablation of atrial fibrillation
Authors: Kim YR
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

This study aimed to identify the volume left atrium (LA) and left atrial appendage (LAA) calculated by multidetector computed tomography (MDCT) is related to the long term out come of radiofrequency catheter ablation (RFCA) for atrial fibrillation(AF).

Methods

We analyzed data from 99 consecutive patients who referred for RFCA due to drug-refractory symptomatic AF (age 56 ± 10 years; 74% men; 64% paroxysmal AF). Prior to the procedure, all patients underwent ECG-gated 128 channels MDCT scan for assessment for pulmonary vein  anatomy, LA and LAA volume estimation, and electro-anatomical mapping integration. 

Results

The volume of LA and LAA calculated by CT was 142.6 ± 32.2 mL and 14.7 ± 6.0 mL, respectively. LA volume was smaller in paroxysmal AF(PAF) than persistent AF(PeAF) (133.9 ± 29.3 mL vs. 158.0 ± 31.4 mL, p < 0.0001) but  LAA volume was not significantly different between PAF and PeAF(13.9 ± 5.0 mL vs. 16.3 ± 7.3 mL, p = 0.09). Patients were classified into 2 groups by the LA volume of 160mL; group 1  (LA volume < 160mL,n = 73) and group 2 (LA volume ≥160mL, n = 26). After a mean follow up 12.6 ± 5.3 months, 78.8% of the patients maintained sinus rhythm after the index ablation. AF free survival was significantly greater in group  1 than group 2 (84.9% vs. 61.5% p = 0.017). No relationship was found between LAA volume and the outcome of RFCA. Multivariate analysis showed that the LA volume >160mL was an independent predictor of arrhythmia-free after ablation (Hazard ration 2.55, 95% confidential interval 1.02-6.35, p = 0.045)

Conclusion

Higher LA volume is independent risk factor for AF recurrence after RFCA but not LAA volume. The LA volume quickly assessed by MDCT could be a good predictor of long term recurrence after AF ablation.
Coronary artery calcium score to predict coronary CT angiography interpretability: an old problem revisited
Authors: Albuquerque F , Lopes P , Freitas P , Presume J , Gomes D , Abecasis J , Guerreiro S , Santos A , Saraiva C , Mendes M , Ferreira A
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Clinical guidelines recommend against the use of coronary computed tomography angiography (CCTA) in patients with heavy calcification due to interpretability concerns, but no specific approach or threshold is provided. Recently, alternative methods have been proposed as more reliable predictors of CCTA interpretability than the classic coronary artery calcium score (CACS).  The purpose this study was to compare the performance of different measures of coronary calcification as predictors of CCTA interpretability.

Methods

We conducted a retrospective analysis of consecutive patients undergoing CACS and CCTA between 2018 and 2020. The key exclusion criteria were known coronary artery disease, CACS of zero, and presence of non-assessable coronary lesions for reasons other than calcification (movement/gating artifacts or vessel diameter < 2mm). CCTA studies were considered non-interpretable if the main reader considered one or more coronary lesions non-assessable due to calcification. Three different measures of coronary calcification were compared using ROC curve analysis: 1) total CACS; 2) CACS-to-lesion ratio (total CACS divided by the number of calcified plaques); and 3) calcium score of the most calcified plaque. Decision-tree analysis was performed to identify the algorithm that best predicts CCTA interpretability.

Results

A total of 432 patients (191 women, mean age 64 ± 11 years) were included. Overall, 31 patients (7.2%) had a non-interpretable CCTA due to calcification. Patients with non-interpretable CCTA had higher CACS (median 589 vs. 50 AU, p < 0.001), higher CACS-to-lesion ratio (median 43 vs. 14 AU/lesion, p < 0.001), and higher score of the most calcified plaque (median 445 vs. 43 AU, p < 0.001). Among the 3 methods, CACS showed the highest discriminative power to predict a non-interpretable CCTA (C-statistic 0.93, 95%CI 0.89-0.95, p < 0.001) - Figure.

Decision-tree analysis identified a single-variable algorithm (CACS value ≤ 515 AU) as the best discriminator of CCTA interpretability: 396 of the 409 patients (97%) with CACS ≤ 515 AU had an interpretable CCTA, whereas only 5 of the 23 patients (22%) with CACS > 515 AU had an interpretable test, yielding a total of 96% correct predictions.

Conclusions

The recently proposed and more complex measures of coronary calcification seem unable to outperform total CACS as a predictor of CCTA interpretability. A simple CACS cutoff-value around 500 AU remains the best discriminator for this purpose.
Incorporating coronary calcification into pretest assessment of the likelihood of coronary artery disease: validation and recalibration of a new diagnostic tool
Authors: Lopes P , Presume J , Araujo Goncalves P , Albuquerque F , Freitas P , Guerreiro S , Abecassis J , Coutinho Santos A , Saraiva C , Mendes M , Marques H , Ferreira A
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

A new clinical tool was recently proposed to improve the estimation of pre-test probability of obstructive coronary artery disease (CAD) by incorporating coronary artery calcium score (CACS) with clinical risk factors. This new model (Clinical + CACS) showed improved prediction when compared to the method recommended by the 2019 ESC guidelines on chronic coronary syndromes, but was never tested or adjusted for use in our population. The aim of this study was to assess the performance of this new method in a Portuguese cohort of symptomatic patients referred for coronary computed tomography angiography (CCTA), and to recalibrate it if necessary.

Methods

We conducted a two-center cross-sectional study assessing symptomatic patients who underwent CCTA for suspected CAD. Key exclusion criteria were age < 30 years, known CAD, suspected acute coronary syndrome, or symptoms other than chest pain or dyspnea. Obstructive CAD was defined as any luminal stenosis ≥50% on CCTA. The Clinical + CACS prediction model was assessed for discrimination and calibration. A logistical recalibration of the model was conducted in a random sample of 50% of the patients and subsequently validated in the other half.

Results

A total of 1910 patients (mean age 60 ± 11 years, 60% women) were included in the analysis. Symptom characteristics were: 39% non-anginal chest pain, 30% atypical angina, 19% dyspnea and 12% typical angina. The observed prevalence of obstructive CAD was 12.9% (n = 247). Patients with obstructive CAD were more often male, were significantly older, had higher prevalence of typical angina and cardiovascular risk factors, and higher CACS values. The new Clinical + CACS tool showed greater discriminative power than the ESC 2019 prediction model, with a C-statistic of 0.83 (CI 95% 0.81-0.86) versus 0.67 (CI 95% 0.64-0.71), respectively (p-value for comparison < 0.001). Before recalibration, the Clinical + CACS model underestimated the likelihood of CAD in our population across all quartiles of pretest probability (mean relative underestimation of 49%), which was subsequently corrected by the recalibration procedure - Figure.

Conclusions

In a Portuguese cohort of symptomatic patients undergoing CCTA for suspected CAD, the new Clinical + CACS model showed better discrimination power than the 2019 ESC method. The underestimation of the Clinical + CACS model was corrected by recalibrating it for our population. This new tool might prove useful for guiding decisions on the need for further testing.
CT-based cardiovascular risk stratification benefits in asymptomatic patients
Authors: Rozhkov AN , Shchekochikhin DY , Kopylov PYU
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research

Background

Cardiovascular risks (CVR) stratification and assessment of atherosclerotic plaques vulnerability in asymptomatic patients are serious challenges in outpatient practice. The use of modern CT techniques can help to personalize stratification.

Methods

The study included ambulatory patients with suspected coronary heart disease, who underwent computed tomography coronary angiography (CTA) in 2019-2020. CVR was estimated via Score, ACC/AHA, Framingham, MESA scales, CTA was performed on 640-slice computed tomography station. The patients were divided into two groups: patent arteries and atherosclerotic lesions (30-99%).

We analyzed of the estimated CVR distribution, using coronary arteries visualization as the cut-off. Then ROC analysis of the scales, and Agatson Index was performed.

Results

The study included 60 patients, mean age is 61,5 years (65% female). 36,7% had no atherosclerosis; 56,7% had 30-99% coronary artery stenosis.  Our results showed risks overestimation using the SCORE and Framingham scales (+33.33% and +52.38%) and underestimation using ACC/AHA and MESA (-33.33% and -9.52%) in patients without coronary atherosclerosis. The ROC analysis showed that the "standard" scales have no diagnostic significance for zero atherosclerosis (p > 0.05) or for >30% plaques (p > 0.05).

Conclusion

Our data shows a significant predictive superiority of CTA. Asymptomatic patients with zero or low coronary calcium with low estimated CVR may have a REAL high risk based on morphological plaque criteria.
Model based adaptive filter: assessment of image noise, sharpness and quality in coronary CT angiography
Authors: Vecsey-Nagy M , Jermendy AJ , Maurovich-Horvath MHP , Szilveszter SB
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

On Behalf of

Cardiovascular Imaging Research Group

Background

The effect of filtered back projection (FBP) and adaptive statistical iterative reconstruction (ASIR) on coronary CT angiography (CCTA) images have been extensively studied and such algorithms are ubiquitously applied in the reconstruction of CCTA datasets. Currently, however, no data is available on the impact of a recently developed model based adaptive filter (MBAF).

Purpose

 Our aim was to determine the effect of MBAF on the image quality of prospectively gated CCTA datasets.

Methods

 We evaluated the images of 102 consecutive patients who underwent clinically indicated CCTA at our department. Four reconstructions of coronary cross-sectional images (FBP, ASIR, MBAF, ASIR + MBAF) were co-registered and assessed for qualitative (graininess, sharpness, overall image quality) and quantitative [image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)] image quality parameters. Image noise and signal were measured in the aortic root and the left main coronary artery, respectively. Graininess, sharpness, and overall image quality was assessed on a 5-point Likert scale by two experienced readers blinded to the reconstruction algorithm.

Results

 No difference in sharpness was observed amongst the reconstructions (p = 0.08). Although ASIR + MBAF was non-superior to ASIR regarding overall image quality (p = 0.99), it performed better than FBP (p < 0.001), and MBAF (p < 0.001) alone. As compared to FBP, ASIR, and MBAF, the combination of ASIR and MBAF resulted in reduced image noise [53 ± 12, 31 ± 9, 36 ± 4, and 26 ± 4 Hounsfield units (HU), respectively; p < 0.001] and improved SNR (8 ± 3, 14 ± 4, 12 ± 2,16 ± 3 HU, respectively; p < 0.001) and CNR (17 ± 3, 16 ± 4, 13 ± 2, 18 ± 4 HU, respectively; p < 0.001).

Conclusion

The combination of ASIR and MBAF resulted in reduced image noise and improved SNR and CNR. The implementation of MBAF in clinical practice may result in easier interpretation of CCTA images and could potentiate radiation dose reduction.
Cardiotoxicity in breast cancer patients: the role of gated myocardial perfusion SPECT
Authors: Pacella S , Bonacina M , Morzenti S , Guerra L , De Ponti E , Crivellaro C , Landoni C , Messa MC
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Patients undergoing chemotherapy (CHT) for breast cancer (BC) need a monitoring of cardiac function due to the possible onset of cardiotoxicity. Cardiotoxicity may occur with heart failure but is often asymptomatic and is detectable only by assessing an increase in cardiac volumes (left ventricular end-diastolic (LV-EDV) and end-systolic (LV-ESV) volumes) and/or by a reduction of the left ventricular ejection fraction (LV-EF). The primary purpose of this study was to evaluate the role of gated SPECT myocardial perfusion imaging in this setting. Dosimetric evaluation was also assessed.

Methods

Seventeen BC patients (mean age 55.93 ± 11.04 years)with invasive ductal carcinoma HER2 + treated with surgery and with an anthracycline-based adjuvant CHT, were enrolled. The trend of cardiac function was assessed by evaluation of LV-EF, LV-EDV and LV-ESV using gSPECT in baseline conditions and at 12, 15 and 52 weeks during treatment and then at 6, 12, 24 and 48 months during follow-up. Each patient was studied 15-20 min after injection of 555 MBq of 99mTc-Tetrofosmin with gSPECT (16 frames/cardiac cycle) using an Infinia Hawkeye IV gamma-camera. Dosimetry was assed according to ICRP reports.

Results

Two out of the 17 patients enrolled left the protocol: one because of a second tumor and the other due to the appearance of cardiotoxicity. 15 patients completed the study: mean LVEF at baseline was 70.67 ± 5.68. The greatest modification occurred after 15th week of treatment, when mean LV-EF showed a significant decrease  to 65.67 ± 8.27, while mean LV-EDV and mean LV-ESV increased from 73.60 ± 16.72 up to 84.73 ± 21.11 and from 21.93 ± 7.17 up to 30.27 ± 14.16, respectively. All parameters progressively returned similar to baseline values at the final examination (after 48th month): mean LV-EF 70.20 ± 5.65, LV-EDV 73.40 ± 16.15 and ESV 22.07 ± 7.50. In one case cardiotoxicity occurred at 15th week: LV-EF decreased from 69 to 47%, LV-EDV increased from 92 up to 142 ml and LV-ESV from 28 up to 75 ml. According to our image protocols, effective dose for gSPECT was 3.83 mSv (ICRP 106). The use of gSPET instead of MUGA (6.47 mSv–ICRP 80) allowed a dose effective saving of 2.64 mSv/each control with a total saving of 21.12 mSv/patient.

Conclusions

Although the small sample size, gSPECT was demonstrated to be an applicable tool for monitoring cardiac  function because it correctly identified  BC patient with cardiotoxicity. gSPECT also allowed a significant radiation dose saving compared to MUGA: this is particularly relevant in cardiotoxicity studies that require repeated and close evaluations.
DSPECT-specific normal limits for LV measurements: a new approach to derivation
Authors: Ibrahim J , Bukhari S , Nieves R , Barakat A , Shpilsky D , Hynal K , Soman P
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Differences in spatial resolution and image filtering between the solid-state DSPECT and traditional Anger SPECT (A-SPECT) cameras are likely to result in differences in LV measurements. However, DSPECT- specific normal values have not been systematically derived. We used healthy organ-donor subjects from our high-volume solid organ transplant center for derivation of normal values.

Purpose

To report DSPECT-specific LV measurements normal limits derived from a unique cohort of donor subjects.

Methods

Subjects were 92 consecutive kidney or liver donors who underwent single day rest (5 mCi)- stress (15mCi) Tc-99m sestamibi gated SPECT myocardial perfusion imaging (MPI) on the DSPECT for pre-operative evaluation. Exclusion criteria included any cardiac disease or medications. LV measurements were made on the post-stress supine stress images using QGS®.

Results

Of 92 subjects (mean age 54.4 ± 15.0 and 39% men), mean EF for women and men were 77.2 ± 14.1% and 70.0 ± 14.7%, respectively. Mean end-diastolic volume for women and men were 67.0 ± 32.2 ml and 99.6 ± 51.6 ml (indexed 38.3 ± 17.2 ml/m2 and 48.1 ± 25.9 ml/m2), respectively. Mean LV wall volume for women and men were 95.9 ± 26.0 ml and 112.0 ± 48.8 ml (indexed 55.0 ± 13.8 ml/m2 and 54.1 ± 24.6 ml/m2), respectively.

Conclusion

We report DSPECT-specific LV measurements from normal subjects from which limits of normality can be derived for clinic use. Organ-donors who undergo pre-operative MPI are a suitable cohort for the derivation of normal values.
Role of the radiopharmacist in myocardial perfusion imaging safety as part of a multidisciplinary team
Authors: Jimenez-Heffernan A , Salgado-Garcia C , Aroui-Luquin T , Sanchez De Mora E , Santos-Bueno AM
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Vasodilator stress agents have limitations and clinical contraindications that must be identified before patients undergo myocardial perfusion imaging (MPI). Clinical pharmacy may be viewed as part of radiopharmacy practice enabling radiopharmacists to recognize patients with an increased risk of complications and identify relative and absolute contraindications for vasodilator cardiac stress.

Purpose

Assessment of the role of the radiopharmacist in a multidisciplinary team focused on the safe performance of regadenoson and adenosine stress MPI.

Methods

We studied 800 patients undergoing SPECT MPI (55.9% female, mean age 67.1 ±11.4 y, range: 24-90 y).

Gender, age, medical history, medications, drug allergies and contraindications for stress testing were registered and the resulting recommendations were reported to the nuclear physician in charge of the patient.

Results

The table displays the findings and recommendations to the nuclear physician. No contraindications were found in 77.2% of patients.

Conclusion

With a systematic approach, the radiopharmacist detected a drug interaction or clinical contraindication in approximately 25% of patients and the reported recommendations were well received and accepted by the nuclear physicians who changed their approach with the resulting increased patient safety. The clinical activity of radiopharmacists can be enhanced and many opportunities will be identified. Physicians and nurses should be aware of the potential role of radiopharmacists as clinical providers in Nuclear Medicine departments.
Triglycerides glucose index and high-sensitivity C-reactive protein are predictors of outcome in chronic coronary syndrome
Authors: Neglia D , Aimo A , Caselli C , Gimelli A
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

It is unknown whether insulin resistance (IR) and inflammation identify residual prognostic risk in patients with chronic coronary syndrome (CCS).

Aims

To assess whether the triglyceride-glucose (TyG) index and high-sensitivity C-reactive protein (hs-CRP) are independent predictors of outcome in CCS.

Methods

TyG index and hs-CRP were evaluated in 1097 consecutive patients (75% men, median age 72 years) with known (26%) or suspected coronary artery disease (CAD) undergoing stress-rest myocardial perfusion scintigraphy (MPS) and coronary angiography and followed-up for a median of 4.5-year.

Results

Moderate/severe perfusion abnormalities during stress were documented in 60% of patients, obstructive CAD in 74%, and 36% underwent early revascularization. TyG index was 8.9 (median, interquartile interval 8.6-9.2) and of hs-CRP was 0.3 mg/L (0.1-0.8). Cardiac death or myocardial infarction occurred in 103 patients and all-cause death in 65. Patients in the fourth TyG quartile (TyG ≥ 9.2), with hs-CRP ≥ 2 mg/L or with both had the shortest survival free from cardiac events or all-cause death. TyG predicted cardiac events (HR 2.46, 95% CI 1.59-3.79, p < 0.001) and all-cause death (HR 3.64, 95% CI 2.22-5.96, p < 0.001) independently of other risk factors, perfusion abnormalities or obstructive CAD. Hs-CRP was also an independent predictor of all-cause death (HR 1.11, 95% CI 1.04-1.19, p = 0.002) and reclassified the risk over the other variables and TyG (IDI 0.05, 95% CI 0.01-0.07, p = 0.005).

Conclusions

The TyG index identifies a high residual risk of cardiac events in patients with CCS. The TyG index and hs-CRP are strong and interacting predictors of all-cause death.
Myocardial perfusion findings evaluated by gated-SPECT in dyslipidemic very high-risk patients
Authors: Puente Barragan A , Olivares Garcia P , Martinez Escobar MC , Trujillo Cortes R
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Dyslipidemia is one of the main risk factors for atherosclerotic disease. Timely diagnosis and appropriate treatment are therefore essential in the prevention and recurrence of cardiovascular disease (CVD). The detection of ischemia with myocardial perfusion gated-SPECT is a valuable diagnostic option that provides complete information to select the best therapeutic option, reducing morbidity and mortality in this group of patients.

Purpose. To evaluate the findings of myocardial perfusion imaging (MPI) using gated-SPECT in a group of patients with dyslipidemia and very high cardiovascular risk.

Methods. We retrospectively evaluated gated-SPECT results of 66 very high-risk dyslipidemic patients with a diagnosis or clinical suspicion of coronary artery disease (CAD). Exclusion criteria: structural heart disease, dilated hypertrophic cardiomyopathy, hemodynamic instability, low-intermediate risk. Rest-stress imaging with gated-SPECT Technetium-99m Sestamibi was acquired on a dedicated cardio gamma camera and subjectively evaluated in a 17-segment analysis. Ischemia was classified as mild, moderate, and severe. Statistical analysis: SPSS system, continuous data were expressed as mean ± SD, percentages were rounded; Chi-square and Student’s t-tests were used.

Results. Mean age 61.06 ± 12.87 years old, 40 (61%) were men; 61 (92%) with primary and 5 (8%) with familial hypercholesterolemia. More than 80% have at least one or more cardiovascular (CV) risk factors; 73% have dyslipidemia, diabetes, and arterial hypertension, 52% tabaquism, 36% obesity, 11% kidney disease, and 30% family history of CV disease; all women were post-menopausal (44%). Asymptomatic (56%), 30% with dyspnea or equivalents, 9% atypical chest pain, and 5% typical angina. Gated-SPECT: 56% with ischemia; mild ischemia was present in 33% and 11% of men and women, and moderate in 35% and 27% respectively. Primary hypercholesterolemia: 26 % with mild, 28% moderate, and 46% without ischemia; 80% of familial hypercholesterolemia with moderate and 20% without ischemia.

Conclusion. Myocardial ischemia was present in 56% of very high-risk dyslipidemic patients, predominantly in men (67.5%). Although 56% were asymptomatic, ischemia was detected in 54% of the patients with primary and 80% with familial hypercholesterolemia. It is advisable to perform MPI with gated-SPECT for the early detection of ischemia in high-risk dyslipidemic patients, even asymptomatic.
Creation of mortality risk calculator using a I-123 mIBG-based machine learning model: differential prediction of arrhythmic death and heart-failure death
Authors: Nakajima K , Nakata T , Doi T , Tada H , Saito S , Maruyama K
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Although I-123 meta-iodobenzylguanidine (mIBG) has been applied to patients with chronic heart failure (CHF), a diagnostic tool for differential prediction of fatal arrhythmic events (ArE) and heart-failure death (HFD) has been pursued. 

Purpose

The aim of this study was to create a calculator of mortality risk for differentiating mode of cardiac death using a machine learning (ML) method, and to test the accuracy in a new cohort of patients with CHF.

Methods

A total of 529 patients with CHF was used as the training database for ML. The ArE group consisted of patients with arrhythmic death, sudden cardiac death and appropriate therapy by implantable cardioverter defibrillator. A heart-to-mediastinum ratio (H/M) standardized to the medium-energy collimator condition was calculated with a planar anterior mIBG scintigram. The best classifier models for predicting HFD and ArE were determined by four-fold cross validation. Input variables included age, sex, New York Heart Association (NYHA) functional class, left ventricular ejection fraction, ischemic etiology, mIBG H/M and washout rate, and b-type natriuretic peptide (BNP) or NT Pro BNP, estimated glomerular filtration rate, hemoglobin, and complications such as diabetes and hypertension. After creating the ML-based model, the constructed classifier functions for ArE, HFD, and survival were exported for subsequent use. A new cohort of patients (n = 312, age 67 ± 13 years, 2015 or later) was used to test the ML-based model.

Results

The training database included 141 events (27%) with ArE (7%) and HFD (20%). Receiver-operating characteristic analysis by four-fold validation showed area under the curve value of 0.90 for HFD and 0.73 for ArE. Among various ML methods, the logistic regression method demonstrated the most stable calculation of the probability of ArE followed by random forest and gradient boosted tree methods. Therefore, the logistic-regression method was used for calculating both HFD and ArE probabilities. In the test cohort, patients with a high HFD probability >8% resulted in 6.3-fold higher HFD than those with low probability (≤ 8%). Patients with high ArE probability >8% showed 2.5-fold higher ArE than those with low probability (≤ 8%).

Conclusion

The ML-based mortality risk calculator could be used for stratifying patients at high and low risks, which might be useful for estimating appropriate treatment strategy.
Quantitation vs visual assessment of 99mTc-DPD cardiac uptake in patients with suspected cardiac amyloidosis
Authors: Casans-Tormo I , Canoves-Llombart A
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Universitary Clinic Hospital of Valencia

Aim

Cardiac uptake of 99mTc-DPD has proved its diagnostic efficacy in transthyretin cardiac amyloidosis(ATTR). We compared the usual visual assessment with two quantitative methods to evaluate cardiac activity and its possible relation with clinical follow-up.

Methods

We have studied 37 successive patients(p):32 men, 52-90 y/o (79.6 ± 9.3), submitted by suspected cardiac amyloidosis TTR by echo/cardiac MRI. After IV administration of 21.5 ± 3.4mCi of 99mTc-DPD, we obtained early (at 5min) and late (at 3h) whole body(WB) planar images and late SPECT. We assessed cardiac uptake in planar images by visual score (0-absent, 1-cardiac uptake lower than bone uptake, 2-equal, 3- higher than bone uptake), considering 2-3 score compatible with ATTR in absence of abnormal light chains on serum-urine. We obtained quantitative evaluation by heart/contralateral thoracic activity ratio (H/CL) in late images and from early and late WB images the heart retention(HR) ratio and heart/whole body(HWB) activity ratio. Clinical follow-up (12.4 ± 8.3 months) considering as cardiac events(CE): cardiac death and heart failure(HF) admissions.

Results

Visual score 0(11p), 1(2p), 2(4p) and 3(20p), considering group1(0-1) not suggestive of ATTR and group2(2-3) compatible with ATTR. SPECT showed biventricular uptake with septal predominance in group2. H/CL index was 2.23 ± 0.54(group2) vs 1.05 ± 0.10(group1) p < 0.001), according to published(≥1.5 compatible with ATTR). HR and HWB ratios were also significantly higher in group2 vs group1, respectively 6 ± 3.14vs2.17 ± 0.4(p < 0.001) and 6.51 ± 1.97vs2.65 ± 0.49(p < 0.001). There were a trend to higher values in p with visual score3 than 2, not reaching statistically significant(only 4p with visual score2). There were significant correlation between H/CL-HR(r:0.66,p < 0.01), H/CL-HWB(r:0.85,p < 0.001) and HR-HWB(r:0.85,p < 0.001). After follow-up we detected 6 CE(3p with HF admission, 3p cardiac death): 5p with visual score3 and one with 2, all 6p with high mean values of H/CL: 2.28 ± 0.76, HR: 6.02 ± 3.4 and HWB:5.97 ± 1.69.

Conclusion

We have found excellent correlation between visual score and the evaluated methods of quantitation of 99mTc-DPD cardiac uptake in our patients referred by suspected cardiac amyloidosis. These quantitative methods could be a helpful tool to correctly identify some patients with doubtful activity and could be useful in the follow-up evaluation, although it is necessary to study a greater number of patients.
Prediction of obstructive coronary artery disease after Rb-82 PET myocardial perfusion imaging and coronary artery calcium scoring using machine learning
Authors: Metselaar RJ , Van Dalen JA , Vendel BN , Mouden M , Slump CH , Van Dijk JD
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Accurate risk stratification in patients with suspected stable coronary artery disease (CAD) is essential for choosing an appropriate treatment strategy but remains challenging in clinical practice.

Purpose

Our aim was to develop and validate a risk model to predict the presence of obstructive CAD after Rubidium-82 PET and a coronary artery calcium score (CACS) scan using a machine learning (ML) algorithm.

Methods

We retrospectively included 1007 patients without prior cardiovascular history and  a low-intermediate pre-test likelihood, referred for rest and regadenoson-induced stress Rubidium-82 PET combined with a CACS scan. Multiple features were included in the ML model; PET derived features such as summed difference score and flow values, CACS, cardiovascular risk factors (cigarette smoking, hypertension, hypercholesterolemia, diabetes, positive family history of CAD), medication; age; gender; body mass index; creatinine serum values; and visual PET interpretation. An XGBoost ML algorithm was developed using a subset of 805 patients to predict obstructive CAD by using 5-fold cross validation in combination with a grid search. Obstructive CAD during follow-up was defined as a significant stenosis during invasive coronary angiography, a percutaneous coronary intervention or a coronary artery bypass graft procedure. The ML algorithm was validated with unseen data of the remaining 202 patients.

Results

Application of the XGBoost algorithm resulted in an area under the curve (AUC) of 0.93 using the training data (n = 805) and an AUC of 0.89 using the unseen data (n = 202) in predicting obstructive CAD. The strongest predictors were the CAC-scores and quantitative PET derived features. The classical risk factors and medication hardly provided an added value in the prediction of obstructive CAD.

Conclusion

The developed ML algorithm is able to provide individualized risk stratification by predicting the probability of obstructive CAD.  Although validation with a larger dataset could result in a more well defined performance range, this model already shows potential to be implemented in the diagnostic workflow.
The value of 18F-FDG PET/CT for the diagnosis of device related infections in patients with a left ventricular assist device - a dual centre study
Authors: Ten Hove D , Wahadat A , Slart RHJA , Damman K , Mecozzi G , Wouthuyzen-Bakker M , Caliskan K , Manintveld O , Sinha B , Budde RPJ , Glaudemans AWJM
Published: July 2021

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Partnership UMCG Siemens for building the future of Health (PUSH)

Background

Left ventricular assist devices (LVADs) are increasingly used for the treatment of end-stage heart failure. LVADs improve quality of life and long-term survival, but device specific infections remain cumbersome. These infections can lead to life threatening complications and are difficult to diagnose with conventional radiological imaging. In this study, FDG-PET/CT accuracy for the diagnosis of LVAD specific infections was evaluated with specific focus on potential confounders and the additive value of semi-quantitative analysis.

Materials/methods

All LVAD recipients with an available FDG-PET/CT from September 2013 until August 2020 in two LVAD centres in the Netherlands, with a suspicion of driveline and/or central device infection were included. FDG-PET/CT was performed according to European Association of Nuclear Medicine (EANM) guidelines. Potential confounders were documented and assessors were blinded to the clinical context of included patients. Assessment of FDG-PET/CT was performed visually and semi-quantitatively with 6 regions of interest alongside the driveline and central device components. The final clinical diagnosis of either driveline infection or central device infection, based on findings during surgical intervention or multidisciplinary consensus, was used as the reference for diagnosis.

Results

In total 38 patients (average age 55 years, 84% males) were evaluated for a total of 55 episodes of suspected device-specific infection. Clinical evaluation established driveline infection in 28 cases, central device infection in 7 and combined infection in 4. Visual analysis obtained  a sensitivity and specificity of 0.83 and 0.75 respectively, in differentiation between infected and non-infected drivelines. Visual analysis of FDG-PET/CT of central device components showed excellent sensitivity: 1.0, but suffered from poor specificity: 0.23.  Semi-quantitative analysis using a SUVmax was comparable to visual analysis for establishing driveline infections, with a sensitivity and specificity of 0.80 and 0.84 respectively, while for central device infections, semi-quantitative analysis using a SUVratio outperformed visual analysis, with a sensitivity and specificity reaching 0.88 and 0.90 respectively.

Conclusions

FDG-PET/CT is a valuable tool for the assessment of device-specific infections in LVAD recipients. Semi-quantitative analysis can significantly increase diagnostic accuracy of FDG-PET/CT for the analysis of the central device components and should be considered in cases where the diagnosis cannot be rejected based on visual analysis.
The prevalence of cardiac sarcoidosis is underestimated: [18F]FDG-PET is the answer
Authors: Borges-Rosa J , Oliveira-Santos M , Silva R , Lopes De Almeida J , Goncalves L , Costa G , Ferreira MJ
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Overt cardiac involvement is reported in 5% of patients with sarcoidosis, although autopsy and imaging studies suggest higher prevalence, worldwide variation. The role of 18F-fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) in non-invasive diagnosis and follow-up has increased in the last decade.

Purpose

Our goal is to describe the prevalence, clinical manifestations and outcomes of cardiac sarcoidosis (CS), diagnosed through [18F]FDG-PET, in a southern European population.

Methods

We included all patients with histological diagnosis of extracardiac sarcoidosis screened with [18F]FDG-PET between 2009 and 2020. We collected data on clinical manifestations, cardiac magnetic resonance (CMR) results, and mortality outcomes and compared those with and without cardiac involvement. We applied the criteria for the diagnosis of CS from Heart Rhythm Society.

Results

Of the 400 patients screened with [18F]FDG-PET, 128 had a histological diagnosis of extracardiac sarcoidosis (54.7% females, mean age 51.0 ± 14.2 years). None underwent endomyocardial biopsy. Ten patients had a pattern of [18F]FDG uptake consistent with CS defined as diffuse (n = 5), focal (n = 3), and focal on diffuse (n = 2). Of the 128 patients, 14 also underwent CMR, which identified 2 subjects with positive findings in both modalities and 3 additional patients: focal (n = 1), multifocal mid-wall (n = 2), focal mid-wall (n = 2), and multifocal subepicardial (n = 1) delayed gadolinium enhancement. Overall, 13 patients (10.2%) fulfilled the criteria for probable CS (53.8% female, mean age 56.2 ± 12.6 years), all with multiorgan involvement, mostly lung and lymph nodes (each 92%), followed by skin and central nervous system (each 15%). Median left ventricle ejection fraction was 62% [55-65] and there were cardiac manifestations of CS in 6 patients (46%): sick sinus syndrome (n = 2), complete heart block (n = 1), frequent premature ventricular complexes (n = 1), ventricular tachycardia plus heart failure (n = 1), and bifascicular block plus heart failure (n = 1). Eleven patients (85%) with probable CS were medicated with immunosuppressant drugs: corticosteroids (n = 9), methotrexate (n = 4), and azathioprine (n = 2). Four patients with previous [18F]FDG screening were revaluated after treatment, each showing no cardiac uptake.  After a mean follow-up of 4.0 ± 1.0 years, mortality was three-fold higher in patients with cardiac involvement, despite the absence of statistical significance (15% vs. 5%, P = 0.151).

Conclusions

In a southern European population with histological extracardiac sarcoidosis, the prevalence of cardiac involvement was 10.2%, most asymptomatic. [18F]FDG-PET improves the diagnostic yield and plays an important role in monitoring response to therapy. The higher mortality trend in those with CS needs to be ascertained in longer follow-up.