bluuebunny/crossref_metadata_2025 huggingface dataset:
How international atomic energy agency can support the management of ischemic heart disease in women
Authors: Peix A , Mesquita C T , Massardo T , Gutierrez-Villamil C , Berrocal I , Puente A , Astesiano A , Aguero R , Sanchez M , Gomez V V , Herrera Y , Mendoza A , Kapitan M , Estrada-Lobato E , Paez D
Published: June 2024

Background/Introduction

Cardiovascular diseases constitute the main cause of death in Latin America and the Caribbean (LAC), with ischemic heart disease (IHD) as the principal cause in most countries. This is particularly complex in women due to the peculiarities of the clinical picture and their specific risk factors. International Atomic Energy Agency (IAEA) supports regional projects with the aim of spreading the adequate use of medical imaging modalities and contributing to capacity building.

Purpose

To contribute to achieve an early diagnosis and an adequate risk stratification of IHD in Latin American women.

Methods

IAEA supported a regional project (2022-2023, 15 countries) in LAC. Regional courses were implemented and diagnostic units using imaging multimodality were established.

Results

Human resources capacities strengthened on the use of nuclear techniques, imaging multimodality, and their benefits in the management of IHD in LAC women. Three regional courses were implemented, with 144 professionals trained on. In addition, two courses (on multimodality and cardiac PET) will be presented in the IAEA Human Health Campus for free access, as well as 5 expert missions to help developing cardiac medical imaging.

Multimodality imaging techniques available in Cardiology (with emphasis on Nuclear Cardiology and hybrid imaging) applied in the management of IHD in LAC women. At the end of the project, two centres of diagnosis of IHD in women with the utilization of nuclear techniques in a multimodality imaging approach were established in each country. In addition, the regional network for dissemination of results, exchange of experiences, discussion of clinical cases, and virtual short courses on multimodality was implemented and is running.

Three publications on the epidemiological situation, technical and human resources available in LAC, and a consensus document adapted to the region on the utilization of multimodality in the management of IHD in women were completed.

Conclusion

The support of international organizations as IAEA contributes to the capacity building and a better management of cardiovascular disease in LAC.
Combination of CZT SPECT stress myocardial blood flow (MBF) and coronary artery calcium (CAC) scoring - opportunity for stress-first/stress-only protocol
Authors: Kaminek M , Havel M , Kincl V , Henzlova L , Dolezilek M , Hudson L
Published: June 2024

Introduction

Typical dynamic CZT SPECT protocol (rest – stress) enables absolute quantification of MBF and coronary flow reserve (CFR = stress MBF/rest MBF). However, its great disadvantage is a complexity. Stress-first protocol enabling stress-only MBF can significantly reduce time, cost and a radiation dose.

Purpose

To assess the prognostic significance of stress MBF, CFR, and CAC scoring.

Methods

Retrospective analysis of 73 patients (26 men, 66±9 years) examined with rest-stress dynamic myocardial SPECT and CAC scoring. The adverse cardiac event (CE) defined as sudden cardiac death, myocardial infarction, situations requiring coronary revascularization, and hospitalization for heart failure with reduced ejection fraction, were recorded.

Results

We observed 12 CE during a mean follow-up of 13±8 months. Patients with CE had higher CAC score (1035±1121 vs 205±445), comparable rest MBF (1.27±0.44 vs 1.23±0.47 ml/min/g) but significantly lower stress MBF (2.01±1.11 vs 2.83±0.98 ml/min/g) and a lower CFR (1.58±0.61 vs 2.47±0.88). A cut-off value for the prediction of CE were: CAC score 230,2 (sensitivity of 91 % and a specificity of 82 %), stress MBF 2.29 ml/min/g (sensitivity of 83 % and a specificity of 70 %), and CFR 1.94 (sensitivity of 75 % and a specificity of 77 %), respectively. There was no superiority of CFR over stress MBF in the identification of CE (P = NS). No CE occurred in patients with the combination of stress MBF ≥ 2.29 ml/min/g and CAC score < 230.2.

Conclusion

We can predict CE by a combination of stress MBF and CAC scoring. A simplification of dynamic SPECT protocol (stress-first/stress-only) enables expansion of the MBF quantification for a larger number of patients.
Predictors of moderate to severe ischemia among patients referred to stress myocardial perfusion scintigraphy
Authors: Stalc M , Boncelj Svetek M , Guzic Salobir B
Published: June 2024

Introduction

Patients with moderate to severe ischemia on stress myocardial perfusion scintigraphy are at highest risk for cardiovascular adverse events and death. The presence, extent and severity of ischemia detected on myocardial perfusion scintigraphy have all decreased over the past few years. Therefore, there is an increasing need to identify patient cohorts where the results of myocardial perfusion scintigraphy will have the greatest impact on clinical management. The data on predictors of moderate to severe ischemia within contemporary population of patients are scarce.

Purpose of our study was to evaluate the predictors of moderate to severe ischemia across all potentially relevant clinical parameters in a cohort of patients referred to stress myocardial perfusion scintigraphy.

Methods

The clinical data and myocardial perfusion scintigraphy results of 4620 consecutive patients admitted to our department from January 2020 to December 2023 were prospectively collected. All patients underwent a 2-day stress/rest 99mTc tetrofosmin (Myoview, GE Healthcare) myocardial perfusion scintigraphy. Patients were imaged in the sitting position using a Cardius® X-ACT camera (Digirad, California, USA). The magnitude of myocardial ischemia was determined semi quantitatively in a 17-segment model according to the European Association of Nuclear Medicine guidelines. Patients were categorized in moderate to severe ischemia (>10% ischemia) and <10% of ischemia groups.

Results

The baseline clinical characteristics of the study population according to the degree of ischemia are shown in Table 1. Of the 4620 patients, 1695 (36.7%) had ischemia, 191 (4.1% of all patients, 11% of patients with ischemia) had moderate to severe ischemia. The proportion of male gender and the frequency of diabetes, dyslipidemia and prior coronary artery disease were higher in patients with moderate to severe ischemia (all p <0.001, Table 1). Patients with moderate to severe ischemia had more often typical chest pain, were inpatients and had a higher frequency of myocardial scar (all p <0.001, Table 1). In multivariable analysis male gender, diabetes, typical chest pain, known coronary artery disease and inpatient status turned out as predictors of moderate to severe ischemia (Table 2). Dyslipidemia and myocardial scar were not significant predictors (Table 2).

Conclusion

The prevalence of moderate to severe ischemia is particularly high among diabetic male patients with typical chest pain and known coronary artery disease. These observations may be used in clinical practice to identify patients who are most likely to benefit from referral to stress myocardial perfusion scintigraphy.
Clinical and scintigraphic characteristics of patient with left bundle branch block
Authors: Guzic Salobir B , Dolenc Novak M , Stalc M
Published: June 2024

Introduction

The presence of left bundle branch block (LBBB), although extensively studied, is still associated with many gaps in the knowledge of the underlying associated diseases. Although LBBB can sometimes be found in asymptomatic individuals with structurally normal heart, majority of patients with LBBB have some form of underlying heart disease, including coronary artery disease (CAD). Myocardial perfusion scintigraphy with pharmacological stress testing is one of the recommended non-invasive tests in patients with LBBB and suspected CAD. Heart failure, progressive conductive system disease and other cardiomyopathies can be also associated with LBBB.

Purpose of our study was to assess the clinical characteristics and results of myocardial perfusion scintigraphy on patients with LBBB.

Methods

The clinical data and myocardial perfusion scintigraphy results of 5168 consecutive patients admitted to our department from January 2020 to December 2023 were prospectively collected. All patients underwent a 2-day stress/rest 99mTc tetrofosmin (Myoview, GE Healthcare) MPI. Patients were imaged in the sitting position using a Cardius® X-ACT camera (Digirad, California, USA). Patients were categorized into LBBB and without LBBB groups.

Results

284 patients (5.5%) had LBBB. Clinical characteristics of the patients with and without LBBB are shown in Table 1. Patients in LBBB group were older and predominantly female. There were no differences in the prevalence of cardiovascular risk factors between the groups. The proportion of patients with reversible ischaemia was lower in patients with LBBB (Table 1). The extent of ischaemia was similar in both groups (Table 2). The summed stress score (on scintigrams with and without attenuation correction) was higher in patients with LBBB, due to expected perfusion artefacts (Table 2).

Conclusions

The findings of our study indicated that the presence of LBBB is associated with a lower incidence of reversible ischaemia on myocardial perfusion scintigraphy than in the non-LBBB population. This suggests that the impact of CAD as the leading underlying cause of LBBB could be less significant, possibly due to modern diagnostic and treatment options. Consequently, other factors might have more influence. Supporting this notion, the data reveals that patients with LBBB were typically older and exhibited a higher prevalence of heart failure.
Multidisciplinary approach for the early detection of amyloid in patients who undergo carpal tunnel syndrome or lumbar stenosis surgery
Authors: Orta N , Ripoll T , Rubi S , Pons J , Fortuny E , Bosch M T , Nadal C M , Torralba I , Salva G , Femenias J , Barcelo B , Daza-Cajigal V , Perez A , Heine D , Pena C
Published: June 2024

Background/Introduction

Symptomatic carpal tunnel syndrome (CTS) and lumbar stenosis (LS) seem to precede the cardiac manifestations of cardiac amyloidosis (CA) due to transthyretin amyloidosis (ATTR), so they could represent early markers of CA. CTS is more commonly present in CA due to wild-type ATTR (ATTRwt), although it can also be present in its hereditary variant (ATTRv) and in primary amyloidosis caused by immunoglobulin light chain deposition (AL).

Purpose

Evaluate the prevalence of amyloidosis in patients undergoing CTS or LS surgery, in an endemic area of the TTR mutation Val50Met (ATTRv).

Methods

237 operated patients have been included (183 CTS, 54 LS) in whom an intraoperative biopsy was obtained (synovial tissue or flexor retinaculum in CTS; ligamentum flavum in LS) for histopathological analysis using Congo Red staining for amyloid detection and immunohistochemistry (IHC) or mass spectrometry (MS) for subtyping in amyloid A (AA), kappa, lambda and ATTR.

Also, a blood and urine test to rule out a monoclonal component and a cardiac scintigraphy (CS) with 99mTc-DPD to detect myocardial uptake were performed, which analysis was visual by Perugini scale and semiquantitative by heart-to-contralateral-lung ratio (H/CL). A cardiac SPECT/CT was performed in cases with a positive planar imaging, according to the ASNC/EANM Cardiac Amyloidosis Practice Points.

Results

Total of 204 biopsies were obtained (154 CTS, 50 LS), 16 of them were amyloid positive (8 CTS, 8 LS). All IHC were negative for AA, kappa and lambda. IHC for ATTR and MS analysis are still pending. 33 operated patients without biopsy (29 CTS, 4 LS).

203 laboratory tests and CS have been performed: 5/203 CS were positive (grade 2-3) in 4 patients who underwent CTS surgery (2 with positive biopsies for amyloid and 2 without biopsy) and 1 LS with also positive biopsy. In 15/203 laboratory tests, a monoclonal component was detected.

149/178 completed cases with negative biopsy, laboratory test and CS have completed the study (all tests negative).

Positivity for amyloid has been obtained in 18/237 cases (7.6%): 16 positive biopsies (2 with positive blood/urine test and negative CS, 3 with positive CS and negative blood/urine test and 11 with negative blood/urine test and CS) and 2 positive CS without biopsy and negative blood/urine test.

In the follow-up (2.41 years) of patients with positivity, 27.8% (5/18) manifests cardiomyopathy, 4 of them with positive CS, and 88.9%(16/18) has previously other orthopedic manifestations.

Conclusion

The estimated prevalence of amyloidosis in our series of surgically treated patients with CTS or LS is 7.6%
Usefulness of scintigraphy with [99mTc]Tc-DPD for the detection of cardiac amyloidosis due to transthyretin. Reference center experience in endemic area
Authors: Orta N , Salomon C , Rubi S , Ripoll T , Bosch M T , Fortuny E , Pena C
Published: June 2024

Background/Introduction

Cardiac amyloidosis (CA) is an infiltrative disorder caused by protein deposition, being transthyretin amyloidosis (ATTR) and primary amyloidosis (AL) the most common forms of CA. ATTR can ocurr in a hereditary form (ATTRv) or wild-type (ATTRwt). Our area is endemic for ATTRv due to the Val50Met mutation.

Purpose

Analyze the usefulness of scintigraphy with [99mTc]Tc-DPD (DPD-CS) in an endemic area and its relationship with the diagnostic of CA.

Methods

Retrospective study (04/2013-12/2022) of DPD-CS performed for suspected/screening of CA. Our acquisition protocol consists of performing planar images after 3h p.i.(anterior, left anterior oblique and left lateral) +/- SPECT/CT. The assessment of myocardial uptake was evaluated using the Perugini scale (PS: 0-3), considering 2-3 as positive scans.

DPD-CS results were classified based on the suspicion of CA, according to the guidelines of the ESC 2021 (we considered cardiomiopathy if: LVH ≥12 mm + ≥3 signs/symptoms), as well as according to their final diagnosis: ATTRv, asymptomatic carriers, ATTRwt, AL, AA and other non-amyloid (NA) causes. Clinical findings were correlated with the results of the DPD-CS.

Results

1145 509 DPD-CS were performed in 478 patients (median age:73 years[22-95], 62% men). Median follow-up: 4.17 años.

127/478 patients were classified with cardiomyopathy (131/509 DPD-CS) and 351/478 without cardiomyopathy (378/509 DPD-CS).

115/509 positive DPD-CS (PS-2: 17, PS-3: 98): 113 had cardiomyopathy (55 ATTRv, 58 ATTRwt) and 2 without cardiomyopathy (1 ATTRv, 1 asymptomatic carrier). These latter two patients developed cardiomyopathy during the follow-up.

394/509 negative DPD-CS (PS 0: 387, PS 1: 7): 18 with cardiomyopathy (1 ATTRv, 1 carrier, 3 AL and 13 NA) and 376 without cardiomyopathy (30 asymptomatic carriers, 88 ATTRv, 2 AA, 9 AL and 247 NA). The only patient with cardiomyopathy and ATTRV, had initial negative DPD-CS with following positive DPD-CS. All ATTRv without cardiomyopathy presented only polyneuropathic disease.

Final diagnoses (according to DPD-CS number): 146 ATTRv (144 Val50Met, 2 Val142Ile), 32 carriers, 58 ATTRwt,12 AL, 2 AA and 259 NA.

The analysis obtained after correlating the results of the DPD-CS regarding the presence of cardiomyopathy was: sensitivity 86.25%, specificity 99.47%, PPV 98.26% and NPV 95.43%.

Conclusion

Our study reaffirms the usefulness of DPD-CS in the non-invasive diagnosis of cardiomyopathy due to ATTR.

DPD-CS has an additional value in endemic areas for the early detection of CA in asymptomatic patients.
Exploring the relationship between aortic valve microcalcification and cardiovascular risk factors with 18F-NaF PET-CT
Authors: Grine M , Borges-Rosa J , Oliveira-Santos M , Silva R , Gomes A , Abrunhosa A , Castelo-Branco M , Goncalves L , Ferreira M J
Published: June 2024

Introduction

18F-NaF-PET-CT (Positron emission tomography­ computed tomography with 18F­sodium fluoride) can identify active microcalcification. Epidemiologic associations between cardiovascular (CV) risk factors and calcific aortic valve disease have been described, but the pathophysiologic links remain unclear.

Purpose

The aim of this study was to explore the relationship between aortic valve microcalcification and a number of cardiovascular risk factors.

Methods

Individuals at high CV risk but no prior events or known aortic valve disease were prospectively scanned with 18F-NaF-PET-CT. Aortic valve 18F-NaF uptake was quantified via the CUL (corrected uptake per lesion = maximum standard uptake value – mean blood-pool standard uptake value in the atria) and the TBR (tissue-to-background ratio = maximum standard uptake value/mean blood-pool standard uptake value in the atria).

Results

Thirty patients were included. Mean age was 63.7 ± 9.5 years, 70.0% were male, most were diabetic and hypertensive (93.3%). Both the TBR and the CUL were positively correlated with age (TBR: rho = 0.53, p = 0.0025; CUL: rho = 0.56, p = 0.0012). Whereas the CUL but not TBR was inversely correlated with the estimated glomerular filtration rate (TBR: cor -0.24, p = 0.196; CUL: cor -0.37, p = 0.04). There was no significant association with other CV risk factors.

Conclusions

In our cohort, age and the estimated glomerular filtration rate were correlated with the aortic valve uptake of 18F­NaF. Larger studies are required to validate these findings and determine the role of microcalcification in aortic valve degeneration.
Cardiac 15O-water PET motion correction using patient specific synthetic dynamic images
Authors: Nordstrom J , Kero T , Lindstrom E , Sigfridsson J , Sorensen J , Lubberink M
Published: June 2024

Introduction

Patient motion is a common problem in cardiac PET, impairing the diagnostic accuracy of hemodynamically significant CAD for both qualitative and quantitative assessments. Motion correction in cardiac PET is challenging in general because of the time-varying distribution of the tracer, and even more so for 15O-water due to its lack of retention in the myocardium. The aim of the present work was to evaluate a frame-by-frame motion correction method using a patient specific synthetic dynamic reference.

Materials and Methods

Motion correction was implemented as follows. The subject’s CT scan was segmented using Total Segmentator (Wasserthal J et al.) and resulting volumes of interest were then projected over the original dynamic PET scans to obtain time activity cures (TACs) for each segmented structure. A patient specific non-moving synthetic dynamic reference was created based on the segmented CT and extracted TACs. Then, each individual frame of the dynamic PET scan was aligned to the corresponding synthetic frame using rigid co-registration (Figure 1). To test the accuracy of the method, 10 cardiac 15O-water stress scans from patients with known or suspected CAD were included. The scans were visually inspected and determined to be without motion before four different types of motion were added as previously described (Nordstrom et al.), and then corrected using the proposed method. All scans were then analyzed using aQuant software and MBF values from scans with and without motion correction were compared to MBF values from the original scans without motion.

Results

After motion correction, average bias in MBF for all motions decreased from 22.1% to 9.8% in the LAD region, from 16.8% to 12.0% in the RCA region, and from 8.4% to 6.2% in the LCX region. The effect of motion correction in the LAD region for each separate motion is seen in Figure 2.

Conclusion

Motion correction clearly reduces the impact of motion on quantitative MBF, especially for motion caused by cough, but motion artefacts are not completely eliminated. The proposed method addresses the challenges associated with frame-by-frame motion correction due to time varying tracer distributionFigure 1.An example of motion correction for an added cough simulated as a 2 cm anterior displacement during one frame at peak first pass. Top row shows the synthetic reference, second row shows the original scan with an added cough in frame 6 and the third row shows the motion corrected scan. The bottom row shows the magnitude of motion correction in x, y and z direction.  Figure 2.Deviation of MBF from the motion-free original scan for the four different added motion types with corresponding motion correction (MoCo).
Prognostic value of modified coronary flow capacity by rubidium-82 pet/ct in patients with suspected cad and normal myocardial perfusion imaging
Authors: D'antonio A , Zampella E , Assante R , Mannarino T , Gaudieri V , Buongiorno P , Falzarano M , Lepre R , Reina F , Panico M , Arumugam P , Cuocolo A , Acampa W
Published: June 2024

Introduction/Aim

Myocardial perfusion imaging (MPI) by positron emission tomography/computed tomography (PET/CT) is able to provide an absolute quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR). Coronary flow capacity (CFC) has been proposed as a comprehensive measure of the entire coronary vascular status, integrating both hyperemic MBF and MFR results into color-coded scatterplot. Recently, modified CFC (mCFC) concept has been introduced by integrating the regional CFC category within each coronary territory into the entire CFC category for each patient. The purpose of this study is to assess the prognostic value of mCFC in patients with suspected CAD and normal MP at 82Rb cardiac PET/CT imaging.

Methods

We evaluated 4560 patients without previous history of CAD who underwent stress/rest 82Rb cardiac PET/CT. Patients without previous history of CAD and normal MPI (n=2053) were included. Six CFC categories were obtained according to MBF and MFR results. The mCFC was defined as impaired in patients with "mildly reduced" or worse coronary flow in at least one coronary territory. End- points were defined as cardiovascular death, nonfatal myocardial infarction, unplanned hospitalization for any cardiac reasons, and unplanned coronary revascularization.

Results

Follow-up was available in 1967 (96%) patients (median age 59±13 years). During a median time of 41 months (range 3-365), 72 events occurred (4% cumulative event rate, AER of 0.7% person-year). Lower hyperemic MBF and MFR values and a higher prevalence of MFR < 2, were observed in patients with events as compared to those without (all P < .001). Moreover, the prevalence of impaired mCFC was significantly higher in patients with events as compared to those without (P < .001). At multivariable Cox's analysis, age, diabetes, MFR < 2 and impaired mCFC (p < .001) resulted as independent predictors of events. In patients with reduced MFR, as well as in patients with normal MFR, the AER was significantly higher in patients with impaired mCFC as compared to those without (both p <.01). At Kaplan-Meier analysis the worse prognosis was observed in patients with impaired mCFC in both MFR groups.

Conclusions

In patients with suspected CAD and normal MPI, impaired mCFC is associated with a higher risk of cardiac events. The mCFC by 82Rb cardiac PET/CT may be useful to identify patients that may benefit by additional therapies in order to prevent future events.
Temporal change in PET myocardial flow reserve is predictive of cardiovascular outcomes
Authors: Nikolakopoulos I , Liu Y H , Sinusas A , Miller E J , Feher A
Published: June 2024

Introduction

The association between serial measurements of myocardial flow reserve (MFR) and outcomes has received limited study.

Purpose

We sought to describe the trends of coronary blood flows over time in patients undergoing evaluation for coronary artery disease, as well as their association with cardiovascular outcomes.

Methods

We analyzed data from 948 positron emission tomography (PET) stress tests performed on 474 patients without prior history of heart transplant for the evaluation of coronary artery disease at our Hospital between 2016-2022. Patients were assigned to categories according to MFR trajectory based on previously established cut-off of 2.0 (low to low, low to high, high to low, high to high). Continuous variables are expressed as median [interquartile range] and rates as percentages. Long-term outcomes defined as death or myocardial infarction (MACE) were analyzed with the Kaplan-Meier method and Cox regression. C-statistic and net reclassification were used to assess model performance.

Results

Median interval time between tests was 804 days. Most common indications for the first and second PET were chest pain (68 and 65%), dyspnea (11 and 15%) and perioperative risk stratification (11 and 9%) without significant difference (P=0.33). MFR was similar in serial exams (2.1 [1.7-2.6] vs 2.1 [1.7,2.5], P=0.68, but rest (1 [0.8, 1.3] vs 0.9 [0.7, 1] P<0.01) and stress flows (2.1 [1.6, 2.8] vs 1.8 [1.4, 2.2], P<0.01) were both reduced on the second PET. In patients with revascularization between tests, MFR was similar in serial exams (1.6 [1.3-2.0] vs 1.7 [1.2,2.2], P=0.55), as was in patients without revascularization (2.2 [1.8, 2.6] vs 2.1 [1.8, 2.5], P=0.36). During the median follow-up time of 457 [202,853] days, rate of MACE was 28% (51 events). At 4 years after the second PET, patients in the low to low and low to high group experienced worse outcomes. (Figure 1A). In Cox-regression multivariable analysis, there was an increase in MACE in patients in the low to low but not in the low to high group (Figure 1B). There was a decrease on the c-statistic for the above model when MFR trajectory was substituted with the baseline MFR value (0.76 to 0.67), indicating increased prognostic ability when serial measurements are taken into account. The model containing MFR trajectory correctly reclassifies 2.4% of patients that experience the outcome from low risk to high risk while down-classifying 0.06% of patients that do not experience the outcome from high to low risk, with a net reclassification index of 0.025.

After rate pressure product correction of both rest and stress flow, there was no association between corrected MFR trajectory and outcomes when using a corrected MFR cut-off of 1.5 or 2. An increase in stress flow was not associated with better outcomes.

Conclusion

Serial MFR measurement may provide prognostic value in patients with low MFR on a PET stress test.
Biodistribution, safety profile, and radiation dosimetry of [18F]SYN2, a new PET perfusion tracer in healthy subjects
Authors: Knuuti J , Kobylecka M , Kalliokoski K , Tolvanen T , Krajewski S , Steczek L , Gotowicz K , Towpik J , Kozanecki P , Wlostowska J , Dziuk M , Krolicki L , Kozanecki C
Published: June 2024

Aims

The phase I clinical, a first-in-man, study aimed to assess safety profile, radiation dosimetry, and biodistribution of a new potential cardiac positron emission tomography (PET) perfusion tracer [18F]SYN2 (18F acridinium derivative) in healthy subjects.

Methods

[18F]SYN2 intravenous administration with PET imaging was performed in healthy volunteers and sequential whole-body imaging was performed for 4 hours. Blood and urine samples were collected for up to 240 min. Safety follow-up visits took place at 2, 5 and 14 days after the administration.

Results

10 subjects (8 females and 2 males) completed all study procedures. The mean age was 38.1 ± 8.8 years, and the mean body mass index was 22.7 ± 3.0 kg/m2. The mean administered dose of radioactivity was 253 MBq (range: 240 – 258 MBq).

There were no drug-related adverse events, and the tracer was well tolerated in all subjects. The mean whole-body effective radiation dose for [18F]SYN2 was 0.0195 mSv/MBq. The tracer was very rapidly taken up by myocardial wall and cleared up from plasma leading to good image quality already after minutes of tracer injection. The accumulation of [18F]SYN2 to left ventricle was 2.2-2.4 %ID/organ.

Conclusions

Based on tracer safety profile, radiation dosimetry, and biodistribution [18F]SYN2 appears a promising agent for clinical PET myocardial perfusion imaging and further clinical studies are warranted.The PET images at each time period
Interplay between myocardial Ischemia and extensive coronary artery disease - insights from a Hybrid CCTA -13N-NH3-PET MPI study
Authors: Giannopoulos A , Rossi A R , Benz D C B , Zdenek Z S , Jurisic S J , Gajic M G , Galafton A G , Albertini T A , Heiniger P S H , Pazhenkottil A P P , Kaufmann P A K , Buechel R R B
Published: June 2024

Background/Introduction

Anatomically extensive (high-risk) coronary artery disease (CAD), jeopardizing more than half of the myocardium, as well as myocardial ischemia and impaired myocardial blood flow have significant diagnostic, therapeutic, and prognostic implications. We aimed to assess the interplay between high-risk CAD, non-invasively identified by CCTA, and myocardial ischemia/myocardial blood flow (MBF) as assessed using PET-MPI.

Methods

Retrospectively, 264 patients with known or suspected CAD referred for hybrid CCTA and 13N-NH3-PET-MPI between 2015 and 2021 were included. The CT-BCIS-Jeopardy score, a simple angiographic scoring system, enabling quantification of the extent of jeopardized myocardium related to clinically significant CAD, was estimated for all patients using an online calculator, with a score of ≥6 indicating extensive CAD. Abnormal PET-MPI was defined as (1) the presence of visually detectable myocardial ischemia, (2) reduced total stress myocardial blood flow (sMBF ≤1.86ml/min/gr) or (3) reduced total myocardial blood flow reserve (MFR ≤2) evaluated in three separate readouts. Logistic regression analysis with adjustment for clinical variables (age, sex, cardiovascular risk factors) was used to determine i) the risk of extensive CAD at CCTA in patients with abnormal PET-MPI and ii) the risk of ischemia and pathological myocardial blood flow in patients with extensive CAD.

Results

Mean patients’ age was 62±11 years and 194 (73%) were male. Median delta time between CCTA and PET-MPI was 0 days (IQR: 0-14.5; range -55 to 95). Extensive CAD at CCTA was detected in 50 (19%) patients, while PET-MPI revealed ischemia in 33 patients (13%), reduced sMBF in 82 patients (31%) and reduced MFR in 36 (14%) patients. Compared to non-extensive CAD, patients with extensive CAD had an 11-fold higher risk of myocardial ischemia (odds ratio [OR]: 11.19 [4.38-28.6]; p<0.001), 3-fold higher risk of abnormal sMBF (OR: 3.17 [1.45-6.96]; p=0.004), and 3-fold higher risk of abnormal MFR (OR: 3.39 [1.36-8.42], p=0.009). Compared to patients with no ischemia, presence of ischemia was associated with 11-fold increased risk of extensive CAD (OR: 11.25 [4.39-28.8]; p<0.001). Patient with impaired sMBF had 2.9-fold higher risk of extensive CAD (OR: 2.89 [1.36-6.16]; p=0.006) and patients with impaired MFR hat 3.7-fold higher risk (OR: 3.71 [1.53-8.99]; p=0.004) of extensive CAD.

Conclusions

CCTA and PET-MPI can independently, and with similar performance, identify and risk-stratify patients with abnormal myocardial perfusion/myocardial blood flow and extensive CAD, respectively.
Quantitative myocardial blood flow and long-term outcome benefit from revascularization
Authors: Maaniitty T , Nammas W , Jukema R , Van Diemen P , Stenstrom I , Harjulahti E , Raijmakers P G , Sprengers R , Planken R N , Bax J J , Knaapen P , Knuuti J , Danad I , Saraste A
Published: June 2024

Background

There is controversy regarding the outcome benefit from myocardial revascularization in patients with chronic coronary artery disease (CAD). We hypothesized that severely reduced regional stress myocardial blood flow (MBF) quantified by [15O]H2O positron emission tomography (PET) is associated with prognostic benefit from early revascularization.

Purpose

To study the interaction of regional stress MBF in absolute terms and early myocardial revascularization in predicting long-term clinical outcome in chronic CAD.

Methods

From pooled cohort of two academic medical centers, we identified consecutive symptomatic patients who underwent [15O]H2O PET myocardial perfusion imaging for evaluation of CAD. The lowest regional stress MBF (ml/g/min) was calculated as an average of two adjacent segments with the lowest MBF. Early revascularization was defined as percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) within 3 or 6 months after MPI (depending on the institution). Statistical interaction between stress MBF and revascularization in predicting composite endpoint of all-cause mortality, myocardial infarction (MI), and unstable angina pectoris (UAP) was analyzed by Cox regression. Hazard ratio (HR) for early revascularization was visualized across MBF values with the use of spline function.

Results

Out of 1600 patients (age 62 ± 9 years, 54% male), 318 (20%) underwent early revascularization (240 PCI and 78 CABG) and 228 (14%) experienced the composite endpoint during median follow-up of 7.0 years (25th–75th percentiles: 4.9–8.6 years). The cumulative incidence of the composite endpoint was higher in revascularized than non-revascularized patients (18% vs. 13%, p=0.036). There was a significant interaction (p=0.042) between the lowest regional stress MBF (adjusted HR 1.71 (95%CI 1.43-2.04) per 1 ml/g/min decrease, p<0.001) and effect of early revascularization (adjusted HR 0.44 (95%CI 0.21-0.93), p=0.032) on the incidence of the composite endpoint. In terms of long-term outcome, the effect of early revascularization was indifferent (i.e., HR=1) when the lowest regional MBF was approximately 2.0 ml/g/min (Figure). When the lowest regional stress MBF was less than 2.0 ml/g/min, early revascularization was associated with reduced long-term risk of the composite endpoint (HR<1).

Conclusion

In chronic CAD, early myocardial revascularization was associated with improved outcome among patients with the lowest regional stress MBF below a cut-off value of 2.0 ml/g/min by [15O]H2O PET. Quantitative severity of regional myocardial ischemia shows promise in identification of patients who gain prognostic benefit from revascularization.
Role of [18F]FDG PET/CT in patients with suspected ventricular assist device infection
Authors: Garcia Sanchez L M , Hervas-Sanz B , Sanchez-Rodriguez I E , Notta P C , Diez-Lopez C , Gonzalez-Costello J , Escrihuela-Vidal F , Sabe-Fernandez N , Ortiz-Berbel D , Osorio-Higa K , Cortes-Romera M
Published: June 2024

Objectives

Ventricular assist devices (VAD) are used in patients with heart failure either as bridge therapy to cardiac transplantation or as destination therapy.

The aim of this study is to evaluate the usefulness and diagnostic capability of [18F]FDG PET/CT in patients carrying VADs with suspected underlying infectious processes.

Material and methods

Retrospective descriptive study of patients (p) carrying VAD, with performance of [18F]FDG PET/CT for suspected infection between July 2018 and January 2023.

Demographic data, baseline pathology, VA purpose and PET/CT findings were studied.

Results

11p (5 female, 5 male, 1 transgender female) with a mean age of 55.4 years [31-76], affected by dilated cardiomyopathy (8 ischaemic, 2 toxic secondary to chemotherapeutic treatment, 1 idiopathic) were analysed. 7p were VAD carriers as bridging therapy and 4p as destination.

The reasons for requesting PET/CT were in 10p clinical suspicion of device infection and in 1p suspicion of interstitial nephritis.

5p presented PET/CT suggestive of infection (4 on driveline entry and subcutaneous tract; 1 on ventricular device and mediastinal cannulae). Microbiological analysis was performed in all of them and was positive in only 3p. Despite this, all 5p received antibiotic treatment with beta-lactams (4p with resolution of the infectious condition and 1p requiring cardiac transplantation).

1p presented a discrete increase in metabolism at the level of the subcutaneous driveline tract attributable to an inflammatory process.

5p showed no findings suggestive of infection by PET/CT and the final diagnosis was unrelated to the VAD (2p without infection and 3p with infection in locations other than the VAD).

The median SUVmax of patients with extrathoracic infection (driveline entry and subcutaneous tract) was 2.5 g/ml vs. 1.36 g/ml in relation to the rest of the patients without infection.

The median SUVmax of patients with intrathoracic infection was 4.99 g/ml vs. 3.6 g/ml for the rest of the patients without infection.

Conclusion

18F]FDG PET/CT has been able to detect in our sample, in a non-invasive way, infection related to ventricular assist devices, presenting higher diagnostic yield and a high negative predictive value with respect to microbiological analysis.
Prognostic value of left ventricular mechanical dyssynchrony in left bundle branch block and preserved left ventricular ejection fraction patients
Authors: Cortes C , Creta V , Klin P , Embon M
Published: June 2024

Background

Patients with left bundle branch block (LBBB) patterns on the electrocardiogram and preserved left ventricular ejection fraction (LVEF) represent a heterogeneous group of patients with different prognosis, including patients with or without left ventricular mechanical dyssynchrony (LVMD). LVMD obtained by gated 99m-technetium single photon emission computed tomography (SPECT) imaging could be a useful tool to detect early myocardial damage, identifying a higher risk group of patients.

Purpose

The aim of this study was to assess the prognostic value of LVMD in patients with LBBB and LVEF ≥ 50%.

Methods

Three hundred and seventy-seven consecutive patients with LBBB and LVEF ≥ 50% were referred for gated-SPECT from August 2011 to June 2019. Phase analysis parameters standard deviation (SD) and histogram bandwidth (HB) were obtained in rest gated SPECT imaging.

LVMD was defined when the HB and the SD exceeded the abnormality threshold values for men (SD ≥ a 24,39° y HB ≥ 62,39°) and women (SD≥ 22,1° y HB ≥ a 49.7) as derived from a normal database. (Threshold = mean plus two standard deviation for each parameter). (1)

Follow-up was performed by telephone contact or medical history review. Endpoint were the composite of all-cause death and myocardial infarction (MI). Logistic regression model and event-free survival curves were obtained. Univariate and multivariate cox regression analysis were performed.

Results

Three hundred and sixty-four patients completed follow-up (median 106.08 months (58.08-176.12)). LVMD was observed in 84 (23%) patients. Fig. 1 shows the population clinical characteristics, perfusion and function results.

The composite of all-cause death and MI occurred in 12 patients (3.3%).

In the multivariate analysis models performed, the LVMD had an OR:8.32 (2.50-32.54, p 0.001) and age ≥ 70 an OR 5.43 (1.54-25.39, p 0.014) for the composite outcome.

Fig. 2 shows Kaplan-Meier curve of event-free survival in relation to LVMD and age ≥ 70 years.

The presence of LVMD was a predictor of high-risk of the composite outcome: adjusted hazard ratio: 7.10 (2.14-23.60; p 0.001), in the multivariate analysis adjusted for age ≥ 70 years.

Conclusion

In our population of patients with LBBB and LVEF ≥ 50%, the presence of LVMD assessed by rest gated SPECT imaging identifies patients with higher risk of adverse events adjusted for age ≥ 70 year.Table 1
Transthyretin cardiac amyloidosis by Cardiac Scintigraphy with 99mTc-diphosphonates and cardiovascular magnetic resonance imaging
Authors: Gracia Sanchez L , Pudis M , Notta P C , Sanchez-Rodriguez I E , Hervas-Sanz B , Diaz-Moreno J L , Claver Garrido E , Diez Lopez C , Rodriguez Gasen A , Martin Marcuartu J J , Cortes-Romera M
Published: June 2024

Aim

Classic imaging features on echocardiography and cardiac magnetic resonance, although typical for cardiac amyloidosis, are not specific enough to distinguish light chain amyloidosis from transthyretin amyloidosis (ATTR-CA). Myocardial bone-avid radiotracer uptake is highly specific for ATTR-CA when plasma cell dyscrasia has been excluded; it is now replacing the need for biopsy in many patients.

The purpose of this study is to analyze the prevalence of ATTR-CA diagnosed by Cardiac Scintigraphy (CS) and Cardiovascular Magnetic Resonance Imaging (CMRI) and the characteristics of these patients.

Materials and Methods

A retrospective study of 894 patients (p) with clinical suspicion and/or genetic background predisposing to ATTR-CA. 139p were scintigraphically positive and we divided them into 3 groups:

Group A: senile ATTR (ATTRwt).

Group B: ATTR associated with genetic mutation (ATTRm).

Group C: recipients of domino liver transplant (DLT) from patients with familial amyloid polyneuropathy.

We analyzed sex, average age, arterial hypertension, electrocardiogram (ECG) alterations, interventricular septum thickness (IVST), clinical signs of heart failure (HF), peripheral nervous system (PNS) involvement, Perugini score (PS) and CMRI results.

Results

Group A: 121p, 95 males, 84-years-old, 103 with hypertension, 98p with ECG alterations (24p with pacemaker). Average IVST of 16,6±3,9mm. 121p (100%) with HF. 15p (12,4%) with PNS involvement. 51p with PS3, 49p with PS2, 21p with PS1. 13p with recent CMRI: 12p of them with a result compatible with CA and 1p with an alternative diagnosis (Fabry disease).

Group B: 17p, 8 males, 68-years-old, 12 with hypertension, 9p with ECG alterations (none with pacemaker). Average IVST of 15,9±4,1mm. 5p (29%) with HF. 9p (53%) with PNS involvement. 12p with PS3, 4p with PS2, 1p with PS1. 5p with recent CMRI: 3p of them with a result compatible with CA and 2p with non-conclusive results. The most frequent genetic mutation was Val30Met in 5p.

Group C: 1p, 70-year-old male with hypertension, without ECG alterations. 16mm of IVST. With HF. Without PNS involvement. PS2. CMRI non-conclusive for CA. 8 years have passed since the DLT.

Conclusion

The senil group had the highest prevalence of ATTR-CA, more cardiac symptoms and ECG abnormalities±pacemakers and less neurological involvement than the other groups.

The most frequent mutation in the genetic group was Val30Met. This group had greater neurological involvement and the CMR was less specific for the diagnosis of CA.

CS should be performed in all the patients with clinical suspicion of CA because it has better diagnostic performance than CMRI.
Correlation between cardiac glycolytic metabolism and clinical-epidemiological variables of cancer patients
Authors: Soares Brandao S , Duarte Ribeiro Sobrinho J M D R S , Lima De Matos Leao E D L M L , Barbosa Accioly B B A , Saura Martins A G S M , Cavalcanti Amorim Martins R J C A M , De Moraes Chaves Becker M M C B , De Oliveira Buril R O B , De Oliveira Menezes V O M , Alves Mourato F A M
Published: June 2024

Introduction

Significant advances in the diagnosis and treatment of cancer have improved the life expectancy of cancer patients. However, these therapies can impact the quality of life and survival of these patients due to the detrimental effects of these treatments, especially on the heart. In this context, early diagnosis of cardiotoxicity to chemotherapy drugs is crucial for the implementation of strategies to prevent progression and death from cardiovascular diseases. Positron Emission Tomography-Computed Tomography (PET/CT) with Fluorodeoxyglucose-Fluorine-18 (FDG) is an examination that evaluates glycolytic metabolism and is routinely used in the staging and therapeutic evaluation of various neoplasms. Furthermore, studies have shown the potential benefit of PET/CT in the evaluation of cardiotoxicity through myocardial FDG uptake.

Objective

To evaluate the association between myocardial FDG uptake and clinical-epidemiological data of cancer patients.

Materials and methods

Cross-sectional and retrospective study. From January to June 2023, clinical-epidemiological data and the presence of myocardial FDG uptake were evaluated in patients referred for FDG PET/CT oncology study at a public and university nuclear medicine service in Northeast Brazil. Patients were grouped according to the absence (G1) or presence (G2) of myocardial FDG uptake, and clinical-epidemiological data were compared between them. Myocardial FDG uptake was considered significant if higher than blood pool uptake in the aorta. A p-value <0.05 was considered statistically significant.

Results

We selected 428 exams, with 63.3% being female, mean age 54 ± 16 years, 34.8% hypertensive, 16.8% diabetic, and 9.6% with dyslipidemia. The analyzed types of cancers were: lymphoma (31.5%), breast (17.8%), melanoma (8.4%), cervical (8.2%), colorectal (6.8%), and lung (6.8%). The most common indications were treatment response evaluation (43.7%), restaging (22.2%), staging (19.4%), and follow-up (12.1%). Cardiac FDG uptake was present in 39.5% of the sample (G2). In the univariate analysis, diabetes was more frequent in G1 (19.1% vs 12.4%, G1 vs G2, respectively, p 0.0498), and male sex was more prevalent in G2 (30.89% vs 45.56%, G1 and G2, respectively, p 0.0021). In the logistic regression analysis, only male sex remained statistically significant between the groups, p= 0.0022.Conclusion: In oncological PET/CT exams, significant myocardial FDG uptake was more prevalent in men. This result may indicate differences between sexes in cellular susceptibility and myocardial mechanisms of metabolic response to oncological treatment toxicity.
A systematic review and meta-analysis of acupuncture for De Quervain’s tenosynovitis treatment
Authors: Qin Yuxi , Luo Dan , Qiu Heng , Zhang Jingyu , Yong Huang , Yu Shuguang
Published: June 2024

Background

De Quervain's tenosynovitis (DQt) is a prevalent chronic inflammatory musculoskeletal disorder predominantly affecting the radial aspect of the wrist. This study conducted a comprehensive review of the efficacy of acupuncture in treating De Quervain’s tenosynovitis (DQt). Although there is evidence suggesting that acupuncture can alleviate symptoms of DQt–characterized by pain, swelling, and functional impairment–higher-level evidence is still required to further substantiate its efficacy and safety. This study conducted a comprehensive review of the efficacy of acupuncture in treating De Quervain's tenosynovitis (DQt).

Methods

By systematically searching databases such as PubMed, Science Direct, Web of Science, Google Scholar, EMbase, PEDro, China National Knowledge Infrastructure Database (CNKI), Wanfang Database, and Chongqing VIP China Science, Technology Journal Database (VIP), we retrieved randomized controlled trial (RCT) literature on acupuncture for DQt, with the search period extending to November 1, 2023. After extracting and assessing data from the included literature, we performed Meta-analysis using RevMan 5.4.1 software.

Results

The results encompassed 14 RCT papers, involving 851 patients. The Meta-analysis findings indicated that, when compared to topical analgesics, acupuncture demonstrated a significant increase in treatment effectiveness (RR = 1.24; 95% CI = 1.11, 1.39, P = 0.0002) and a notable reduction in VAS pain scores (MD = −1.06; 95% CI = −1.51, −0.61, P < 0.00001). However, no statistically significant difference was observed in conney wrist joint scores. Furthermore, acupuncture was found to reduce VAS pain scores compared to the waiting list group. In comparison to corticosteroid injections (CSI), acupuncture did not show statistical significance in VAS, effectiveness rate, and conney wrist scores.

Conclusion

Acupuncture exhibited a promising trend in alleviating pain associated with DQt and enhancing treatment effectiveness. Nonetheless, due to limitations in the quantity and quality of the included studies, these findings warrant further validation through additional research.