bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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 &lt; 0.001) and all-cause death (HR 3.64, 95% CI 2.22-5.96, p &lt; 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

Abstract

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

Abstract

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 &gt;8% resulted in 6.3-fold higher HFD than those with low probability (≤ 8%). Patients with high ArE probability &gt;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

Abstract

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 &lt; 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 &lt; 0.001) and 6.51 ± 1.97vs2.65 ± 0.49(p &lt; 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 &lt; 0.01), H/CL-HWB(r:0.85,p &lt; 0.001) and HR-HWB(r:0.85,p &lt; 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

Abstract

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

Abstract

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

Abstract

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.