bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and scintigraphic characteristics of patient with left bundle branch block
Authors: Guzic Salobir B , Dolenc Novak M , Stalc M 
Published: June 2024

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 &lt; 2, were observed in patients with events as compared to those without (all P &lt; .001). Moreover, the prevalence of impaired mCFC was significantly higher in patients with events as compared to those without (P &lt; .001). At multivariable Cox's analysis, age, diabetes, MFR &lt; 2 and impaired mCFC (p &lt; .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 &lt;.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

Abstract

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&lt;0.01) and stress flows (2.1 [1.6, 2.8] vs 1.8 [1.4, 2.2], P&lt;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

Abstract

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

Abstract

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&lt;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&lt;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.