bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of coronary CT angiography (CCTA) in the prepartecipation screening (PPS) of apparently healthy master athletes
Authors: Moliterno E , Giarletta L , Brancasi A , Rovere G , Natale L , Marano R 
Published: June 2024

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

Results
Totally 365 patients with previously known CAD were analyzed, of whom 318 (87.1%) have had prior PCI and 114 (31.2%) – prior MI. True myocardial perfusion defect was detected in 55 patients (15.1%). The patients without performed further diagnostic tests were excluded.
In patient group with prior MI, the significant perfusion defect was detected in 25 (21.9%) cases and in 15 women (60.0% form all positive cardiac SPECT/CTs in this group) repeated PCI was performed. Of patients with prior PCI, the significant perfusion defect was detected in 47 (14.8%) cases and in 24 women (51.0% form all positive cardiac SPECT/CTs in this group) repeated PCI was performed. In patients without prior PCI or MI (n=47), but with intermediate stenosis in coronary arteries, the primary PCI was performed in 17 (36.2%) cases.

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Conclusion
While a reduction in septal uptake due to LBBB is well described in SPECT MPI, it appears that LBBB rarely produces a septal perfusion defect or septal changes in absolute MBF or MFR as assessed by 82Rb PET MPI. The etiology of this difference deserves further study. If confirmed, PET MPI should be a superior imaging modality for patients with LBBB.