bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical performance can be improved by revascularization if treatment decision is guided by quantitative assessment of myocardial perfusion using cardiac positron emission tomography
Authors: Akil S , Szekely A S , Mosen H , Hedeer F , Arheden H , Engblom H 
Published: June 2024

Abstract

Background
Revascularization in patients with chronic coronary syndrome (CCS) is performed to improve patient prognosis and/or to alleviate ischemic symptoms and thereby possibly improve patient physical capacity. To select patients with suspected CCS that would benefit from revascularization, current guidelines (1) recommend assessment of myocardial perfusion prior to treatment decision. However, revascularization decisions are still often only guided by presence of coronary stenoses on coronary angiography.

Purpose
The aim of this study was to investigate how patient physical performance is affected by revascularization of vessel territories which prior to treatment show reduced myocardial perfusion reserve (MPR) in relation to territories with normal MPR as assessed by quantitative cardiac positron emission tomography (PET).

Methods
Twenty-eight patients (11 females) with suspected CCS, referred for a clinical coronary angiography (CA), were included. All patients performed a baseline cardiopulmonary exercise test (CPET) for assessment of physical performance and stress/rest cardiac 13NH3-PET 4±4 weeks before CA. A follow-up CPET examination was performed 7±2 months after the CA. By study design, the angiographer making the decision to perform a revascularization was blinded to the CPET and PET data. MPR was calculated from stress/rest dynamic cardiac PET images according to the 17-segment model (excluding apex) (2) for each vessel territory separately (LAD, RCA and LCx), and MPR &lt;2.0 was considered reduced. Physical performance was assessed from the CPET by calculating peak oxygen uptake (VO2peak) expressed as percentage of predicted maximum.

Results
A revascularization was performed in 21/28 patients (32 vessel territories). Figure 1 shows that a higher proportion of patients with vessel territories showing MPR&lt;2.0 at baseline improved in VO2peak compared to those with an MPR&gt;2.0 (79% [11/14] vs 14% [1/7], p=0.02). In 3/7 patients that were not revascularized, MPR was &lt;2.0 at baseline. All three of them had decreased VO2peak at follow-up compared to baseline.

Conclusion
Patient physical performance improves when vessel territories with reduced MPR are revascularized but not if MPR is normal. Thus, quantitative assessment of myocardial perfusion by cardiac PET prior to coronary intervention may enable appropriate selection of patients that will benefit from revascularization.
Fibroblast activation following myocardial infarction and left ventricular remodelling
Authors: Barton A K , Tzolos E , Craig N , Loganath K , Joshi S , Fletcher A , Van Beek E , Slomka P , Newby D , Dweck M 
Published: June 2024

Abstract

Background
Novel molecular positron emission tomography (PET) assessments of fibrosis are now available but have not been compared directly to cardiovascular magnetic resonance (CMR), the current reference standard for myocardial scar assessment. Using 68Gallium-fibroblast activation protein inhibitor (FAPI), a radiotracer that binds to activated fibroblasts, we compared CMR and PET assessments of myocardial scar following ST-elevation myocardial infarction.

Methods
Hybrid 68Ga-FAPI-46 PET/MR with gadolinium-based contrast agent was performed in 40 patients within 4 weeks of acute ST-elevation myocardial infarction (acute STEMI) with 19 returning at 12 weeks for repeat PET/MR (subacute STEMI). Scar burden (%LGE) was measured on late enhancement short axis CMR images (Circle Cardiovascular Imaging software, Canada). Volume and intensity of global myocardial 68Ga-FAPI uptake was quantified (QPET, Cedars Sinai, Los Angeles) to determine the volume myocardium with tracer uptake (%68Ga-FAPI) and intensity of PET signal (target-to-background ratio, TBRmax) after correcting for right atrial blood-pool activity.

Results
In acute STEMI, high intensity uptake of 68Ga-FAPI was observed localized to the infarct. The area of fibroblast activation greatly exceeded the area of scar detected by late gadolinium enhancement (LGE) (%68Ga-FAPI 26.6+-15.4% vs 14.5+-11.4%, p&lt;0.001). 68Ga-FAPI volume and intensity declined between acute and subacute STEMI (%68Ga-FAPI 26.6+-15.4% vs 12.8+-8.1%, p&lt;0.001, TBRmax 3.9+-1.1 vs 2.7+-0.7, p&lt;0.001). By week 12, there was no difference between the area of fibroblast activation detected by 68Ga-FAPI uptake and area of scar detected by LGE (%68Ga-FAPI 12.8+-8.1% vs %LGE 10.3+-6.1%, ns).

Conclusion
Molecular PET assessments of myocardial scar formation provide different but complementary information to structural assessments of myocardial scar. Fibroblast activation following myocardial infarction is a dynamic process that can be non-invasively measured for the first time by 68Ga-FAPI PET.
Left bundle branch block predicts inadequate glucose metabolism suppression in [18F]-FDG PET/CT
Authors: Hartikainen S , Tompuri T , Laitinen T M , Hedman M , Laitinen T 
Published: June 2024

Abstract

Introduction
Inadequate glucose metabolism suppression (GMS) may hamper diagnostics of inflammatory cardiac diseases in cardiac [18F]-FDG PET/CT. Even with successful one-day ketogenic diet with elongated fasting with or without heparin premedication, studies show inadequate GMS in 20-30 % of cases. Patient-to-patient variation of GMS is not well understood. Left bundle branch block (LBBB) is associated with altered myocardial perfusion and heterogenous myocardial glucose metabolism in viability imaging.(1,2) However, there are no reports on LBBB associated inadequate GMS in inflammation imaging with [18F]-FDG PET/CT.

Purpose
The aim of our study was to recognize variables that lead to inadequate GMS.

Methods
60 patients (31 male) with known or suspected inflammatory cardiac disease were recruited for this study. Cohort included twelve patients with LBBB. All patients had followed the ketogenic diet for one day and fasted for at least 12 hours before imaging. Blood β-hydroxybutyrate (BHB) level was measured both with a point-of-care device and in laboratory. Blood glucose, cholesterol, high- and low-density lipoproteins (HDL and LDL), triglyceride and free fatty acid (FFA) levels were measured in laboratory. HOMA-IR was calculated from glucose and insulin levels. Those whose point-of-care measured BHB was less than 0.35 mmol/l, received unfractionated heparin 50 IU/kg 15-20 min before FDG-injection. FDG uptake was measured from PET imaging data as maximal standardized uptake values (SUVmax) from eight 1 cm diameter regions of interest in the left ventricle lateral wall and septum, and mean of those was calculated (SUVlv), and one region of interest in the left ventricle blood pool background (SUVbackground). Adequate GMS was defined as SUVlv/SUVbackground (SUVratio) ≤ 1. Spearmans ρ was used to evaluate bivariate correlations between SUVratio and other variables. Continuous variables were tested using the Mann-Whitney U test and categorical variables using the chi-square test.

Results
Median SUVratio was 0.84 (min-max 0.45-12.98), with adequate GMS in 40 patients (67 %). Median BHB was 0.4 mmol/l (0.1-3.0 mmol/l) with point-of-care device and 0.30 mmol/l (0.0-2.49 mmol/l) with laboratory analysis. Median HOMA-IR was 1.96 (0.28-13.22, and triglyceride level 0.99 mmol/l (0.44-7.33 mmol/l). Variables that correlated with SUVratio were BHB level (r=-0.310, p=0.017 for point-of-care, r=-0.378, p=0.01 for laboratory analyzed), triglyceride level (r=-0.367, p=0.004), FFA (r=-0.386, p=0.003). Median SUVratio was 1.17 (0.66-4.88) in those with LBBB and 0.80 (0.45-12.98) in those without LBBB (p=0.044). There was no difference between LBBB and no-LBBB groups in variables that correlated with adequate GMS.

Conclusion
Patients with LBBB seem to have poorer GMS response to the ketogenic diet and a longer diet with these individuals should be considered. Studies with larger cohort to analyze underlying pathophysiology is needed.
FDG PET/CT of AtriClip left atrial appendage closure device: always active, infected or not
Authors: Scholtens A 
Published: June 2024

Abstract

Introduction
FDG PET/CT is used increasingly for the diagnosis of cardiac implant infection, with the newly revised ESC guidelines further cementing its role. Data show the accuracy of FDG PET/CT in diagnosing infection varies between different types of implants. The AtriClip, a left atrial appendage closure device, is becoming more common in clinical practice, but there is little knowledge regarding the normal variation of FDG uptake surrounding these devices.

Purpose
To describe and better understand the appearance of AtriClip devices on FDG PET/CT.

Methods
We retrospectively searched FDG PET/CT reports for the terms "AtriClip" or "Atrial closure device". Scans with AtriClips in situ were re-evaluated and SUVmax and SUVratio (compared to aortic blood pool) were measured on EARL 1.0 reconstructions. We compared the findings in scans performed for a suspicion of infection with scans performed for other indications. SUV findings were compared with students' T-test.

Results
We retrieved 13 scans in 8 patients. 9 were performed for suspicion of infection, 3 for cancer (1 lungcarcinoma, 2 coloncarcinoma) and 1 for sarcoidosis. There was increased FDG uptake surrounding the AtriClip on all FDG PET/CT scans, with no obvious visual differences between scans performed for infection and scans performed for other indications (Figure 1). There were no statistical differences between SUVmax or SUVratio (Figure 2), with SUVmax (mean ± SD) 5.4 ± 0.8 versus 4.8 ± 0.4 (p=0.118) and SUVratio 2.63 ± 0.45 versus 2.88 ± 0.38 (p=0.204), for infection and other indications respectively.

Conclusions
FDG uptake occurs commonly around AtriClip devices, and does not imply or differentiate infection.Scans for infection (A) and cancer (B). SUV measurements surrounding AtriClips.
Molecular imaging of the immune-fibrosis axis to guide therapeutic intervention after myocardial infarction
Authors: Strunk M , Fernandez-Mayola M , Hess A , Al-Bazaz S , Ross T L , Bengel F M , Thackeray J T 
Published: June 2024

Abstract

Objectives
Myocardial infarction evokes inflammation and activation of quiescent cardiac fibroblasts, leading to heart failure progression. We hypothesized that targeted molecular imaging of fibroblast activation protein (FAP) on activated fibroblasts could predict subsequent remodeling and monitor fibroblast response to anti-inflammatory therapy.

Methods
In vitro uptake of 68Ga-FAPI-46 was assessed in human cardiac fibroblasts stimulated by supernatant from inflammatory macrophages. C57Bl/6 mice underwent 60min left coronary artery ischemia/ reperfusion (I/R) (n=22) or sham (n=7). Serial 68Ga-FAPI-46 and 18F-FDG PET imaging was performed 1d, 3d, 7d, 14d and 42d after surgery. Left ventricle (LV) function and perfusion defect size were assessed by MRI and SPECT at 6wks. Additional animals were treated with anti-inflammatory enalapril and similarly scanned.

Results
Exposure to M1-like macrophage supernatant increased 68Ga-FAPI46 uptake by cardiac fibroblasts (p=0.01), associated with higher expression of IL-1β (p&lt;0.05) and TGF-β (p=0.003). I/R induced moderate infarct size at 6wks post I/R (18.1±5.3% of LV). I/R animals exhibited increased LV volumes compared to sham (systole, 38±7 vs 21±4µL, p&lt;0.001; diastole, 69±9 vs 49±4µL, p&lt;0.001) and decreased LV ejection fraction (EF)(46±10 vs 58±2%, p&lt;0.001). Serial FAP imaging revealed biphasic upregulation in the infarcted myocardium. Signal intensity 3d after injury was significantly increased (%ID/g, 0.69.±0.1 vs 1.3±0.3, p&lt;0.001). After declining to sham levels at 7d, signal was again elevated 14d after I/R(%ID/g 0.70±0.1 vs 0.94±0.1, p=0.05) before returning to sham levels at 6wks. Signal increase was not restricted to infarct area, but similarly observed in non-infarcted remote myocardium at 3d (p&lt;0.001) and 14d (p&lt;0.05), suggesting involvement of both replacement and reactive fibrosis. There is modest inverse correlation between 3d infarct area FAPI signal and LVEF 6wks later (r=-0.43, p&lt;0.05), but stronger with 14d FAPI signal (r=-0.51, p&lt;0.05). Assuming the elevation at 3d would reflect inflammatory cell infiltration and lead to replacement fibrosis, whereas the later wave would derive from interstitial fibrosis, we treated animals with ACE inhibitor enalapril for 10d, beginning 2d prior to surgery to prevent mobilization of myeloid cells from the spleen. FAPI signal was significantly reduced in the infarct area in enalapril-treated mice at 3d (p=0.05), supporting the notion that early FAP expression is regulated by inflammatory environment.

Conclusions
Molecular imaging of FAP provides a prognostic biomarker of subsequent remodeling reflecting both early inflammation driven replacement and later interstitial fibrosis, ultimately supporting its capacity to monitor novel therapies.
Cardiac amyloidosis beyond Perugini. Can diphosphonate scan tell you more?
Authors: Pereira B , Albergueiro R , Soeiro P 
Published: June 2024

Abstract

Introduction
Cardiac transthyretin amyloidosis is a restrictive cardiomyopathy that poses a diagnostic challenge due to its rarity and overlapping clinical symptoms with other diseases. While [99mTc]Tc-diphosphonate has proven to be sensitive for detecting ATTR, there remains a gap in understanding the correlation between the intensity of cardiac uptake and disease severity.

Purpose
The aim of this study is to investigate whether there is a correlation between the intensity grade and specific clinical and analytical parameters in patients with ATTR amyloidosis.

Methods
A single-tertiary center observational, retrospective, and longitudinal study was conducted, encompassing patients aged ≥ 18 years who underwent bone scintigraphy with [99mTc]Tc-DPD or [99mTc]Tc-HMDP from 2020 to 2021. Inclusion criteria involved patients witha Perugini score of ≥2. Exclusion criteria were applied to individuals lacking follow-up information. Planar anterior images of the chest were reprocessed to assess the maximum and average uptake within regions of interest, encompassing both the heart and the contralateral thoracic region. Clinical, analytical, and imaging data were extracted from available digital records. Statistical analyses using single and multiple linear regression were conducted using R software.

Results
33 patients met the inclusion criteria (85% men, average age: 79 ± 10 years old). Sixteen patients were classified as grade 2, while 17 were classified as grade 3 on the Perugini amyloidosis scale. The radiopharmaceutical used was [99mTc]Tc-HMDP in 25 patients. The main referring specialties were internal medicine (55%) and cardiology (30%). One patient was referred for bone metastasis, and amyloidosis was an incidental finding. Twenty nine patients had hypertension, 21 had atrial fibrillation, 18 were dyslipidemic, 14 had aortic stenosis, 13 had diabetes mellitus, 6 had chronic kidney disease, and 5 had obstructive airway disease. All patients exhibited left ventricular hypertrophy on echocardiography, the average ejection fraction was 50 ± 12 (58% with preserved ejection fraction), septal thickness of 15.87 ± 2.26 mm and relative myocardial wall thickness was 0.60 ± 0.16 mm. Several patients had degenerative articular disease (11 hip prosthesis, 3 carpal tunnel syndrome surgeries, 3 vertebral surgeries).
There were statistically significant associations between an older age and a higher ratio of average counts and the presence of aortic stenosis and a higher ratio of maximum counts. No other correlation was found for other ATTR manifestations (neurological, muscular or cardiac).

Conclusion
Higher intensity of [99mTc]Tc-diphosphonate uptake ratios in ATTR seem to be correlated with aortic stenosis and older age.
Atrial fibroblast activity and atrial fibrillation
Authors: Loganath K , Lakshmanan S , Craig N , Vickneson K , Whittington B , Joshi S , Barton A , Newby D , Williams S , Dweck M 
Published: June 2024

Abstract

Introduction
Atrial fibrosis is a key factor in the development of atrial fibrillation (AF)(1). 68Gallium-labelled fibroblast activation protein inhibitor (68Ga-FAPI) binds to activated fibroblasts, enabling the tracking of fibroblast activation and fibrosis activity (2).

Methods
Participants with heart failure with preserved ejection fraction (HFPEF), aortic stenosis (AS) and healthy volunteers underwent 68Ga-FAPI PET, cardiac magnetic resonance (CMR) imaging and echocardiography. 2 analysers were blinded to the AF status of the participants. Regions with increased visual PET uptake were identified in the atria, their position recorded and the intensity of 68Ga-FAPI activity quantified. When no regions of increased activity were identified regions of interest were drawn in the atrial septum. Maximum standardised uptake values (SUVmax) were recorded and maximum tissue-to-background ratios (TBRmax) were calculated.

Results
In this initial analysis of an ongoing study, 40 (28 with aortic stenosis, 8 with heart failure with preserved ejection fraction and 3 healthy volunteers) participants underwent 68Ga-FAPI PET imaging. 11 participants had AF (2 paroxysmal, 9 persistent). A total of 47 regions of increased visual uptake were identified. All participants with AF demonstrated increased visual 68Ga-FAPI PET in the cardiac atria, which commonly localised to the left atrial wall and the point of insertion of the pulmonary veins into the left atrium. 14 (48.3%) participants without AF demonstrated increased 68Ga-FAPI uptake in their atria. Upon quantification participants with AF had increased 68Ga-FAPI uptake in their atria, with higher SUVmax [2.30 (0.39) in AF vs 1.86 (SD 0.35) without; p&lt;0.05] and TBRmax values [ 1.58 (SD 0.23) in AF vs 1.39 (SD 0.32) without; p&lt;0.05] (Figure 1). In participants without AF, the TBRmax of regions of interest drawn in the atrial septum correlated moderately with left atrial diameter (r=0.50, p= 0.01) on echocardiography

Conclusion
Participants with atrial fibrillation have increased 68Ga-FAPI activity in their cardia atria compared with participants without AF. This technique holds major promise in improving our understanding of fibrosis activity in the pathogenesis of atrial fibrillation.Figure 1
Preventive medication efficacy after 1-year follow-up for graft failure in coronary artery bypass surgery patients: Bayesian network meta-analysis
Authors: Uimonen Mikko , Liukkonen Rasmus , Ponkilainen Ville , Vaajala Matias , Tarkiainen Jeremias , Pakarinen Oskari , Haapanen Marjut , Kuitunen Ilari 
Published: June 2024

Abstract
To compare preventive medications against graft failures in coronary artery bypass graft surgery (CABG) patients after a 1-year follow-up. Systematic review with Bayesian network meta-analysis and meta-regression analysis. We searched PubMed, Scopus, and Web of Science databases in February 2023 for randomized controlled trials, comparing preventive medications against graft failure in CABG patients. We included studies that reported outcomes at 1 year after surgery. Our primary outcome was graft failure After screening 11,898 studies, a total of 18 randomized trials were included. Acetylsalicylic acid (ASA) [odds ratios (OR) 0.51, 95% credibility interval (CrI) 0.28–0.95, meta-regression OR 0.54, 95% CrI 0.26–1.00], Clopidogrel + ASA (OR 0.27, 95% CrI 0.09–0.76, meta-regression OR 0.28, 95% CrI 0.09–0.85), dipyridamole + ASA (OR 0.50, 95% CrI 0.30–0.83, meta-regression OR 0.49, 95% CrI 0.26–0.90), ticagrelor (OR 0.40, 95% CrI 0.16–1.00, meta-regression OR 0.43, 95% CrI 0.15–1.2), and ticagrelor + ASA (OR 0.26, 95% CrI 0.10–0.62, meta-regression OR 0.28, 95% CrI 0.10–0.68) were superior to placebo in preventing graft failure. Rank probabilities suggested the highest likelihood to be the most efficacious for ticagrelor + ASA [surface under the cumulative ranking (SUCRA) 0.859] and clopidogrel + ASA (SUCRA 0.819). The 95% CrIs of ORs for mortality, bleeding, and major adverse cardio- and cerebrovascular events (MACE) were wide. A trend towards increased bleeding risk and decreased MACE risk was observed when any of the medication regimens were used when compared to placebo. Sensitivity analysis excluding studies with a high risk of bias yielded equivalent results. Of the reviewed medication regimens, dual antiplatelet therapy combining ASA with ticagrelor or clopidogrel was found to result in the lowest rate of graft failures.
Allocation of Female Talent and Cross-Country Productivity Differences
Authors: Lee Munseob 
Published: June 2024

Abstract
Cross-country disparities in labour productivity are more pronounced in agriculture than other sectors. I posit that the misallocation of female talent between sectors distorts productivity and formalise a general equilibrium Roy model with gender-specific frictions. If female workers encounter greater barriers in non-agricultural sectors, female workers who are better skilled at non-agricultural jobs may select into the agricultural sector. Analysis of data from sixty-six countries reveals that low-income countries have higher frictions against female workers in non-agricultural sectors. By aligning these frictions with those of the United States, agricultural labour productivity sees gains of 2.5%–7.6%, with GDP per capita rising by 0.5%–1.5% on average.
Long-term outcomes of isolated mechanical versus bioprosthetic mitral valve replacement in different age groups of propensity-matched patients
Authors: Rokui Sorush , Gottschalk Byron , Peng Defen , Groenewoud Rosalind , Ye Jian 
Published: June 2024

Abstract

OBJECTIVES
Prothesis choice in isolated mitral valve replacement for patients aged 75 years or younger remains debated as most studies comparing prothesis type have included large proportions of combined operations and benefits are influenced by concomitant procedures. This study compared long-term outcomes of isolated mechanical versus bioprosthetic mitral valves in different age groups of propensity-matched populations.

METHODS
This is a retrospective, multicentre, propensity-matched observational study. Baseline characteristics, operative details and long-term outcomes (mortality and freedom from surgical/transcatheter reintervention) were collected.

RESULTS
Totally, 1536 isolated mitral valve replacements (806 mechanical, 730 bioprosthetic) were performed between 2000 and 2017. Over 90% of eligible patients successfully underwent propensity matching, yielding 226 each of mechanical and bioprosthetic valves in patients aged &lt;65 years and 171 each of bioprosthetic and mechanical valves in patients aged 65–75 years with median follow-up of 13 years (maximum 20 years). In matched patients &lt;65 years, 10-year survival was superior with mechanical valves versus bioprosthetic valves (78.2% vs 69.8%, P = 0.029), as was 10-year freedom from reintervention (96.2% vs 81.3%, P &lt; 0.001). For matched patients between 65 and 75 years, there were no differences between mechanical and bioprosthetic valves in 10-year survival (64.6% vs 60.8%, P = 0.86) or 10-year freedom from reintervention (94.0% vs 97.2%, P = 0.23). Rates of post-operative stroke, gastrointestinal bleeding, renal failure and permanent pacemaker insertion were similar.

CONCLUSIONS
In patients requiring isolated mitral valve replacement, mechanical valves confer significantly better long-term survival and freedom from reintervention for patients &lt;65 years, while no benefit is observed at age 65–75 years compared to bioprosthetic valves.