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Morishima M, Kiriyama T, Miyagi Y, Otsuka T, Fukushima Y, Kumita SI, Ishii Y. Serial change in perfusion-metabolism mismatch after coronary artery bypass grafting. Ann Nucl Med 2021; 36:244-254. [PMID: 34822103 PMCID: PMC8897360 DOI: 10.1007/s12149-021-01696-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/14/2021] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Myocardial ischemia is known to suppress fatty acid metabolism and favor glucose metabolism. However, changes in myocardial metabolism after coronary revascularization are not fully elucidated. METHODS Thirty-eight patients with coronary artery disease were retrospectively enrolled. These patients had undergone stress perfusion single photon emission computed tomography (SPECT) and 123I-BMIPP SPECT in both the short-term (6.4 ± 4.7 months) and mid-term (29.9 ± 7.2 months) after isolated coronary artery bypass grafting. Tracer uptake was graded using a 17-segment, 5-point scoring model. Serial changes in SRS (summed rest score), SDS (summed difference score), the BMIPP score (total defect score of BMIPP), and the mismatch score (BMIPP score-SRS) were evaluated. In addition, persistent perfusion-metabolism mismatch (PM) was defined as mismatch score minus SDS of 3 or more during the mid-term postoperative period. The clinical parameters associated with PM were examined. RESULTS From short- to mid-term postoperative period, the extent of infarcted myocardium (SRS) did not change significantly (7.8 ± 8.0 to 7.1 ± 7.0, P = 0.117). The extent of ischemic myocardium (SDS), the BMIPP score and the mismatch score, which reflects perfusion-metabolism mismatch, were significantly improved (2.0 ± 2.8 to 0.7 ± 1.0, P = 0.010; 12.2 ± 9.0 to 9.5 ± 7.9, P < 0.001; 4.4 ± 3.7 to 2.5 ± 2.6, P < 0.001; respectively). Remarkably, perfusion-metabolism mismatch persisted in 13 patients (34%) even in the mid-term postoperative period. eGFR and SYNTAX score were independent predictors of persistent perfusion-metabolic mismatch in multivariable analysis (OR = 0.951, 95% CI 0.898-0.985, P = 0.010 and OR = 1.126, 95% CI 1.011-1.254, P = 0.031, respectively). The mismatch score both in the short- and mid-term significantly correlated with SYNTAX score (r = 0.400 and r = 0.472, respectively). CONCLUSIONS Fatty acid metabolism disturbance improved from short- to mid-term postoperative period in patients with successful reperfusion by coronary artery bypass grafting. However, in patients with severe atherosclerosis, impaired fatty acid metabolism was sustained until the mid-term postoperative period, even though ischemia had resolved.
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Affiliation(s)
- Motoko Morishima
- Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | | | - Yasuo Miyagi
- Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.,Center for Clinical Research, Nippon Medical School, Tokyo, Japan
| | | | | | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
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Takehana K. Importance of Visualizing Heart Failure With Nuclear Medicine Techniques. Circ J 2021; 85:2109-2110. [PMID: 34456203 DOI: 10.1253/circj.cj-21-0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kazuya Takehana
- Division of Cardiology, Department of Medicine II, Kansai Medical University
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Hashimoto H, Nakanishi R, Mizumura S, Hashimoto Y, Okamura Y, Ota K, Yamazaki J, Ikeda T. Prognostic values of coronary artery calcium score and 123I-BMIPP SPECT in patients with non-ischemic heart failure with preserved ejection fraction. Int J Cardiovasc Imaging 2021; 37:3573-3581. [PMID: 34224046 DOI: 10.1007/s10554-021-02332-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
This study aimed to determine whether coronary artery calcium score (CACS) can be a prognostic indicator for the development of major adverse cardiac events (MACEs) and compare the value of CACS with that of the 123I-betamethyl-p-iodophenyl-pentadecanoic acid (123I-BMIPP) defect score (BDS) in patients with non-ischemic heart failure with preserved ejection fraction (NIHFpEF). Among 643 consecutive patients hospitalized due to acute heart failure, 108 (74 ± 13y) were identified to have NIHFpEF on non-contrast regular chest computed tomography and 123I-BMIPP single-photon emission computed tomography (SPECT). We evaluated whether CACS and BDS were associated with MACEs using multivariate Cox models. Thirty-two MACEs developed at a mean follow-up period of 2.4 years. CACS > 0 (hazard ratio [HR] 2.38, 95% confidence interval [CI] 1.02-5.54) and higher BDS (HR 16.00, 95% CI 5.88-43.49) were significantly associated with the development of MACEs. The proportion of patients who experienced MACEs was significantly higher in the CACS > 0 and high BDS group than in the CACS = 0 and low BDS group (3% vs. 75%, p < 0.001). CACS, as well as BDS, could serve as potential prognostic indicators in patients with NIHFpEF.
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Affiliation(s)
- Hidenobu Hashimoto
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan.
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| | - Sunao Mizumura
- Department of Radiology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yukiko Hashimoto
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| | - Yuriko Okamura
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| | - Kyoko Ota
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| | - Junichi Yamazaki
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Hiruma S, Shigiyama F, Hisatake S, Mizumura S, Shiraga N, Hori M, Ikeda T, Hirose T, Kumashiro N. A prospective randomized study comparing effects of empagliflozin to sitagliptin on cardiac fat accumulation, cardiac function, and cardiac metabolism in patients with early-stage type 2 diabetes: the ASSET study. Cardiovasc Diabetol 2021; 20:32. [PMID: 33530982 PMCID: PMC7852076 DOI: 10.1186/s12933-021-01228-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background While the cardioprotective benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors have been established in patients with cardiovascular disease (CVD), their advantages over other anti-diabetic drugs at earlier stages remain unclear. We compared the cardioprotective effects of empagliflozin, an SGLT2 inhibitor, with those of sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, focusing on cardiac fat accumulation, cardiac function, and cardiac metabolism in patients with early-stage type 2 diabetes mellitus (T2DM) without CVD complications. Methods This was a prospective, randomized, open-label, blinded-endpoint, parallel-group trial that enrolled 44 Japanese patients with T2DM. The patients were randomized for 12-week administration of empagliflozin or sitagliptin. Pericardial fat accumulation and myocardial triglyceride content were evaluated by magnetic resonance imaging and proton magnetic resonance spectroscopy, respectively. Echocardiography, 123I-β-methyl-iodophenyl pentadecanoic acid myocardial scintigraphy, and laboratory tests were performed at baseline and after the 12-week treatment period. Results The patients were middle-aged (50.3 ± 10.7 years, mean ± standard deviation) and overweight (body mass index 29.3 ± 4.9 kg/m2). They had a short diabetes duration (3.5 ± 3.2 years), HbA1c levels of 7.1 ± 0.8%, and preserved cardiac function (ejection fraction 73.8 ± 5.0%) with no vascular complications, except for one baseline case each of diabetic nephropathy and peripheral arterial disease. After the 12-week treatment, no differences from baseline were observed between the two groups regarding changes in pericardial, epicardial, and paracardial fat content; myocardial triglyceride content; cardiac function and mass; and cardiac fatty acid metabolism. However, considering cardiometabolic biomarkers, high-density lipoprotein cholesterol and ketone bodies, including β-hydroxybutyric acid, were significantly increased, whereas uric acid, plasma glucose, plasma insulin, and homeostasis model assessment of insulin resistance were significantly lower in the empagliflozin group than in the sitagliptin group (p < 0.05). Conclusions Although the effects on cardiac fat and function were not statistically different between the two groups, empagliflozin exhibited superior effects on cardiometabolic biomarkers, such as uric acid, high-density lipoprotein cholesterol, ketone bodies, and insulin sensitivity. Therefore, when considering the primary preventive strategies for CVD, early supplementation with SGLT2 inhibitors may be more beneficial than DPP-4 inhibitors, even in patients with early-stage T2DM without current CVD complications. Clinical Trial Registration: UMIN000026340; registered on February 28, 2017. https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000030257
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Affiliation(s)
- Shigenori Hiruma
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Fumika Shigiyama
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Shinji Hisatake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Sunao Mizumura
- Department of Radiology, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Nobuyuki Shiraga
- Department of Radiology, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Takanori Ikeda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Naoki Kumashiro
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan.
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Shigiyama F, Hiruma S, Hisatake S, Shiraga N, Ikeda T, Hirose T, Kumashiro N. Rationale, Design for the ASSET Study: A Prospective Randomized Study Comparing Empagliflozin's Effect to Sitagliptin on Cardiac Fat Accumulation/Function in Patients with Type 2 Diabetes. Diabetes Ther 2019; 10:1509-1521. [PMID: 31172455 PMCID: PMC6612347 DOI: 10.1007/s13300-019-0640-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Ectopic fat accumulation has been found to play a pathophysiological role in insulin resistance, type 2 diabetes (T2DM), and coronary artery diseases. Findings from a number of previous studies suggest that sodium glucose cotransporter 2 (SGLT2) inhibitors reduce lipid accumulation, including myocardial and pericardial fat, while dipeptidyl peptidase 4 (DPP4) inhibitors suppress ectopic lipid accumulation and improve cardiac function. However, a clinical study that precisely explains and compares the efficacy of SGLT2 inhibitors and DPP4 inhibitors on cardiac fat accumulation has not been performed. Moreover, the association between cardiac fat accumulation and cardiac function or metabolic changes, such as tissue-specific insulin resistance, remains unclear. It is our intention to conduct the first study to assess the effects of empagliflozin compared to sitagliptin in reducing ectopic fat accumulation, specifically pericardial fat, and its association with improvement in cardiac function and tissue-specific insulin sensitivity. METHODS We have designed a prospective, randomized open-label, and blinded-endpoint study with the intention to enroll 44 Japanese patients with T2DM. The patients are to be divided them into two groups, an empagliflozin group and an sitagliptin group, with the former to be supplemented with empagliflozin 10 mg and the latter to be supplemented with sitagliptin 100 mg, both groups for 12 weeks. The primary endpoint of the study is the change in the amount of pericardial fat. The secondary endpoints are the changes in the amount of intracellular fat in the myocardium, cardiac function, tissue-specific insulin sensitivity, fatty acid metabolism in myocardial tissue, assessed by parameters of iodine-123-β-methyl-iodophenyl pentadecanoic acid myocardial scintigraphy, blood and urine biomarkers, and lifestyle evaluation. PLANNED OUTCOMES The results of this study will be available in 2020. The aim of this study is to provide an effective treatment strategy for patients with T2DM by considering cardiac fat accumulation, cardiac function, and insulin resistance. FUNDING Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trial Registry: UMIN000026340.
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Affiliation(s)
- Fumika Shigiyama
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Shigenori Hiruma
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Shinji Hisatake
- Division of Cardiovascular, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Nobuyuki Shiraga
- Division of Radiology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Takanori Ikeda
- Division of Cardiovascular, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Naoki Kumashiro
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan.
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Hashimoto H, Nakanishi R, Mizumura S, Hashimoto Y, Okamura Y, Kiuchi S, Yamazaki J, Ikeda T. Prognostic Value of 123I-BMIPP SPECT in Patients with Nonischemic Heart Failure with Preserved Ejection Fraction. J Nucl Med 2017; 59:259-265. [PMID: 28775200 DOI: 10.2967/jnumed.117.195743] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/06/2017] [Indexed: 12/30/2022] Open
Abstract
Imaging of myocardial fatty acid metabolism using 123I-betamethyl-p-iodophenyl-pentadecanoic acid (123I-BMIPP) SPECT is useful for identifying high-risk patients with known ischemic heart disease. However, its utility for patients who have nonischemic heart failure with preserved ejection fraction is not well known. This study aimed to evaluate the prognostic value of the 123I-BMIPP defect score in such patients. Methods: Of 804 consecutive patients who were admitted to the hospital because of acute heart failure and underwent 123I-BMIPP SPECT, we identified 133 (mean age ± SD, 73 ± 13 y) who had normal coronary arteries by invasive coronary angiography and preserved left ventricular ejection fraction (≥50%) by echocardiography. 123I-BMIPP defects were quantitatively scored to obtain summed defect scores in 17 segments of 123I-BMIPP SPECT images. The patients were divided into 2 groups based on their score. The multivariate Cox model was used to assess a possible correlation between a higher score (≥4, n = 46) and major adverse cardiac events, including cardiac death, cardiovascular events, and hospitalization for heart failure, compared with a lower score (<4, n = 87). Results: During a mean follow-up of 2.5 y, 35 major adverse cardiac events occurred. The median scores in the high-score and low-score groups were 7.13 ± 4.21 and 1.29 ± 0.80, respectively. By multivariate Cox analysis, a higher score was associated with increased major adverse cardiac events, compared with a lower score (hazard ratio, 11.04; 95% confidence interval, 4.93-24.74; P < 0.001). Conclusion: This study demonstrated that the defect score by 123I-BMIPP SPECT may have potential prognostic value in patients who have nonischemic heart failure with preserved ejection fraction.
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Affiliation(s)
- Hidenobu Hashimoto
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan; and
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan; and
| | - Sunao Mizumura
- Department of Radiology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yukiko Hashimoto
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan; and
| | - Yuriko Okamura
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan; and
| | - Shunsuke Kiuchi
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan; and
| | - Junichi Yamazaki
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan; and
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan; and
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Nakata T, Hashimoto A, Moroi M, Tamaki N, Nishimura T, Hasebe N, Kikuchi K, Nakatani E. Sudden death prediction by C-reactive protein, electrocardiographic findings, and myocardial fatty acid uptake in haemodialysis patients: analysis of a multicentre prospective cohort sub-study. Eur Heart J Cardiovasc Imaging 2015; 17:1394-1404. [DOI: 10.1093/ehjci/jev294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/11/2015] [Indexed: 11/14/2022] Open
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Zen K, Tamaki N, Nishimura M, Nakatani E, Moroi M, Nishimura T, Hasebe N, Kikuchi K. Cardiac event risk stratification in patients with end-stage renal disease: Sub-analysis of the B-SAFE study. Int J Cardiol 2015; 202:694-700. [PMID: 26454538 DOI: 10.1016/j.ijcard.2015.09.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 09/26/2015] [Accepted: 09/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether 123I-labelled β-methyl iodophenyl-pentadecanoic acid (BMIPP) imaging as an abnormal myocardial fatty acid metabolism indicator better predicted fatal and non-fatal cardiac events than conventional predictors [e.g. peripheral artery disease (PAD) and diabetes mellitus (DM)] in haemodialysis patients. METHODS In a sub-analysis of the BMIPP SPECT Analysis for Decreasing Cardiac Events in Haemodialysis Patients (B-SAFE) study, 677 asymptomatic patients with ≥1 cardiovascular risk factor and without known coronary artery disease were followed for 3 years. The amount of radioactivity in each 17-left ventricular segment was graded visually and assigned a score from 0 (normal) to 4 (absent). Its total values were designated as baseline summed BMIPP scores. Outcome measures were composite cardiac events. RESULTS Cardiac events correlated with age, PAD [hazard ratio (HR): 2.15; p=0.003], DM (HR: 1.76; p=0.006) and summed BMIPP scores (4-8, HR: 1.82; p<0.001; ≥9, HR: 3.49; p<0.001). Cardiac event-free rates decreased with increasing summed BMIPP scores, PAD and DM. Areas under the receiver operating curves (AUCs) indicated that a BMIPP-based model (AUC: 0.656) was more predictive than DM or PAD models (AUC: 0.591); a model with all three was most predictive (AUC: 0.708). The three-year cardiac event-free rates significantly decreased in patients with PAD and/or DM in all summed BMIPP score categories. CONCLUSIONS Abnormal myocardial fatty acid metabolism strongly predicts cardiac events in haemodialysis patients; those with PAD or DM are at high risk for cardiac events.
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Affiliation(s)
- Kan Zen
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan.
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Eiji Nakatani
- Department of Statistical Analysis, Translational Research Informatics Center, Kobe, Japan
| | - Masao Moroi
- Department of Cardiology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tsunehiko Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoyuki Hasebe
- Cardiovascular Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical College, Asahikawa, Japan
| | - Kenjiro Kikuchi
- Cardiovascular Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical College, Asahikawa, Japan
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Nishimura M, Hashimoto T, Tamaki N, Kobayashi H, Ono T. Focal impairment in myocardial fatty acid imaging in the left anterior descending artery area, a strong predictor for cardiac death in hemodialysis patients without obstructive coronary artery disease. Eur J Nucl Med Mol Imaging 2015; 42:1612-21. [PMID: 26112389 PMCID: PMC4521091 DOI: 10.1007/s00259-015-3120-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/14/2015] [Indexed: 02/01/2023]
Abstract
Purpose We investigated whether impaired patterns of myocardial fatty acid imaging were associated with cardiac death in dialysis patients without coronary lesions. Methods We prospectively enrolled 155 hemodialysis patients without obstructive coronary artery disease, who had been examined by single-photon emission computed tomography (SPECT) using the iodinated fatty acid analogue BMIPP. Uptake of BMIPP on SPECT was graded in 17 segments on a five-point scale (0, normal; 4, absent) and assessed as BMIPP summed scores. Of the enrolled 155 participants, we analyzed 95 who had BMIPP summed scores ≥ 6 (52 men and 43 women, 65 ± 11 years). BMIPP scores ≥ 2 in ≥ 2 consecutive segments in SPECT were defined as focal, and the others as non-focal pattern. Results Of 95 participants analyzed, 42 (44.2 %) showed focal and 53 (55.8 %) non-focal type. During follow-up for 5.1 ± 2.0 years, 42 died of cardiac events. The occurrence of cardiac death was higher in the focal than in the non-focal group (30/42 [71.4 %] versus 12/53 [22.6 %], p = 0.001). In stepwise Cox hazard analysis, focal pattern was associated with cardiac death (hazard ratio 2.266), independent of impairment of BMIPP SPECT (BMIPP summed scores ≥ 12). The predictive potential of BMIPP SPECT for cardiac death was higher (p < 0.001) in the left anterior descending artery area compared with other coronary territories. Conclusions Focal impairment in myocardial fatty acid imaging in the left anterior descending area may strongly predict cardiac death in this population.
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Affiliation(s)
- Masato Nishimura
- Cardiovascular Division, Toujinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan,
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11
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A preliminary feasibility study of simultaneous dual-isotope imaging with a solid-state dedicated cardiac camera for evaluating myocardial perfusion and fatty acid metabolism. Heart Vessels 2014; 31:38-45. [DOI: 10.1007/s00380-014-0578-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/29/2014] [Indexed: 11/26/2022]
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12
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Iwasaki T, Kurisu S, Abe N, Tamura M, Watanabe N, Ikenaga H, Shimonaga T, Higaki T, Ishibashi K, Mitsuba N, Dohi Y, Kihara Y. Validation of automated quantification of myocardial perfusion single-photon emission computed tomography using Heart Score View in patients with known or suspected coronary artery disease. Int Heart J 2014; 55:350-6. [PMID: 24898598 DOI: 10.1536/ihj.13-313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Heart Score View (HSV) is a free software package for automated quantification of myocardial single photon emission computed tomography (SPECT) imaging using a standard Windows computer. We compared scoring results of myocardial perfusion among visual analysis, Quantitative Perfusion SPECT (QPS), and HSV in patients with known or suspected coronary artery disease.This study included 75 consecutive patients with known or suspected coronary artery disease who underwent adenosive stress-rest Tl-201 SPECT. Analysis of myocardial perfusion SPECT was performed on a standard 17-segment model visually and using QPS and HSV.There were 54 male and 21 female patients with a mean age of 70.5 ± 10.7 years. Thirteen patients (17%) had prior myocardial infarction. Summed stress score (SSS) and summed rest score (SRS) in the mid and basal areas were significantly higher on HSV than visual analysis or QPS. There was no significant difference in SDS in the whole area among the 3 methods. Similar results were found even in patients without prior myocardial infarction. Manual setting of the left ventricular cavity improved the correlations of SSS, SRS and SDS between HSV and the other methods.Our data suggested that HSV was comparable with visual analysis or QPS in scoring myocardial perfusion when manual setting of the left ventricular cavity is applied.
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Affiliation(s)
- Toshitaka Iwasaki
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
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Yoshinaga K, Naya M, Shiga T, Suzuki E, Tamaki N. Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations. Eur J Nucl Med Mol Imaging 2013; 41:384-93. [PMID: 24218099 DOI: 10.1007/s00259-013-2615-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/14/2013] [Indexed: 12/01/2022]
Abstract
"Ischaemic memory" is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[(123)I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of (123)I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with (18)F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations.
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Affiliation(s)
- Keiichiro Yoshinaga
- Department of Molecular Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Umezawa R, Takase K, Jingu K, Takanami K, Ota H, Kaneta T, Takeda K, Matsushita H, Ariga H, Takahashi S, Yamada S. Evaluation of radiation-induced myocardial damage using iodine-123 β-methyl-iodophenyl pentadecanoic acid scintigraphy. JOURNAL OF RADIATION RESEARCH 2013; 54:880-9. [PMID: 23412468 PMCID: PMC3766284 DOI: 10.1093/jrr/rrt011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We evaluated radiation-induced myocardial damage using iodine-123 β-methyl-iodophenyl pentadecanoic acid (I-123 BMIPP) scintigraphy. Between May 2010 and April 2011 we performed I-123 BMIPP scintigraphy for patients who had maintained complete response to curative radiotherapy (RT) for esophageal cancer for more than six months. We compared the area of the myocardium in the RT fields with that of reduced I-123 BMIPP uptake using a 15-segment model that is based on axial computed tomography (CT) images. We classified the segments into three categories: segments receiving 40 Gy (Segment 40 Gy), segments receiving 60 Gy (Segment 60 Gy) and segments out of the radiation fields (Segment 0 Gy). A segment with reduced uptake in the RT fields was defined as positive. A total of 510 segments in 34 patients were used for analysis. The median interval from completion of RT to I-123 BMIPP scintigraphy was 22 months (range, 6-103 months). The numbers of Segment 0 Gy, Segment 40 Gy and Segment 60 Gy were 324, 133 and 53, respectively. Reduced uptake was detected in 42.9% (57/133) of Segment 40 Gy, 67.9% (36/53) of Segment 60 Gy and 13.3% (43/324) of Segment 0 Gy. The odds ratios of 40 Gy and 60 Gy compared with regions out of the RT fields were 5.2 (95% confidence interval [CI]: 3.7-7.4) and 15.4 (95% CI: 6.9-34.6), respectively. Reduced myocardial I-123 BMIPP uptake in RT fields, suggesting RT-induced myocardial damage, was frequently observed. I-123 BMIPP myocardial scintigraphy may be useful for identifying RT-induced myocardial damage.
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Affiliation(s)
- Rei Umezawa
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
- Corresponding author. Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan. Tel: +81-22-717-7312; Fax: +81-22-717-7316;
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Tomohiro Kaneta
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Ken Takeda
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Hisanori Ariga
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Shoki Takahashi
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Shogo Yamada
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
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Moroi M, Tamaki N, Nishimura M, Haze K, Nishimura T, Kusano E, Akiba T, Sugimoto T, Hase H, Hara K, Nakata T, Kumita S, Nagai Y, Hashimoto A, Momose M, Miyakoda K, Hasebe N, Kikuchi K. Association Between Abnormal Myocardial Fatty Acid Metabolism and Cardiac-Derived Death Among Patients Undergoing Hemodialysis: Results From a Cohort Study in Japan. Am J Kidney Dis 2013. [DOI: 10.1053/j.ajkd.2012.09.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nakata T, Hashimoto A, Matsuki T, Yoshinaga K, Tsukamoto K, Tamaki N. Prognostic value of automated SPECT scoring system for coronary artery disease in stress myocardial perfusion and fatty acid metabolism imaging. Int J Cardiovasc Imaging 2013; 29:253-62. [PMID: 22782310 PMCID: PMC3550698 DOI: 10.1007/s10554-012-0069-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 05/07/2012] [Indexed: 11/30/2022]
Abstract
Quantitative SPECT analysis contributes to the diagnostic and prognostic assessment of coronary artery disease. A novel automated scoring system (heart score view) can provide identical quantitative information to that determined by expert visual analysis. The aim of the present study is to evaluate the prognostic value of the automated SPECT scoring system when applied to stress thallium and resting beta-methyl-iodophenyl pentadecanoic acid (BMIPP) SPECT images. After a preliminary validation of the automated system by comparison with expert visual analyses, outcome data from 151 consecutive patients with suspected or known coronary artery disease without prior myocardial infarction were analyzed using automated SPECT scores on stress thallium and resting BMIPP images. The software quantified abnormalities as summed stress (SSS), summed rest and summed difference scores for stress thallium and as summed BMIPP scores (SBS). Cardiac events occurred over a period of 48 months in 29 (19.2%) patients with diabetes mellitus, a lower left ventricular ejection fraction (LVEF) and more abnormal scores for thallium and BMIPP. Multivariate predictors of all cardiac events included diabetes mellitus and thallium SSS. The global Chi-square value was significantly increased when SSS was added to the clinical information (diabetes mellitus and LVEF). Negative predictive values of thallium SSS and SBS were almost identical at 84% for all cardiac events and 98% for hard cardiac events. Automatically quantified perfusion and BMIPP scores are related to cardiac events and these values can improve the risk stratification of coronary patients particularly when stress thallium imaging is combined with clinical information.
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Affiliation(s)
- Tomoaki Nakata
- Second Department of Nuclear Medicine, Sapporo Medical University of Medicine, S-1, W-16, Chuo-Ku, Sapporo, Hokkaido, 060-8638, Japan.
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Yoshinaga K, Matsuki T, Hashimoto A, Tsukamoto K, Nakata T, Tamaki N. Validation of automated quantitation of myocardial perfusion and fatty acid metabolism abnormalities on SPECT images. Circ J 2011; 75:2187-95. [PMID: 21747199 DOI: 10.1253/circj.cj-10-1272] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Myocardial perfusion and fatty acid imaging have played important roles in the risk stratification of patients with coronary artery disease (CAD). However, visual image assessment requires considerable experience and training. Therefore, an automated program has been developed that can quantify perfusion and fatty acid uptake on myocardial single emission computed tomography (SPECT). The present study aimed to validate the automated quantitative program. METHODS AND RESULTS A total of 50 patients were studied with known or suspected CAD who underwent stress ²⁰¹Thallium (²⁰¹Tl) and resting ¹²³I-labelled β-methyl iodophenyl pentadecanoic acid (BMIPP) SPECT. The SPECT images were quantified in 17 segments visually and using our Heart Score View software. Values were compared with those in a normal Japanese database and calculated summed stress (SSS), summed rest (SRS), summed difference (SDS), and summed BMIPP scores for each modality. Summed scores obtained using standard visual analysis and Heart Score View significantly correlated (²⁰¹Tl: SSS: r=0.934; SRS: r=0.827; SDS: r=0.743 summed BMIPP score: r=0.913) (each P<0.001) and Bland-Altman analysis revealed good agreement between the 2 approaches. CONCLUSIONS Correlations between scores determined using Heart Score View software and standard visual interpretation were linear for both perfusion and fatty acid images. Thus, our new automated program might be useful for the risk stratification of patients with CAD in the clinical setting.
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Affiliation(s)
- Keiichiro Yoshinaga
- Department of Photobiology, Division of Molecular, Cellular Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Abstract
With the rapid growth of molecular biology, in vivo imaging of such molecular process (i.e., molecular imaging) has been well developed. The molecular imaging has been focused on justifying advanced treatments and for assessing the treatment effects. Most of molecular imaging has been developed using PET camera and suitable PET radiopharmaceuticals. However, this technique cannot be widely available and we need alternative approach. ¹²³I-labeled compounds have been also suitable for molecular imaging using single-photon computed tomography (SPECT) ¹²³I-labeled meta-iodobenzylguanidine (MIBG) has been used for assessing severity of heart failure and prognosis. In addition, it has a potential role to predict fatal arrhythmia, particularly for those who had and are planned to receive implantable cardioverter-defibrillator treatment. ¹²³I-beta-methyl-iodophenylpentadecanoic acid (BMIPP) plays an important role for identifying ischemia at rest, based on the unique capability to represent persistent metabolic alteration after recovery of ischemia, so called ischemic memory. Since BMIPP abnormalities may represent severe ischemia or jeopardized myocardium, it may permit risk analysis in CAD patients, particularly for those with chronic kidney disease and/or hemodialysis patients. This review will discuss about recent development of these important iodinated compounds.
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Affiliation(s)
- Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Kita-Ku, Sapporo, Hokkaido, Japan.
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Nakajima K. Normal values for nuclear cardiology: Japanese databases for myocardial perfusion, fatty acid and sympathetic imaging and left ventricular function. Ann Nucl Med 2010; 24:125-35. [PMID: 20108130 PMCID: PMC2855806 DOI: 10.1007/s12149-009-0337-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/15/2009] [Indexed: 08/30/2023]
Abstract
Myocardial normal databases for stress myocardial perfusion study have been created by the Japanese Society of Nuclear Medicine Working Group. The databases comprised gender-, camera rotation range- and radiopharmaceutical-specific data-sets from multiple institutions, and normal database files were created for installation in common nuclear cardiology software. Based on the electrocardiography-gated single-photon emission computed tomography (SPECT), left ventricular function, including ventricular volumes, systolic and diastolic functions and systolic wall thickening were also analyzed. Normal databases for fatty acid imaging using 123I-beta-methyl-iodophenyl-pentadecanoic acid and sympathetic imaging using 123I-meta-iodobenzylguanidine were also examined. This review provides lists and overviews of normal values for myocardial SPECT and ventricular function in a Japanese population. The population-specific approach is a key factor for proper diagnostic and prognostic evaluation.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan.
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Inaba Y, Bergmann SR. Prognostic value of myocardial metabolic imaging with BMIPP in the spectrum of coronary artery disease: a systematic review. J Nucl Cardiol 2010; 17:61-70. [PMID: 19851821 DOI: 10.1007/s12350-009-9157-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 09/18/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We conducted a systematic review to summarize the current literature on the prognostic value of BMIPP imaging, fatty-acid metabolic imaging, for the prediction of cardiovascular events in coronary artery disease. METHODS AND RESULTS Electronic databases (including Japanese medical literature search engines) were searched by a Japanese investigator using a predefined search strategy. Eleven studies, all conducted in Japan, were included in the meta-analysis. In three studies involving 541 patients with suspected acute coronary syndrome who were excluded for acute myocardial infarction (AMI), an abnormal finding on BMIPP imaging was significantly associated with future hard events (cardiac death or non-fatal myocardial infarction). The negative predictive value of BMIPP imaging for future hard events was 98.9% (96.8-99.7%) over 3.5 years. In six studies involving 542 patients with AMI, a larger defect on BMIPP imaging was significantly associated with future hard events. The prognostic value of perfusion-metabolism mismatch compared with myocardial perfusion imaging was dependent upon the relative timing of BMIPP imaging, revascularization, and myocardial perfusion damage. CONCLUSIONS BMIPP imaging is useful for the risk stratification of patients with coronary artery disease, particularly patients with acute chest pain.
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Affiliation(s)
- Yoichi Inaba
- Division of Cardiovascular Medicine, Oregon Health and Science University, UHN62, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
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Combining chronic kidney disease with 201thallium/123iodine β methyliodophenyl pentadecanoic acid dual myocardial single-photon emission computed tomography findings is useful for the evaluation of cardiac event risk. Nucl Med Commun 2009; 30:54-61. [DOI: 10.1097/mnm.0b013e328314b879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Clinical utility of myocardial fatty acid imaging in patients with end-stage renal disease. J Nucl Cardiol 2008; 15:830-7. [PMID: 18984459 DOI: 10.1007/bf03007365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The prevalence of coronary artery disease (CAD) appears to be much higher in patients with end-stage renal disease (ESRD) undergoing dialysis than in a non-ESRD population. Cardiac death due to myocardial ischemia significantly contributes to the high mortality rate of ESRD patients. However, the method for screening for CAD in ESRD patients has not been established, because the frequency of silent myocardial ischemia is high and examinations requiring stress are often difficult to perform among this population. Myocardial fatty acid imaging may be a new modality to detect myocardial ischemia and identify the group at high risk for cardiac death among ESRD patients without adding any stress.
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Nishimura M, Tsukamoto K, Hasebe N, Tamaki N, Kikuchi K, Ono T. Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging. J Am Coll Cardiol 2008; 51:139-45. [DOI: 10.1016/j.jacc.2007.08.057] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 08/09/2007] [Accepted: 08/13/2007] [Indexed: 10/22/2022]
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Abstract
INTRODUCTION In normal condition, the heart obtains more than two-thirds of its energy from the oxidative metabolism of long chain fatty acids, although a wide variety of substrates such as glucose, lactate, ketone bodies and amino acids are also utilised. In ischaemic myocardium, on the other hand, oxidative metabolism of free fatty acid is suppressed and anaerobic glucose metabolism plays a major role in residual oxidative metabolism. Therefore, metabolic imaging can be an important technique for the assessment of various cardiac diseases and conditions. MATERIALS AND METHODS In SPECT, several iodinated fatty acid traces have been introduced and studied. Of these, (123)I-labelled 15-(p-iodophenyl)3-R, S-methylpentadecanoic acid (BMIPP) has been the most commonly used tracer in clinical studies, especially in some of the European countries and Japan. RESULTS AND DISCUSSION In this review article, several fatty acid tracers for SPECT are characterised, and the mechanism of uptake and clinical utility of BMIPP are discussed in detail.
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Affiliation(s)
- Junichi Taki
- Department of Biotracer Medicine, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Japan.
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Tamaki N, Morita K, Kawai Y. The Japanese experience with metabolic imaging in the clinical setting. J Nucl Cardiol 2007; 14:S145-52. [PMID: 17556183 DOI: 10.1016/j.nuclcard.2007.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
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Akashi YJ, Kida K, Suzuki K, Inoue K, Kawasaki K, Yamauchi M, Musha H, Anker SD. The significance of 123I-BMIPP delayed scintigraphic imaging in cardiac patients. Int J Cardiol 2007; 117:145-51. [PMID: 16843549 DOI: 10.1016/j.ijcard.2006.04.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 04/29/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Earlier studies have not fully investigated the significance of radionuclide planar imaging in cardiac patients using the fatty acid analogue 123I-beta-methyl-iodophenylpentadecanoic acid (123I-BMIPP). OBJECTIVES This study was to clarify the effectiveness of 123I-BMIPP in assessing the heart-to-mediastinum ratio (H/M) and myocardial washout rate (WR) in patients with heart disease. METHODS Myocardial 123I-BMIPP imaging was performed in 33 patients (20 with chronic heart failure [CHF] and 13 with stable angina pectoris [AP]) and 11 control subjects. Myocardial 123I-BMIPP planner images were obtained 30 min (early image) and 4 h (delayed image) after tracer injection. The left ventricular ejection fraction (LVEF) was measured by quantitative gated single photon emission computed tomography. The concentration of plasma brain natriuretic peptide (BNP) was measured before the scintigraphic study. RESULTS (1) Delayed H/M was much lower in CHF than in AP (1.93 +/- 0.37 vs. 2.21 +/- 0.38, p < 0.05) and controls (vs. 2.47 +/- 0.38, p < 0.001). (2) The WR in CHF and AP were higher than the WR in controls (39.8 +/- 12.7% and 38.7 +/- 11.1 vs. 27.9 +/- 10.2%, p < 0.01 and p < 0.05, respectively). (3) In all subjects, LVEF was correlated with delayed H/M (r = 0.39, p < 0.01). And, the BNP was correlated with both the WR (r = 0.36, p < 0.05) and delayed H/M (r = - 0.29, p = 0.05). CONCLUSION These data strongly suggest that the delayed H/M and myocardial WR of 123I-BMIPP enhances the assessment of the myocardial fatty acid metabolism disorders in patients with heart disease in both masked and unmasked conditions.
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Affiliation(s)
- Yoshihiro J Akashi
- Department of Cardiology, St. Marianna University Yokohama-city Seibu Hospital, 1197-1 Yasashi-cho Asahi-district, Yokohama-city, Kanagawa-prefecture, 241-0811, Japan.
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Chikamori T, Yamashina A, Hida S, Nishimura T. Diagnostic and prognostic value of BMIPP imaging. J Nucl Cardiol 2007; 14:111-25. [PMID: 17276313 DOI: 10.1016/j.nuclcard.2006.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hashimoto A, Nakata T, Tamaki N, Kobayashi T, Matsuki T, Shogase T, Furudate M. Serial alterations and prognostic implications of myocardial perfusion and fatty acid metabolism in patients with acute myocardial infarction. Circ J 2006; 70:1466-74. [PMID: 17062973 DOI: 10.1253/circj.70.1466] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Impaired fatty acid metabolism the myocardial infarction (MI)-related area has prognostic value, but can alter over time. The aim of this study was to correlate alterations in myocardial fatty acid uptake and perfusion assessed by serial imaging with future outcomes in post-MI patients. METHODS AND RESULTS Following 2 imaging procedures using 15-4-iodophenyl-3-(R,S)-methylpentadecanoic acid (BMIPP) and perfusion tracers at an 11-month interval, 97 patients with acute MI were followed up for 33 months with respect to the primary endpoints of death, non-fatal MI and heart failure. Regional tracer uptake was semi-quantified for both the MI-related and remote coronary territories. A large BMIPP defect relative to a perfusion defect appeared on MI-related coronary territories. Thirteen patients with cardiac events had a greater prevalence of large BMIPP and perfusion defect scores for the MI-related areas on the first scan, previous MI, diabetes mellitus, and worsening of perfusion tracer uptake in the MI-related area than those without cardiac events. Multivariate analysis identified worsening perfusion in the MI-related area on the second scan, a large BMIPP defect in the same area on the first scan and previous MI as significant predictors with chi-square values of 3.48, 6.41 and 6.84, respectively. A combination of 3 predictors significantly (p<0.05) increased the global chi-square value to 15.45 compared with each chi-square value. CONCLUSIONS The size of the infarct-related risk area assessed by early cardiac BMIPP imaging and deterioration of perfusion tracer uptake in the compromised area for the first 12 months following acute MI are related to future cardiac events, indicating a rationale for identifying metabolically damaged but viable myocardium for further risk stratification of post-MI patients.
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Affiliation(s)
- Akiyoshi Hashimoto
- Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo 060-0061, Japan.
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Hatano T, Chikamori T, Usui Y, Morishima T, Hida S, Yamashina A. Diagnostic significance of positive I-123 BMIPP despite negative stress Tl-201 myocardial imaging in patients with suspected coronary artery disease. Circ J 2006; 70:184-9. [PMID: 16434813 DOI: 10.1253/circj.70.184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is frequently discordance in the interpretation of myocardial single-photon emission computed tomography images using both rest iodine-123 15-(p-iodophenyl)-3-(R,S) methylpentadecanoic acid (BMIPP) and stress thallium-201 ((201)Tl); that is, negative BMIPP vs positive (201)Tl studies. However, little attention has been paid to reverse discordance (ie, positive BMIPP despite negative stress (201)Tl). METHODS AND RESULTS In the present study 105 consecutive patients with suspected coronary artery disease (CAD) who underwent both rest BMIPP and stress (201)Tl imaging were evaluated. No patient with previous myocardial infarction was included. Scintigraphic studies revealed that BMIPP was in concordance with (201)Tl in 71 patients: both were positive in 38 and negative in 33, whereas both were discordant in 20 and reverse discordant in 14. In patients with reverse discordance, the pattern of BMIPP abnormality was segmental in 8 and spotty in 6; the former was related to coronary territory. Based on the BMIPP findings and clinical symptoms, 7 patients with positive BMIPP despite negative (201)Tl underwent coronary angiography: 3-vessel CAD was found in 3 patients, 2-vessel CAD in 1, coronary spasm in 2, and insignificant lesions in 1. In the remaining 7 patients, no cardiac event was observed during 2-year follow-up. CONCLUSIONS In patients showing positive BMIPP despite negative (201)Tl, a segmental BMIPP perfusion abnormality indicates a high likelihood for CAD, despite normal stress (201)Tl imaging. Thus, adding BMIPP to (201)Tl imaging may help to better identify patients with significant CAD, including multivessel disease.
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Affiliation(s)
- Tsuguhisa Hatano
- Department of Internal Medicine II, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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Kleiman NS, White HD. The declining prevalence of ST elevation myocardial infarction in patients presenting with acute coronary syndromes. Heart 2005; 91:1121-3. [PMID: 16103531 PMCID: PMC1769107 DOI: 10.1136/hrt.2004.056085] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The management of patients with acute coronary syndromes may be about to undergo a dramatic change.
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Tamaki N. Role of BMIPP imaging for risk stratification in patients with coronary artery disease. J Nucl Cardiol 2005; 12:148-50. [PMID: 15812367 DOI: 10.1016/j.nuclcard.2005.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chikamori T, Fujita H, Nanasato M, Toba M, Nishimura T. Prognostic value of I-123 15-(p-iodophenyl)-3-(R,S) methylpentadecanoic acid myocardial imaging in patients with known or suspected coronary artery disease. J Nucl Cardiol 2005; 12:172-8. [PMID: 15812371 DOI: 10.1016/j.nuclcard.2004.12.293] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although iodine 123 15-(p-iodophenyl)-3-(R , S) methylpentadecanoic acid (BMIPP) can assess abnormal utilization of fatty acid in the diseased myocardium, the prognostic value of BMIPP imaging at rest in patients with known or suspected coronary artery disease (CAD) remains unclear. METHODS AND RESULTS A total of 270 patients were included by a retrospective search of the existing databases of 4 institutions. In addition to hard events, consisting of cardiac death and nonfatal myocardial infarction, any significant events including death, nonfatal myocardial infarction, coronary revascularization, heart failure, and unstable angina were assessed. During a median follow-up of 3.9 years, 33 patients had significant events, among whom 10 had hard events. Kaplan-Meier survival estimates revealed a hard event-free survival rate of 98% at 3 years in patients with a BMIPP defect score lower than 5 but 93% in those with a defect score of 5 or greater ( P = .03). With regard to significant events, the analysis showed an event-free survival rate of 92% at 3 years in patients with a BMIPP defect score lower than 5 but 80% in those with a defect score of 5 or greater ( P = .0003). CONCLUSIONS These results indicate that resting BMIPP imaging has prognostic value and may have a role in the risk stratification of patients with known or suspected CAD.
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Affiliation(s)
- Taishiro Chikamori
- Second Department of Internal Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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Tamaki N, Morita K. Is BMIPP a sensitive marker for myocardial ischaemic stress? For. Eur J Nucl Med Mol Imaging 2004; 31:1031-3. [PMID: 15168089 DOI: 10.1007/s00259-004-1586-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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