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Xu Z, Tao B, Liu C, Han D, Zhang J, Liu J, Li S, Li W, Wang J, Liang J, Cao F. Three-dimensional quantitative assessment of myocardial infarction via multimodality fusion imaging: methodology, validation, and preliminary clinical application. Quant Imaging Med Surg 2021; 11:3175-3189. [PMID: 34249644 DOI: 10.21037/qims-20-702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 02/24/2021] [Indexed: 11/06/2022]
Abstract
Background The precise assessment of myocardial infarction (MI) is crucial both for therapeutic interventions in old MI and the development of new and effective techniques to repair injured myocardium. A novel method was developed to assess left ventricular (LV) quantitatively infarction through three-dimensional (3D) multimodality fusion based on computed tomography angiography (CTA) and technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography (SPECT) images. This study sought to develop a 3D quantitative method for MI for pre-clinical study and clinical application. Methods Three months after the MI models were established in 20 minipigs, CTA and SPECT images were acquired separately, which were then aligned automatically with the constraints of the shape and the whole heart and LV myocardium position. Infarct ratios were quantified based on the 3D fusion images. The quantitative assessment was then experimentally validated via an ex vivo histology analysis using triphenyl-tetrazolium-chloride staining and subsequently applied to post-MI patients (n=8). Results The location of an infarct identified by the SPECT was consistent with that identified by an ex vivo heart in a 3D space. Infarct size determined by CTA-SPECT was correlated with infarct size assessed by triphenyl-tetrazolium-chloride pathology {27.6% [interquartile range (IQR) 17.1-34.7%] vs. 24.1% (IQR 14.7-32.5%), r2=0.99, P<0.01}. In clinical cases, the CTA-SPECT 3D fusion quantitative results were significantly correlated with the quantitative perfusion SPECT results (r=0.976, P<0.01). Conclusions The proposed 3D fusion quantitative assessment method provides reliable and intuitive evaluations of infarction. This novel quantification technique enables whole heart quantification for the pre-operation evaluation and post-diagnosis management of old MI patients. It could also be applied to the design of 3D-printed cardiac patches.
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Affiliation(s)
- Zhenzhen Xu
- School of Life Science and Technology, Xidian University, Xi'an, China
| | - Bo Tao
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.,Department of Cardiology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Chuanbin Liu
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Dong Han
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jibin Zhang
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Junsong Liu
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.,Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Sulei Li
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Weijie Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jimin Liang
- School of Electronic Engineering, Xidian University, Xi'an, China
| | - Feng Cao
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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Bulluck H, White SK, Fröhlich GM, Casson SG, O'Meara C, Newton A, Nicholas J, Weale P, Wan SMY, Sirker A, Moon JC, Yellon DM, Groves A, Menezes L, Hausenloy DJ. Quantifying the Area at Risk in Reperfused ST-Segment-Elevation Myocardial Infarction Patients Using Hybrid Cardiac Positron Emission Tomography-Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2016; 9:e003900. [PMID: 26926269 DOI: 10.1161/circimaging.115.003900] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hybrid positron emission tomography and magnetic resonance allows the advantages of magnetic resonance in tissue characterizing the myocardium to be combined with the unique metabolic insights of positron emission tomography. We hypothesized that the area of reduced myocardial glucose uptake would closely match the area at risk delineated by T2 mapping in ST-segment-elevation myocardial infarction patients. METHODS AND RESULTS Hybrid positron emission tomography and magnetic resonance using (18)F-fluorodeoxyglucose (FDG) for glucose uptake was performed in 21 ST-segment-elevation myocardial infarction patients at a median of 5 days. Follow-up scans were performed in a subset of patients 12 months later. The area of reduced FDG uptake was significantly larger than the infarct size quantified by late gadolinium enhancement (37.2±11.6% versus 22.3±11.7%; P<0.001) and closely matched the area at risk by T2 mapping (37.2±11.6% versus 36.3±12.2%; P=0.10, R=0.98, bias 0.9±4.4%). On the follow-up scans, the area of reduced FDG uptake was significantly smaller in size when compared with the acute scans (19.5 [6.3%-31.8%] versus 44.0 [21.3%-55.3%]; P=0.002) and closely correlated with the areas of late gadolinium enhancement (R 0.98) with a small bias of 2.0±5.6%. An FDG uptake of ≥45% on the acute scans could predict viable myocardium on the follow-up scan. Both transmural extent of late gadolinium enhancement and FDG uptake on the acute scan performed equally well to predict segmental wall motion recovery. CONCLUSIONS Hybrid positron emission tomography and magnetic resonance in the reperfused ST-segment-elevation myocardial infarction patients showed reduced myocardial glucose uptake within the area at risk and closely matched the area at risk delineated by T2 mapping. FDG uptake, as well as transmural extent of late gadolinium enhancement, acutely can identify viable myocardial segments.
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Affiliation(s)
- Heerajnarain Bulluck
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Steven K White
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
| | - Georg M Fröhlich
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Steven G Casson
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Celia O'Meara
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Ayla Newton
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Jennifer Nicholas
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Peter Weale
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Simon M Y Wan
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Alex Sirker
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - James C Moon
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Derek M Yellon
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Ashley Groves
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Leon Menezes
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Derek J Hausenloy
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
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Rischpler C, Langwieser N, Souvatzoglou M, Batrice A, van Marwick S, Snajberk J, Ibrahim T, Laugwitz KL, Nekolla SG, Schwaiger M. PET/MRI early after myocardial infarction: evaluation of viability with late gadolinium enhancement transmurality vs. 18F-FDG uptake. Eur Heart J Cardiovasc Imaging 2015; 16:661-9. [PMID: 25680385 DOI: 10.1093/ehjci/jeu317] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/03/2014] [Indexed: 01/03/2023] Open
Abstract
AIMS F-18 fluorodeoxyglucose (FDG) myocardial PET imaging is since more than two decades considered to delineate glucose utilization in dysfunctional but viable cardiomyocytes. Late gadolinium enhancement (LGE) MRI was introduced more than a decade ago and identifies increased extravascular space in areas of infarction and scar. Although the physiological foundation differs, both approaches are valuable in the prediction of functional outcome of the left ventricle, but synergistic effects are yet unknown. We aimed to compare the improvement of LV function after 6 months based on the regional FDG uptake and the transmurality of scar by LGE in patients early after acute myocardial infarction (AMI). METHODS AND RESULTS Twenty-eight patients with primary AMI underwent simultaneous PET/MRI for assessment of regional FDG uptake and degree of LGE transmurality 5-7 days after PCI. Follow-up by MRI was performed in 20 patients 6 months later. Myocardium was defined 'PET viable' based on the established threshold of ≥ 50% FDG uptake compared with remote myocardium or as 'MRI viable' when LGE transmurality of ≤ 50% was present. Regional wall motion was measured by MRI. Ninety-five dysfunctional segments were further analysed regarding regional wall motion recovery. There was a substantial intermethod agreement for segmental LGE transmurality and reduction of FDG uptake (κ = 0.65). 'PET viable' and 'MRI viable' segments showed a lower wall motion abnormality score (PET: initial: 1.4 ± 0.6 vs. 1.9 ± 0.8, P < 0.008; follow-up: 0.5 ± 0.7 vs. 1.5 ± 1.0, P < 0.0001; MRI: initial: 1.5 ± 0.6 vs. 2.0 ± 0.8, P < 0.002; follow-up: 0.7 ± 0.8 vs. 1.6 ± 1.0, P < 0.0001) and a better regional wall motion improvement (PET: -0.9 ± 0.7 vs. -0.4 ± 0.7, P < 0.0007; MRI: -0.8 ± 0.7 vs. -0.4 ± 0.7, P < 0.009) compared with 'PET non-viable' or 'MRI non-viable' segments, respectively. Eighteen per cent of the dysfunctional segments showed discrepant findings ('PET non-viable' but 'MRI viable'). At follow-up, the regional wall motion of these segments was inferior compared with 'PET viable/MRI viable' segments (1.1 ± 0.8 vs. 0.5 ± 0.7, P < 0.01), had an inferior functional recovery (-0.5 ± 0.6 vs. -0.9 ± 0.7, P < 0.03), but showed no difference compared with concordant 'PET non-viable/MRI non-viable' segments. CONCLUSION The simultaneous assessment of LGE and FDG uptake using a hybrid PET/MRI system is feasible. The established PET and MRI 'viability' parameter prior to revascularization therapy also predicts accurately the regional outcome of wall motion after AMI. In a small proportion of segments with discrepant FDG PET and LGE MRI findings, FDG uptake was a better predictor for functional recovery.
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Affiliation(s)
- Christoph Rischpler
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany DZKH (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart Alliance, Munich, Germany
| | - Nicolas Langwieser
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Souvatzoglou
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Anja Batrice
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sandra van Marwick
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Julian Snajberk
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tareq Ibrahim
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany DZKH (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart Alliance, Munich, Germany
| | - Stephan G Nekolla
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany DZKH (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart Alliance, Munich, Germany
| | - Markus Schwaiger
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany DZKH (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart Alliance, Munich, Germany
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