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Yamamoto A, Nagao M, Kawakubo M, Nakao R, Matsuo Y, Sakai A, Kaneko K, Fukushima K, Momose M, Sakai S, Yamaguchi J. Risk Stratification Using Right Ventricular Longitudinal Strain Ratio Derived from 13N-Ammonia PET in Patients with Ischemic Heart Disease. Radiol Cardiothorac Imaging 2024; 6:e230298. [PMID: 38814185 PMCID: PMC11211937 DOI: 10.1148/ryct.230298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/18/2024] [Accepted: 04/15/2024] [Indexed: 05/31/2024]
Abstract
Purpose To investigate whether right ventricular (RV) myocardial strain ratio (RVMSR) assessed using nitrogen 13 ammonia (13N-NH3) PET can predict cardiovascular events in patients with ischemic heart disease (IHD). Materials and Methods This retrospective study included 480 consecutive patients (mean age, 66 years ± 12 [SD]; 334 males and 146 females) with IHD who underwent 13N-NH3 PET. RVMSR was defined as the ratio of RV strain during stress to that at rest. The primary end point was major adverse cardiac events (MACEs), defined as cardiac death or heart failure hospitalization. The ability of RVMSR to predict MACE was assessed using receiver operating characteristic (ROC) curve and Kaplan-Meier analyses. Cox proportional hazards regression analysis was used to calculate hazard ratios (HRs) with 95% CIs. Results ROC curve analysis identified a sensitivity and specificity of 84% and 82%, respectively, for predicting MACE from RVMSR. Patients with reduced RVMSR (<110.2) displayed a significantly higher rate of MACE than those with a preserved RVMSR (34 of 240 vs four of 240; P < .001). Cox proportional hazards regression analysis of imaging parameters, including myocardial flow reserve, indicated that RVMSR was an independent predictor of MACE (HR, 0.94 [95% CI: 0.92, 0.97]; P < .001). Conclusion RVMSR was an independent predictor of MACE and has potential to aid in the risk stratification of patients with IHD. Keywords: Right Ventricular Myocardial Strain Ratio, Myocardial Flow Reserve, Ischemic Heart Disease, 13N-Ammonia Positron Emission Tomography Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Atsushi Yamamoto
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Michinobu Nagao
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Masateru Kawakubo
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Risako Nakao
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Yuka Matsuo
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Akiko Sakai
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Koichiro Kaneko
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Kenji Fukushima
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Mitsuru Momose
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Shuji Sakai
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Junichi Yamaguchi
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
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Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, Miyamatsu N, Nishio Y, Ogura M, Sata M, Sekiguchi K, Takeya Y, Tamura K, Wakatsuki A, Yoshida H, Fujioka Y, Fukazawa R, Hamada O, Higashiyama A, Kabayama M, Kanaoka K, Kawaguchi K, Kosaka S, Kunimura A, Miyazaki A, Nii M, Sawano M, Terauchi M, Yagi S, Akasaka T, Minamino T, Miura K, Node K. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J 2024; 88:763-842. [PMID: 38479862 DOI: 10.1253/circj.cj-23-0285] [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: 04/26/2024]
Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuhiko Hara
- Department of Health and Nutrition, Wayo Women's University
| | - Hisashi Kai
- Department of Cardiology, Kurume Univeristy Medical Center
| | | | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Masatsune Ogura
- Department of General Medical Science, Chiba University School of Medicine
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Yasushi Takeya
- Division of Helath Science, Osaka University Gradiate School of Medicine
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | | | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Yoshio Fujioka
- Division of Clinical Nutrition, Faculty of Nutrition, Kobe Gakuin University
| | | | - Osamu Hamada
- Department of General Internal Medicine, Takatsuki General Hospital
| | | | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kenjiro Kawaguchi
- Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
| | | | | | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
- Yale New Haven Hospital Center for Outcomes Research and Evaluation
| | | | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Meidicine
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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3
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Tamaki N, Manabe O. Current status and perspectives of nuclear cardiology. Ann Nucl Med 2024; 38:20-30. [PMID: 37891375 DOI: 10.1007/s12149-023-01878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Nuclear cardiology has long been used to identify myocardial ischemia for appropriate treatment strategies for stable coronary artery disease (CAD). After the Ischemia Trial, it is time to reevaluate the significance of ischemia assessment. Functional imaging continues to play pivotal role in detecting microcirculatory disturbances. PET provides a clear image of blood flow distribution and is useful for the quantitative evaluation of myocardial flow reserve (MFR), which plays an important role in predicting treatment strategies and improving prognosis in CAD. Heart failure has become a major area of focus in cardiovascular medicine. Radionuclide imaging has been widely applied in this field. FDG PET is useful in identifying cardiac sarcoidosis and active inflammation. Clinical values of I-123 MIBG and BMIPP SPECT have been reported worldwide from Japan. Additionally, clinical experiences of Tc-99m pyrophosphate imaging have recently gained attention for assessing cardiac amyloidosis. Cardiac PET/CT and PET/MR imaging permit combined assessment of metabolic/functional/structural analyses of various cardiac diseases. While other non-invasive imaging modalities have rapidly been developed, the roles of radionuclide imaging remain to be valuable for early and accurate diagnosis and patient management in most cases of chronic CAD and various cardiovascular diseases.
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Affiliation(s)
- Nagara Tamaki
- Kyoto College of Medical Science, Kyoto, Japan.
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Petretta M, Megna R, Assante R, Zampella E, Nappi C, Gaudieri V, Mannarino T, Green R, Cantoni V, D’Antonio A, Panico M, Acampa W, Cuocolo A. External validation and update of the J-ACCESS model in an Italian cohort of patients undergoing stress myocardial perfusion imaging. J Nucl Cardiol 2023; 30:1443-1453. [PMID: 36598749 PMCID: PMC10371932 DOI: 10.1007/s12350-022-03173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cardiovascular risk models are based on traditional risk factors and investigations such as imaging tests. External validation is important to determine reproducibility and generalizability of a prediction model. We performed an external validation of t the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) model, developed from a cohort of patients undergoing stress myocardial perfusion imaging. METHODS We included 3623 patients with suspected or known coronary artery disease undergoing stress single-photon emission computer tomography (SPECT) myocardial perfusion imaging at our academic center between January 2001 and December 2019. RESULTS In our study population, the J-ACCESS model underestimated the risk of major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and severe heart failure requiring hospitalization) within three-year follow-up. The recalibrations and updated of the model slightly improved the initial performance: C-statistics increased from 0.664 to 0.666 and Brier score decreased from 0.075 to 0.073. Hosmer-Lemeshow test indicated a logistic regression fit only for the calibration slope (P = .45) and updated model (P = .22). In the update model, the intercept, diabetes, and severity of myocardial perfusion defects categorized coefficients were comparable with J-ACCESS. CONCLUSION The external validation of the J-ACCESS model as well as recalibration models have a limited value for predicting of three-year major adverse cardiac events in our patients. The performance in predicting risk of the updated model resulted superimposable to the calibration slope model.
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Affiliation(s)
- Mario Petretta
- IRCCS Synlab SDN, Via Gianturco 113, 80142 Naples, Italy
| | - Rosario Megna
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Adriana D’Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Mariarosaria Panico
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
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5
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Nakajima K, Nishimura T. J-ACCESS investigation and nuclear cardiology in Japan: implications for heart failure. Ann Nucl Med 2023; 37:317-327. [PMID: 37039970 DOI: 10.1007/s12149-023-01836-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/26/2023] [Indexed: 04/12/2023]
Abstract
While coronary heart disease remains a global cause of mortality, the prevalence of heart failure (HF) is increasing in developed countries including Japan. The continuously increasing aging population and the relatively low incidence of ischemic origins are features of the HF background in Japan. Information about nuclear cardiology practice and prognosis has accumulated, thanks to the multicenter prognostic J-ACCESS investigations (Series 1‒4) over two decades in Japan. Although the rate of hard cardiac events is lower in Japan than in the USA and Europe, similar predictors have been identified as causes of major adverse cardiac events. The highest proportion (50-75%) of major events among patients indicated for nuclear cardiology examinations in the J-ACCESS registries is severe HF requiring hospitalization. Therefore, the background and the possible reasons for the higher proportion of severe HF events in Japan require clarification. Combinations of age, myocardial perfusion defects, left ventricular dysfunction, and comorbid diabetes and chronic kidney disease are major predictors of cardiovascular events including severe HF. Although the Japanese Circulation Society has updated its clinical guidelines to incorporate non-invasive imaging modalities for diagnosing chronic coronary artery disease, the importance of risk-based approaches to optimal medical therapy and coronary revascularization is emphasized herein.
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Affiliation(s)
- Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, 920-8640, Japan.
| | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Nakajima K, Tada H. Seeing is believing: Visualization of multivariable risk models. J Nucl Cardiol 2023; 30:764-768. [PMID: 36097243 DOI: 10.1007/s12350-022-03103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan.
| | - Hayato Tada
- Department of Cardiology, Kanazawa University, Kanazawa, 920-8640, Japan
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Prognostic risk stratification based on left ventricular mechanical dyssynchrony in patients at low or intermediate risk of major cardiac events using the J-ACCESS risk model. Heart Vessels 2023; 38:195-206. [PMID: 35960340 DOI: 10.1007/s00380-022-02155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/27/2022] [Indexed: 01/10/2023]
Abstract
There have been no reports on prognostic prediction and risk stratification based on stress phase bandwidth (SPBW), or a left ventricular (LV) mechanical dyssynchrony index, in patients with known or suspected stable coronary artery disease (CAD) at low or intermediate risk of major cardiac events (MCEs) using the J-ACCESS risk model. We retrospectively investigated 4,996 consecutive patients with known or suspected CAD who underwent rest 201Tl and stress 99mTc-tetrofosmin electrocardiogram (ECG)-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) and followed up for 3 years to confirm their prognosis. MCE risk over 3 years was estimated using an equation based on that used in the J-ACCESS study. The composite endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction (MI), and severe heart failure requiring hospitalization. SPBW was calculated by phase analysis with the Heart Risk View-F software and its normal upper limit was set to 38°. Based on the estimated 3-year incidence of MCEs obtained from the J-ACCESS risk model, 4,123 of the 4,996 consecutive patients were classified as low (n = 2,653) or intermediate risk (n = 1,470) and they were analyzed for follow-up. During the follow-up, 153 patients experienced MCEs: cardiac death (n = 38), non-fatal MI (n = 45), and severe heart failure (n = 70). The results of the multivariate analysis showed age, estimated glomerular filtration rate (eGFR), stress LV ejection fraction, and stress SPBW to be independent predictors of MCEs. The actual 3-year MCE rate in patients at intermediate risk was significantly higher than in those at low risk (6.7% vs. 2.1%, P < 0.0001). However, the actual 3-year MCE rate in patients with abnormal SPBW (> 38°) was 4.0% and 9.2% in low- and intermediate-risk patients, respectively, which corresponded to intermediate and high risk. Kaplan-Meier analysis also showed significant risk stratification by normal SPBW values for both low- and intermediate-risk patients. LV mechanical dyssynchrony assessed with ECG-gated SPECT MPI is useful for risk stratification of known or suspected stable CAD patients at low or intermediate risk of MCEs and may help identify higher risk patients who could not be identified as being at risk based on J-ACCESS risk assessment.
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8
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Chen X, Zhou B, Xie H, Miao T, Liu H, Holler W, Lin M, Miller EJ, Carson RE, Sinusas AJ, Liu C. DuDoSS: Deep-learning-based dual-domain sinogram synthesis from sparsely sampled projections of cardiac SPECT. Med Phys 2023; 50:89-103. [PMID: 36048541 PMCID: PMC9868054 DOI: 10.1002/mp.15958] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/04/2022] [Accepted: 08/19/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Myocardial perfusion imaging (MPI) using single-photon emission-computed tomography (SPECT) is widely applied for the diagnosis of cardiovascular diseases. In clinical practice, the long scanning procedures and acquisition time might induce patient anxiety and discomfort, motion artifacts, and misalignments between SPECT and computed tomography (CT). Reducing the number of projection angles provides a solution that results in a shorter scanning time. However, fewer projection angles might cause lower reconstruction accuracy, higher noise level, and reconstruction artifacts due to reduced angular sampling. We developed a deep-learning-based approach for high-quality SPECT image reconstruction using sparsely sampled projections. METHODS We proposed a novel deep-learning-based dual-domain sinogram synthesis (DuDoSS) method to recover full-view projections from sparsely sampled projections of cardiac SPECT. DuDoSS utilized the SPECT images predicted in the image domain as guidance to generate synthetic full-view projections in the sinogram domain. The synthetic projections were then reconstructed into non-attenuation-corrected and attenuation-corrected (AC) SPECT images for voxel-wise and segment-wise quantitative evaluations in terms of normalized mean square error (NMSE) and absolute percent error (APE). Previous deep-learning-based approaches, including direct sinogram generation (Direct Sino2Sino) and direct image prediction (Direct Img2Img), were tested in this study for comparison. The dataset used in this study included a total of 500 anonymized clinical stress-state MPI studies acquired on a GE NM/CT 850 scanner with 60 projection angles following the injection of 99m Tc-tetrofosmin. RESULTS Our proposed DuDoSS generated more consistent synthetic projections and SPECT images with the ground truth than other approaches. The average voxel-wise NMSE between the synthetic projections by DuDoSS and the ground-truth full-view projections was 2.08% ± 0.81%, as compared to 2.21% ± 0.86% (p < 0.001) by Direct Sino2Sino. The averaged voxel-wise NMSE between the AC SPECT images by DuDoSS and the ground-truth AC SPECT images was 1.63% ± 0.72%, as compared to 1.84% ± 0.79% (p < 0.001) by Direct Sino2Sino and 1.90% ± 0.66% (p < 0.001) by Direct Img2Img. The averaged segment-wise APE between the AC SPECT images by DuDoSS and the ground-truth AC SPECT images was 3.87% ± 3.23%, as compared to 3.95% ± 3.21% (p = 0.023) by Direct Img2Img and 4.46% ± 3.58% (p < 0.001) by Direct Sino2Sino. CONCLUSIONS Our proposed DuDoSS is feasible to generate accurate synthetic full-view projections from sparsely sampled projections for cardiac SPECT. The synthetic projections and reconstructed SPECT images generated from DuDoSS are more consistent with the ground-truth full-view projections and SPECT images than other approaches. DuDoSS can potentially enable fast data acquisition of cardiac SPECT.
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Affiliation(s)
- Xiongchao Chen
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States, 06511
| | - Bo Zhou
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States, 06511
| | - Huidong Xie
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States, 06511
| | - Tianshun Miao
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States, 06511
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, United States, 06511
| | - Hui Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, United States, 06511
| | | | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, United States, 06511
- Visage Imaging, Inc., San Diego, California, United States, 92130
| | - Edward J. Miller
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, United States, 06511
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, Connecticut, United States, 06511
| | - Richard E. Carson
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States, 06511
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, United States, 06511
| | - Albert J. Sinusas
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States, 06511
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, United States, 06511
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, Connecticut, United States, 06511
| | - Chi Liu
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States, 06511
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, United States, 06511
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9
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Prediction of cardiovascular events using myocardial strain ratio derived from 13N-ammonia positron emission tomography. Eur Radiol 2022; 33:3889-3896. [PMID: 36562782 DOI: 10.1007/s00330-022-09359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 09/23/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Myocardial flow reserve (MFR), derived from ammonia N-13 positron emission tomography (NH3-PET), can predict the prognosis of patients with various heart diseases. We aimed to investigate whether myocardial strain ratio (MSR) was useful in predicting MACE and allowed for further risk stratification of cardiovascular events in patients with ischemic heart disease (IHD) in addition to MFR. METHODS Ninety-five patients underwent NH3-PET because of IHD. MFR was determined as the ratio of hyperemic to resting myocardial blood flow (MBF). MSR was defined as the ratio of strains at stress and rest. The endpoint was major adverse cardiac events (MACE), including all-cause death, acute coronary syndrome, heart failure hospitalization, and revascularization. The ability to predict MACE was assessed using receiver operating characteristic (ROC) analysis, and the predictability of ME was analyzed using Kaplan-Meier analysis. The Cox proportional hazards regression model was used to calculate the hazard ratio (HR) with 95% confidence interval (CI). RESULTS The ROC curve analysis demonstrated a cutoff of 0.93 for MACE with MSR (sensitivity and specificity of 77% and 71%, respectively). Patients with MSR < 0.93 displayed a significantly higher MACE rate than those with MSR ≥ 0.93 (p = 0.0036). The Cox proportional hazards regression analysis indicated that MSR was an independent marker that could predict MACE in imaging and clinical parameters (HR, 7.32; 95% CI: 1.59-33.7, p = 0.011). CONCLUSIONS MSR was an independent predictor of MACE and was useful for further risk stratification in IHD. MSR has the potential for a new indicator of revascularization in patients with IHD. KEY POINTS • We hypothesized that combining myocardial flow reserve (MFR) with the myocardial strain ratio (MSR) obtained by applying the feature-tracking technique to ammonia N-13 PET would make it predictive of major adverse cardiac events (MACE) compared to MFR alone. • MSR was an independent predictor of MACE, allowing for further risk stratification in addition to MFR in patients with ischemic heart disease. • MSR is a potential new indicator of revascularization.
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Chen X, Hendrik Pretorius P, Zhou B, Liu H, Johnson K, Liu YH, King MA, Liu C. Cross-vender, cross-tracer, and cross-protocol deep transfer learning for attenuation map generation of cardiac SPECT. J Nucl Cardiol 2022; 29:3379-3391. [PMID: 35474443 DOI: 10.1007/s12350-022-02978-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/28/2022] [Indexed: 01/18/2023]
Abstract
It has been proved feasible to generate attenuation maps (μ-maps) from cardiac SPECT using deep learning. However, this assumed that the training and testing datasets were acquired using the same scanner, tracer, and protocol. We investigated a robust generation of CT-derived μ-maps from cardiac SPECT acquired by different scanners, tracers, and protocols from the training data. We first pre-trained a network using 120 studies injected with 99mTc-tetrofosmin acquired from a GE 850 SPECT/CT with 360-degree gantry rotation, which was then fine-tuned and tested using 80 studies injected with 99mTc-sestamibi acquired from a Philips BrightView SPECT/CT with 180-degree gantry rotation. The error between ground-truth and predicted μ-maps by transfer learning was 5.13 ± 7.02%, as compared to 8.24 ± 5.01% by direct transition without fine-tuning and 6.45 ± 5.75% by limited-sample training. The error between ground-truth and reconstructed images with predicted μ-maps by transfer learning was 1.11 ± 1.57%, as compared to 1.72 ± 1.63% by direct transition and 1.68 ± 1.21% by limited-sample training. It is feasible to apply a network pre-trained by a large amount of data from one scanner to data acquired by another scanner using different tracers and protocols, with proper transfer learning.
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Affiliation(s)
- Xiongchao Chen
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - P Hendrik Pretorius
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Bo Zhou
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Hui Liu
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520, USA
- Department of Engineering Physics, Tsinghua University, Beijing, People's Republic of China
| | - Karen Johnson
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Yi-Hwa Liu
- Department of Internal Medicine (Cardiology), Yale University, New Haven, CT, USA
- Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Michael A King
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Chi Liu
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520, USA.
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11
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Yamabe S, Yamada A, Kawada Y, Ueda S, Hoshino N, Hoshino M, Takada K, Sakaguchi E, Ito R, Kakuno M, Sakakibara T, Ohshima S, Sarai M, Izawa H. Association of resting left ventricular global longitudinal strain with myocardial perfusion abnormalities evaluated by 13 N-ammonia positron emission tomography in patients with stable angina pectoris and normal left ventricular ejection fraction. Echocardiography 2022; 39:1555-1562. [PMID: 36376254 DOI: 10.1111/echo.15487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/22/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
AIMS Little is known about whether resting left ventricular global longitudinal strain (GLS) impairment is associated with myocardial perfusion abnormalities evaluated using 13 N-ammonia positron emission tomography (13 N-NH3 -PET)-myocardial perfusion imaging (MPI). This study aimed to investigate the correlation between resting GLS and myocardial perfusion parameters in patients with a normal left ventricular ejection fraction (LVEF). We evaluated whether resting GLS can predict myocardial perfusion abnormalities in these patients. METHODS AND RESULTS We selected 157 patients with suspected stable angina pectoris who underwent both ATP-stress NH3 -PET-MPI and 2-dimentional speckle tracing echocardiography. All subjects had a preserved LVEF and no known history of myocardial infarction. Patients were stratified into Group N (normal perfusion; summed stress score [SSS], 0-3; n = 101), Group M (mildly to moderately abnormal perfusion; SSS, 4-11; n = 41), or Group S (severely abnormal perfusion; SSS, 12+; n = 15). GLS was more impaired as myocardial perfusion abnormality severity increased (-17.9 ± 2.9% for Group N, -16.8 ± 3.1% for Group M, and -14.2 ± 3.5% for Group S; p < .001). GLS was weakly but significantly correlated with SSS (R = .32, p < .001), summed difference score (R = .32, p < .001), and myocardial blood flow during stress (R = -0.27, p < .001). Multivariate logistic regression analysis showed that male sex, diabetes mellitus, systolic blood pressure, and GLS were independent predictors of myocardial perfusion abnormality defined as Groups M and S. Additionally, the area under the curve for GLS for detecting myocardial perfusion abnormality was .65, and the optimal cutoff value for GLS was -16.5%, with sensitivity and specificity of 59% and 66%, respectively. CONCLUSION In patients with suspected angina pectoris, resting GLS impairment despite a normal LVEF might aid the detection of hemodynamically significant coronary artery disease.
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Affiliation(s)
- Sayuri Yamabe
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Akira Yamada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yuka Kawada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Sayano Ueda
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Naoki Hoshino
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Meiko Hoshino
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kayoko Takada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Eirin Sakaguchi
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Ryuta Ito
- Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Motohiko Kakuno
- Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Takashi Sakakibara
- Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Satoru Ohshima
- Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Chen X, Zhou B, Shi L, Liu H, Pang Y, Wang R, Miller EJ, Sinusas AJ, Liu C. CT-free attenuation correction for dedicated cardiac SPECT using a 3D dual squeeze-and-excitation residual dense network. J Nucl Cardiol 2022; 29:2235-2250. [PMID: 34085168 DOI: 10.1007/s12350-021-02672-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Attenuation correction (AC) using CT transmission scanning enables the accurate quantitative analysis of dedicated cardiac SPECT. However, AC is challenging for SPECT-only scanners. We developed a deep learning-based approach to generate synthetic AC images from SPECT images without AC. METHODS CT-free AC was implemented using our customized Dual Squeeze-and-Excitation Residual Dense Network (DuRDN). 172 anonymized clinical hybrid SPECT/CT stress/rest myocardial perfusion studies were used in training, validation, and testing. Additional body mass index (BMI), gender, and scatter-window information were encoded as channel-wise input to further improve the network performance. RESULTS Quantitative and qualitative analysis based on image voxels and 17-segment polar map showed the potential of our approach to generate consistent SPECT AC images. Our customized DuRDN showed superior performance to conventional network design such as U-Net. The averaged voxel-wise normalized mean square error (NMSE) between the predicted AC images by DuRDN and the ground-truth AC images was 2.01 ± 1.01%, as compared to 2.23 ± 1.20% by U-Net. CONCLUSIONS Our customized DuRDN facilitates dedicated cardiac SPECT AC without CT scanning. DuRDN can efficiently incorporate additional patient information and may achieve better performance compared to conventional U-Net.
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Affiliation(s)
- Xiongchao Chen
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Bo Zhou
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Luyao Shi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Hui Liu
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520-8048, USA
- Department of Engineering Physics, Tsinghua University, Beijing, People's Republic of China
| | - Yulei Pang
- Department of Mathematics, Southern Connecticut State University, New Haven, CT, USA
| | - Rui Wang
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520-8048, USA
- Department of Engineering Physics, Tsinghua University, Beijing, People's Republic of China
| | - Edward J Miller
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520-8048, USA
- Department of Medicine (Cardiology), Yale University, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520-8048, USA
- Department of Medicine (Cardiology), Yale University, New Haven, CT, USA
| | - Chi Liu
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520-8048, USA.
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Kato T, Momose M, Uemura Y, Naya M, Matsumoto N, Hida S, Yamauchi T, Nakajima T, Suzuki E, Inoko M, Tamaki N. Association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan. J Cardiol 2022; 80:475-481. [PMID: 35835641 DOI: 10.1016/j.jjcc.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is an ongoing controversy regarding the necessity of single-photon emission computed tomography (SPECT) for patients with ischemic heart diseases after the publication of the results of the ISCHEMIA trial. We aimed to evaluate the association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan. METHODS From the data of 2780 patients with stable angina who were enrolled prospectively between January 2006 and March 2008 in Japan and had undergone physician-referrednon-invasive imaging tests (Japanese Coronary-Angiography or Myocardial Imaging for Angina Pectoris Study), 1205 patients managed with SPECT were stratified by 10% myocardial ischemia. Major adverse cardiac events (MACEs), including death, myocardial infarction, hospitalization for heart failure, and late revascularization, were followed-up for 1year. RESULTS Patients with ≥10% myocardial ischemia (n=173) were less likely to be women than patients with <10% myocardial ischemia (n=1032) and had a significantly higher 1-year cumulative incidence of MACEs (6.9% vs. 1.8%, p<0.0001). After adjusting for confounders, the risk of ≥10% myocardial ischemia relative to <10% myocardial ischemia for MACEs remained significant [adjusted hazard ratio (95% confidence interval), 2.40 (1.09-5.26), p=0.029]. After adjusting including treatments, the risk of MACEs became insignificant between the ≥10% myocardial ischemia group and the <10% myocardial ischemia group [adjusted hazard ratio (95% confidence interval), 1.04 (0.45-2.45), p=0.92]. CONCLUSION The presence of ≥10% myocardial ischemia at diagnosis was significantly associated with the 1-year risk for MACEs in Japanese patients with suspected coronary artery disease.
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Affiliation(s)
- Takao Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Mitsuru Momose
- Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Section, Department of Data Science, Center for Clinical Science, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoya Matsumoto
- Department of Cardiovascular Medicine, Nihon University, Tokyo, Japan
| | - Satoshi Hida
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Takao Yamauchi
- Cardiovascular Medicine, JCHO Sagamino Hospital, Sagamihara, Japan
| | | | - Eriko Suzuki
- Department of Nuclear Medicine, Hokkaido University, Sapporo, Japan
| | - Moriaki Inoko
- Cardiovascular Center, Kitano Hospital, Osaka, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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14
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Chen X, Zhou B, Xie H, Shi L, Liu H, Holler W, Lin M, Liu YH, Miller EJ, Sinusas AJ, Liu C. Direct and indirect strategies of deep-learning-based attenuation correction for general purpose and dedicated cardiac SPECT. Eur J Nucl Med Mol Imaging 2022; 49:3046-3060. [PMID: 35169887 PMCID: PMC9253078 DOI: 10.1007/s00259-022-05718-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/06/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE Deep-learning-based attenuation correction (AC) for SPECT includes both indirect and direct approaches. Indirect approaches generate attenuation maps (μ-maps) from emission images, while direct approaches predict AC images directly from non-attenuation-corrected (NAC) images without μ-maps. For dedicated cardiac SPECT scanners with CZT detectors, indirect approaches are challenging due to the limited field-of-view (FOV). In this work, we aim to 1) first develop novel indirect approaches to improve the AC performance for dedicated SPECT; and 2) compare the AC performance between direct and indirect approaches for both general purpose and dedicated SPECT. METHODS For dedicated SPECT, we developed strategies to predict truncated μ-maps from NAC images reconstructed with a small matrix, or full μ-maps from NAC images reconstructed with a large matrix using 270 anonymized clinical studies scanned on a GE Discovery NM/CT 570c SPECT/CT. For general purpose SPECT, we implemented direct and indirect approaches using 400 anonymized clinical studies scanned on a GE NM/CT 850c SPECT/CT. NAC images in both photopeak and scatter windows were input to predict μ-maps or AC images. RESULTS For dedicated SPECT, the averaged normalized mean square error (NMSE) using our proposed strategies with full μ-maps was 1.20 ± 0.72% as compared to 2.21 ± 1.17% using the previous direct approaches. The polar map absolute percent error (APE) using our approaches was 3.24 ± 2.79% (R2 = 0.9499) as compared to 4.77 ± 3.96% (R2 = 0.9213) using direct approaches. For general purpose SPECT, the averaged NMSE of the predicted AC images using the direct approaches was 2.57 ± 1.06% as compared to 1.37 ± 1.16% using the indirect approaches. CONCLUSIONS We developed strategies of generating μ-maps for dedicated cardiac SPECT with small FOV. For both general purpose and dedicated SPECT, indirect approaches showed superior performance of AC than direct approaches.
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Affiliation(s)
- Xiongchao Chen
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Bo Zhou
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Huidong Xie
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Luyao Shi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Hui Liu
- Department of Radiology and Biomedical Imaging, Yale University, CT, New Haven, USA
- Department of Engineering Physics, Tsinghua University, Beijing, People's Republic of China
| | | | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale University, CT, New Haven, USA
- Visage Imaging, Inc, San Diego, CA, USA
| | - Yi-Hwa Liu
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, CT, USA
- Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Edward J Miller
- Department of Radiology and Biomedical Imaging, Yale University, CT, New Haven, USA
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, CT, New Haven, USA
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, CT, USA
| | - Chi Liu
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
- Department of Radiology and Biomedical Imaging, Yale University, CT, New Haven, USA.
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15
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Prediction of multivessel coronary artery disease and candidates for stress-only imaging using multivariable models with myocardial perfusion imaging. Ann Nucl Med 2022; 36:674-683. [PMID: 35661104 PMCID: PMC9226096 DOI: 10.1007/s12149-022-01751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022]
Abstract
Purpose Selecting patients with coronary multivessel disease (MVD) or no stenosis using myocardial perfusion imaging (MPI) is challenging. We aimed to create a model to predict MVD using a combination of quantitative MPI values and background factors of patients. We also assessed whether patients in the same database could be selected who do not require rest studies (stress-only imaging). Methods We analyzed data from 1001 patients who had been assessed by stress MPI at 12 centers and 463 patients who had not undergone revascularization in Japan. Quantitative values based on MPI were obtained using cardioREPO software, which included myocardial perfusion defect scores, left ventricular ejection fractions and volumes. Factors in MPI and clinical backgrounds that could predict MVD were investigated using univariate and multivariate analyses. We also investigated whether stress data alone could predict patients without coronary stenosis to identify candidates for stress-only imaging. Results We selected summed stress score (SSS), rest end-diastolic volume, and hypertension to create a predictive model for MVD. A logistic regression model was created with an area under the receiver operating characteristics curve (AUC) of 0.825. To more specifically predict coronary three-vessel disease, the AUC was 0.847 when SSS, diabetes, and hypertension were selected. The mean probabilities of abnormality based on the MVD prediction model were 12%, 24%, 40%, and 51% for no-, one-, two-, and three-vessel disease, respectively (p < 0.0001). For the model to select patients with stress-only imaging, the AUC was 0.78 when the model was created using SSS, stress end-systolic volume and the number of risk factors (diabetes, hypertension, chronic kidney disease, and a history of smoking). Conclusion A model analysis combining myocardial SPECT and clinical data can predict MVD, and can select patients for stress-only tests. Our models should prove useful for clinical applications.
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Nakano S, Kohsaka S, Chikamori T, Fukushima K, Kobayashi Y, Kozuma K, Manabe S, Matsuo H, Nakamura M, Ohno T, Sawano M, Toda K, Ueda Y, Yokoi H, Gatate Y, Kasai T, Kawase Y, Matsumoto N, Mori H, Nakazato R, Niimi N, Saito Y, Shintani A, Watanabe I, Watanabe Y, Ikari Y, Jinzaki M, Kosuge M, Nakajima K, Kimura T. JCS 2022 Guideline Focused Update on Diagnosis and Treatment in Patients With Stable Coronary Artery Disease. Circ J 2022; 86:882-915. [DOI: 10.1253/circj.cj-21-1041] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shintaro Nakano
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Kenji Fukushima
- Department of Radiology and Nuclear Medicine, Fukushima Medical University
| | | | - Ken Kozuma
- Cardiology, Teikyo University School of Medicine
| | - Susumu Manabe
- Cardiac Surgery, International University of Health and Welfare Mita Hospital
| | | | - Masato Nakamura
- Cardiovascular Medicine, Toho University Ohashi Medical Center
| | | | | | - Koichi Toda
- Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Hiroyoshi Yokoi
- Cardiovascular Center, International University of Health and Welfare Fukuoka Sanno Hospital
| | - Yodo Gatate
- Cardiology, Self-Defense Forces Central Hospital
| | | | | | | | - Hitoshi Mori
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Yuichi Saito
- Cardiovascular Medicine, Chiba University School of Medicine
| | - Ayumi Shintani
- Medical Statistics, Osaka City University Graduate School of Medicine
| | - Ippei Watanabe
- Cardiovascular Medicine, Toho University School of Medicine
| | | | - Yuji Ikari
- Cardiology, Tokai University School of Medicine
| | | | | | - Kenichi Nakajima
- Functional Imaging and Artificial Intelligence, Kanazawa University
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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Muscogiuri G, Guglielmo M, Serra A, Gatti M, Volpato V, Schoepf UJ, Saba L, Cau R, Faletti R, McGill LJ, De Cecco CN, Pontone G, Dell’Aversana S, Sironi S. Multimodality Imaging in Ischemic Chronic Cardiomyopathy. J Imaging 2022; 8:jimaging8020035. [PMID: 35200737 PMCID: PMC8877428 DOI: 10.3390/jimaging8020035] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
Ischemic chronic cardiomyopathy (ICC) is still one of the most common cardiac diseases leading to the development of myocardial ischemia, infarction, or heart failure. The application of several imaging modalities can provide information regarding coronary anatomy, coronary artery disease, myocardial ischemia and tissue characterization. In particular, coronary computed tomography angiography (CCTA) can provide information regarding coronary plaque stenosis, its composition, and the possible evaluation of myocardial ischemia using fractional flow reserve CT or CT perfusion. Cardiac magnetic resonance (CMR) can be used to evaluate cardiac function as well as the presence of ischemia. In addition, CMR can be used to characterize the myocardial tissue of hibernated or infarcted myocardium. Echocardiography is the most widely used technique to achieve information regarding function and myocardial wall motion abnormalities during myocardial ischemia. Nuclear medicine can be used to evaluate perfusion in both qualitative and quantitative assessment. In this review we aim to provide an overview regarding the different noninvasive imaging techniques for the evaluation of ICC, providing information ranging from the anatomical assessment of coronary artery arteries to the assessment of ischemic myocardium and myocardial infarction. In particular this review is going to show the different noninvasive approaches based on the specific clinical history of patients with ICC.
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Affiliation(s)
- Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
- Correspondence: ; Tel.: +39-329-404-9840
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, 3584 Utrecht, The Netherlands;
| | - Alessandra Serra
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09042 Cagliari, Italy; (A.S.); (L.S.); (R.C.)
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (M.G.); (R.F.)
| | - Valentina Volpato
- Department of Cardiac, Neurological and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy;
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, MUSC Ashley River Tower, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA; (U.J.S.); (L.J.M.)
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09042 Cagliari, Italy; (A.S.); (L.S.); (R.C.)
| | - Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09042 Cagliari, Italy; (A.S.); (L.S.); (R.C.)
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (M.G.); (R.F.)
| | - Liam J. McGill
- Department of Radiology and Radiological Science, MUSC Ashley River Tower, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA; (U.J.S.); (L.J.M.)
| | - Carlo Nicola De Cecco
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA;
| | | | - Serena Dell’Aversana
- Department of Radiology, Ospedale S. Maria Delle Grazie—ASL Napoli 2 Nord, 80078 Pozzuoli, Italy;
| | - Sandro Sironi
- School of Medicine and Post Graduate School of Diagnostic Radiology, University of Milano-Bicocca, 20126 Milan, Italy;
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
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Sakatani T, Nakajima K, Nishimura T. Cardiovascular event risk estimated by myocardial perfusion SPECT combined with clinical data. J Cardiol 2021; 80:64-71. [PMID: 34728122 DOI: 10.1016/j.jjcc.2021.10.004] [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: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023]
Abstract
Myocardial scintigraphy plays important roles in the diagnosis of coronary artery disease, prognostic risk stratification, and determination of the treatment policy. Recently, several large-scale clinical trials reported that coronary intervention was not necessarily advantageous for preventing future cardiac events in patients with stable angina. This review summarizes how we can estimate cardiac event risks based on Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS), and describes that the combination of scintigraphy and other clinical features leads to more accurate stratification of prognosis and the determination of subsequent treatment policy.
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Affiliation(s)
- Tomohiko Sakatani
- Department of Cardiology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan.
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan
| | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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19
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Toyama T, Kasama S, Sato M, Sano H, Ueda T, Sasaki T, Nakahara T, Higuchi T, Tsushima Y, Kurabayashi M. A 2-Year Prospective Study on the Differences in Prognostic Factors for Major Adverse Cardiovascular, Cerebrovascular and Renal Events Between Patients with Mild and Severe Chronic Kidney Disease. ANNALS OF NUCLEAR CARDIOLOGY 2021; 7:17-26. [PMID: 36994132 PMCID: PMC10040944 DOI: 10.17996/anc.21-00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022]
Abstract
Purpose/Method: No studies have reported on prognostic markers in patients with chronic kidney disease (CKD) according to the severity of the disease. Therefore, in this multicenter, prospective trial performed as part of the Gunma CKD SPECT Multicenter Study, we recruited 311 patients with CKD (eGFR < 60 min/mL/1.73 m2) including 50 patients on hemodialysis and followed them for 2 years. The study sample underwent stress 99mTc-tetrofosmin SPECT for suspected or possible ischemic heart disease. We evaluated the summed stress score (SSS), summed rest score (SRS), summed difference score (SDS) and cardiac function with electrocardiogram-gated SPECT. Then, we compared the differences in prognostic markers for major adverse cardiac, cerebrovascular, and renal events (MACCRE) between patients with mild CKD (30 min/mL/1.73 m2 ≤ eGFR <60 min/mL/1.73 m2; n=184) and those with severe CKD (eGFR <30 min/mL/1.73 m2; n=97). Results: Of 281 patients available for analysis, 91 experienced MACCRE. In a multivariate Cox proportional hazards analysis of factors related to MACCRE, in patients with mild CKD the significant prognostic markers were SDS (P=0.002) and end-systolic volume (ESV, P=0.034); and in the patients with severe CKD, they were eGFR (P=0.03) and diabetes-mellitus (DM, P=0.023). Conclusions: Our findings indicate that SDS and ESV are significant prognostic markers for MACCRE in patients with mild CKD and eGFR and DM are significant prognostic markers in patients with severe CKD.
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Affiliation(s)
- Takuji Toyama
- Division of Cardiology, Toyama Cardiovascular Clinic
| | - Shu Kasama
- Clinical Research Center, Nara Medical University Graduate School of Medicine
| | - Makito Sato
- Department of Internal Medicine, Tatebayashi Kosei Hospital
| | - Hirokazu Sano
- Department of Cardiovascular Medicine, Isesaki Municipal Hospital
| | - Tetsuya Ueda
- Division of Cardiology, Fujioka General Hospital
| | | | - Takehiro Nakahara
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
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20
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Kawamura I, Tanigaki T, Omori H, Mizukami T, Hirata T, Kikuchi J, Ota H, Sobue Y, Miyake T, Kawase Y, Okubo M, Kamiya H, Kawasaki M, Tsuchiya K, Nakagawa M, Kondo T, Suzuki T, Matsuo H. Stress Myocardial Perfusion Imaging Interpretation From the Viewpoint of Fractional Flow Reserve. Circ J 2021; 85:2043-2049. [PMID: 34148928 DOI: 10.1253/circj.cj-21-0122] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) and fractional flow reserve (FFR) are established approaches to the assessment of myocardial ischemia. Recently, various FFR cutoff values were proposed, but the diagnostic accuracy of MPI in identifying positive FFR using various cutoff values is not well established.Methods and Results:We retrospectively studied 273 patients who underwent stress MPI and FFR within a 3-month period. Results for FFR were obtained from 218 left anterior descending artery (LAD) lesions and 207 non-LAD lesions. Stress MPI and FFR demonstrated a good correlation in the detection of myocardial ischemia. However, the positive predictive value (PPV) of FFR for detecting MPI-positive lesions at the optimal FFR thresholds was insufficient (44% for LAD and 65% for non-LAD lesions). This was caused by a sharp drop in PPV at an FFR threshold of 0.7 or more. Notably, 41% of the lesions with normal MPI demonstrated FFRs <0.80. However, MPI-negative lesions had an extremely low lesion rate with FFR <0.65 (6%). Conversely, 78% and 41% of MPI-positive lesions had FFR <0.80 and <0.65, respectively. CONCLUSIONS The data confirmed that decisions based on MPI are reasonable because MPI-negative patients have an extremely low rate of lesions with a FFR below the cutoff point for a hard event, and MPI-positive lesions include many lesions with FFR <0.65.
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Affiliation(s)
- Itta Kawamura
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Toru Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Hiroyuki Omori
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Takuya Mizukami
- Department of Cardiovascular Medicine, Gifu Heart Center.,Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University
| | - Tetsuo Hirata
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Jun Kikuchi
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Hideaki Ota
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Yoshihiro Sobue
- Department of Cardiovascular Medicine, Gifu Heart Center.,Department of Cardiology, Fujita Health University Bantane Hospital
| | - Taiji Miyake
- Department of Cardiovascular Medicine, Gifu Heart Center
| | | | - Munenori Okubo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Hiroki Kamiya
- Department of Cardiovascular Medicine, Gifu Heart Center
| | | | | | | | - Takeshi Kondo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Takahiko Suzuki
- Department of Cardiovascular Medicine, Gifu Heart Center.,Department of Cardiovascular Medicine, Toyohashi Heart Center
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
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21
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Kohsaka S, Fukushima K, Watanabe I, Manabe S, Niimi N, Gatate Y, Sawano M, Nakano S. Contemporary Management of Stable Coronary Artery Disease - Implications of the ISCHEMIA Trial. Circ J 2021; 85:1919-1927. [PMID: 34148929 DOI: 10.1253/circj.cj-21-0345] [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] [Indexed: 11/09/2022]
Abstract
Coronary artery disease (CAD) remains a leading cause of mortality and morbidity in developed countries. Although urgent revascularization is the cornerstone of management of acute coronary syndrome (ACS), for patients with stable CAD recent large-scale clinical trials indicate that a mechanical 'fix' of a narrowed artery is not obviously beneficial; ACS and stable CAD are increasingly recognized as different clinical entities. We review the perspectives on (1) modifying the diagnostic pathway of stable CAD with the incorporation of modern estimates of pretest probability, (2) non-imaging evaluations based on their availability, (3) the optimal timing of invasive coronary angiography and revascularization, and (4) the implementation of medical therapy during the work-up.
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Affiliation(s)
- Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Kenji Fukushima
- Department of Nuclear Medicine, Saitama Medical University International Medical Center
| | - Ippei Watanabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Susumu Manabe
- Department of Cardiac Surgery, University of International Health and Welfare, Narita Hospital
| | - Nozomi Niimi
- Department of Cardiology, Keio University School of Medicine
| | - Yodo Gatate
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Mitsuaki Sawano
- Department of Cardiology, Tokyo Dental College, Ichikawa General Hospital
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center
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22
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Risk stratification in coronary artery disease using NH 3-PET myocardial flow reserve and CAD-RADS on coronary CT angiography. Int J Cardiovasc Imaging 2021; 37:3335-3342. [PMID: 34117587 DOI: 10.1007/s10554-021-02312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
Myocardial flow reserve (MFR) derived from 13N-ammonia positron emission tomography (NH3-PET) can predict the prognosis of patients with various heart diseases. Coronary computed tomography angiography (CCTA) is a non-invasive investigation for ischemic heart disease. The coronary artery disease reporting and data system (CAD-RADS) was established to standardize and facilitate the reporting of CCTA data regarding CAD. This study aimed to investigate the prognostic value of CAD-RADS and MFR. A total of 133 patients who underwent NH3-PET and CCTA within 3 months were enrolled. Patients were divided into groups with CAD-RADS 0-2 and ≥ 3 and into groups with MFR ≥ 2.0 and < 2.0. The endpoint was major adverse cardiac events (MACE) comprising all-cause death, acute coronary syndrome, hospitalization due to heart failure, and cerebrovascular disease. The ability of CAD-RADS and MFR to predict MACE was analyzed using Kaplan-Meier analysis. There was no significant difference in MFR between patients with CAD-RADS 0-2 and ≥ 3 (2.3 ± 0.9 vs. 2.2 ± 0.7, p = 0.50). The MACE rate for patients with CAD-RADS 0-2 and ≥ 3 was equivalent (log-rank test, p = 0.64). Patients with MFR < 2.0 had a significantly higher MACE rate than those with MFR ≥ 2.0 (p = 0.017). In patients with CAD-RADS ≥ 3, patients with MFR < 2.0 had a significantly higher MACE rate than those with MFR ≥ 2.0 (p = 0.034). CAD-RADS did not contribute to MACE prediction. Conversely, MFR was useful in predicting MACE, allowing for further risk stratification in addition to CAD-RADS.
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23
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Suzuki Y, Matsumoto N, Nagumo S, Matsuo R, Kuronuma K, Ashida T, Tani S, Yoda S, Amano Y, Okumura Y. Incremental Predictive Value of Coronary Calcium Score in Risk Stratification of Coronary Revascularization in Patients With Normal or Mild Ischemia Using Nuclear Myocardial Perfusion Single Photon Emission Computed Tomography. Circ J 2021; 85:877-882. [PMID: 33504711 DOI: 10.1253/circj.cj-20-0805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The incremental predictive value of the coronary artery calcium score (CACS) for risk stratification of coronary revascularization in patients with normal or mildly abnormal nuclear myocardial perfusion single photon emission computed tomography (MPS) scores is unknown.Methods and Results:We analyzed 528 patients in whom CACS was calculated and who underwent stress MPS within 3 months. Patients with known coronary artery disease, prior coronary revascularization, and those undergoing hemodialysis were excluded. Patients were followed-up with coronary revascularization based on the evidence of physiological ischemia defined by fractional flow reserve or severe coronary stenosis (≥90%). CACS was significantly associated with the summed stress score (SSS) from MPS assessment. Multivariate logistic regression analysis showed that high CACS (≥300; odds ratio [OR] 5.44, 95% confidence interval [CI] 2.28-13.0) and SSS (OR 1.29, 95% CI 1.18-1.40) were significant (P<0.001) predictors of future coronary revascularization. The log-rank test showed that high CACS stratified coronary revascularization in normal SSS (0-3; P<0.001) or mildly abnormal SSS (4-8; P=0.028) groups, whereas high CACS did not significantly stratify coronary revascularization in moderate to severe SSS (≥9; P=0.757). CONCLUSIONS Risk stratification using CACS with a cut-off value 300 may have incremental predictive value for revascularization in patients with normal or mildly abnormal MPS.
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Affiliation(s)
| | | | - Sakura Nagumo
- Department of Cardiology, Showa University Fujigaoka Hospital
| | - Rei Matsuo
- Department of Cardiology, Nihon University Hospital
| | | | | | | | - Shunichi Yoda
- Division of Cardiology, Department of Medicine, Nihon University
| | - Yasuo Amano
- Department of Radiology, Nihon University Hospital
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University
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24
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Abstract
The ISCHEMIA was eagerly awaited study in the field of ischemic heart disease. Following the presentation and publication of ISCHEMIA, multiple opinions and viewpoints get complicated. The ongoing debates have been including the relevance of coronary revascularization, non-invasive diagnostic methods, and invasive ischemic testing in patients with stable ischemic heart disease (SIHD). Prior to ISCHEMIA, observational studies indicated the potential of coronary revascularization for improving clinical outcomes, while the randomized COURAGE trial did not support the plausible concept. Although the FAME 2 trial implied the superiority of percutaneous coronary intervention over medical therapy alone, the clinical relevance of coronary revascularization to improve outcomes and quality of life has been questioned. As a consequence, the ISCHEMIA trial did not demonstrate clear benefits in reducing clinical events but showed antianginal effects of revascularization. This landmark trial also suggested the difficulties of non-invasive ischemia testing rather than computed tomography angiography. Despite the complex results, the ISCHEMIA trial may simplify the clinical indications of coronary revascularization in patients with SIHD. Future publications from the ISCHEMIA trial and debates on the results will sharpen our thinking and understanding.
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25
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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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26
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Sakatani T, Nakajima K, Fujita H, Nishimura T. Cardiovascular event risk estimated after coronary revascularization and optimal medical therapy: J-ACCESS4 prognostic study. Ann Nucl Med 2021; 35:241-252. [PMID: 33389665 PMCID: PMC7895784 DOI: 10.1007/s12149-020-01558-4] [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: 08/29/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
Background An assessment of cardiac events and survival using quantitative gated myocardial single-photon emission computed tomography (SPECT) (J-ACCESS) associated several risk factors with cardiac events in Japan. The clinical course after revascularization and/or optimal medical therapy (OMT) was followed in patients with coronary artery disease (CAD) at moderate-to-high risk estimated by software incorporating the J-ACCESS risk model. The present study aimed to determine the relevance of changes in estimated risk to outcomes of these therapies. Methods This study included 494 patients with possible or definite CAD who underwent initial pharmacological stress 99mTc-tetrofosmin myocardial perfusion SPECT (MPS) before and eight months after therapy. Major cardiac event risk during 3 years of follow-up was calculated using an equation based on that in the J-ACCESS study. Patients with ≥ 10% cardiac event risk estimated at the first MPS (n = 31) were analyzed and followed up for at least 1 year. Results Estimated risk was reduced by ≥ 5% in 14 patients (45%) after therapy. During a follow-up period of 22.1 ± 6.7 months, one patient without such reduction had a major cardiac event. Mean %summed stress scores significantly decreased from baseline to follow-up in patients with and without risk reduction. Left ventricular ejection fraction (LVEF [%]) at rest was significantly increased at the second, compared with the first MPS between patients with, than without risk reduction (57 ± 17 vs. 45 ± 16%, p = 0.001 and 50 ± 11 vs. 49 ± 9%, p = 0.953, respectively). Conclusions A reduction in cardiac ischemia and an increase in LVEF by revascularization and/or OMT were necessary to avoid cardiac events among patients with moderate-to-high estimated risk, and changes in event risk were quantifiable.
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Affiliation(s)
- Tomohiko Sakatani
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawara-Machi Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
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27
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Hatta T, Yoda S, Hayase M, Monno K, Hori Y, Fujito H, Suzuki Y, Matsumoto N, Okumura Y. Prognostic Value of Left Ventricular Dyssynchrony Assessed with Nuclear Cardiology in Patients with Known or Suspected Stable Coronary Artery Disease with Preserved Left Ventricular Ejection Fraction. Int Heart J 2020; 61:685-694. [PMID: 32684598 DOI: 10.1536/ihj.20-008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Left ventricular (LV) mechanical dyssynchrony assessed with phase analysis of electrocardiogram (ECG) -gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is useful for predicting major cardiac events (MCEs) in patients with cardiac dysfunction. However, there is no report on its usefulness in Japanese patients with known or suspected stable coronary artery disease (CAD) with preserved LV ejection fraction (LVEF).We retrospectively investigated 3,374 consecutive patients with known or suspected CAD who underwent rest 201Tl and stress 99mTc-tetrofosmin ECG-gated SPECT MPI and had preserved LVEF (≥ 45%), and followed them up to confirm their prognosis for three years. The composite endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction (MI), unstable angina pectoris, and severe heart failure requiring hospitalization. LV mechanical dyssynchrony was evaluated with phase analysis with the Heart Risk View-F software to obtain the phase bandwidth and standard deviation.During the follow-up, 179 patients experienced MCEs: cardiac death (n = 42); non-fatal MI (n = 34); unstable angina pectoris (n = 54); and severe heart failure (n = 49). Results of the multivariate analysis showed age, a history of MI, diabetes mellitus, summed stress score, and stress phase bandwidth to be independent predictors for MCEs. In Kaplan-Meier analysis, prognoses were significantly stratified with the tertiles of stress phase bandwidth.LV mechanical dyssynchrony assessed with ECG-gated SPECT MPI is useful for predicting a prognosis and stratifying the risk of MCEs in Japanese patients with known or suspected stable CAD with preserved LVEF.
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Affiliation(s)
- Takumi Hatta
- Department of Cardiology, Nihon University School of Medicine
| | - Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine
| | - Misa Hayase
- Department of Cardiology, Nihon University School of Medicine
| | - Koyuru Monno
- Department of Cardiology, Nihon University School of Medicine
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine
| | - Hidesato Fujito
- Department of Cardiology, Nihon University School of Medicine
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine
| | - Yasuo Okumura
- Department of Cardiology, Nihon University School of Medicine
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28
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Matsutomo N, Seki H, Hishikawa M, Motegi K, Yamamoto T. Technical Note: Development of an ischemic defect model insert attachable to a commercially available myocardial phantom. Med Phys 2020; 47:4340-4347. [PMID: 32463928 DOI: 10.1002/mp.14296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to develop a novel myocardial phantom insert model that attaches to commercially available myocardial phantoms and simulates an ischemic area, using three-dimensional printing technology. METHODS Ischemic inserts were designed to give four levels of absolute percent contrast (Low; 10%, Medium; 20%, High; 35%, and Defect; 100%) using CT images and computer-aided design software. The ischemic insert was composed of multiple slit structures to replicate myocardial ischemia. Myocardial phantom images with developed ischemic inserts were acquired using a SPECT/CT system and were then reconstructed using filtered back projection (FBP) and iterative reconstruction (IR) with various cutoff frequencies of a Butterworth filter. The performance and utility of ischemic inserts were evaluated according to percent contrast and 5-point scoring. RESULTS The percent contrast and scoring results changed according to the ischemic insert type, cutoff frequency, and reconstruction method. The percent contrast of each insert obtained by FBP with 0.4 cycles/cm was 4.1% (Low), 15.7% (Medium), 17.4% (High), and 36.1% (Defect). Similarly, the percent contrast of each insert obtained by IR with 0.4 cycles/cm was 5.0% (Low), 17.0% (Medium), 21.9% (High), and 47.7% (Defect). CONCLUSIONS We successfully developed an ischemic insert that attaches to a commercially available myocardial phantom by using CT imaging and 3D printing technology. Our proposed ischemic insert provided several abnormal perfusion patterns on myocardial SPECT images and may be useful for evaluating SPECT image quality.
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Affiliation(s)
- Norikazu Matsutomo
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan.,Graduate School of Health Sciences, Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan
| | - Harumi Seki
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan
| | - Mizuho Hishikawa
- Graduate School of Health Sciences, Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan
| | - Kazuki Motegi
- Graduate School of Health Sciences, Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan.,Department of Nuclear Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Tomoaki Yamamoto
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan.,Graduate School of Health Sciences, Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan
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Abstract
Nuclear cardiology for patients with ischemic heart disease and cardiac failure is expanding in Asia, although quite heterogeneously. In Asia, Israel showed the highest utilization with more than 1000 scans/100,000 inhabitants a year followed by Korea, Japan, UAE, Turkey, Australia (250-999 scans/100,000). Saudi Arabia, Kuwait, Jordan, Lebanon, Iran, and Pakistan practiced 60-99 scans/100,000. Most of South East Asian countries, China, India, and Bangladesh practiced 1-50 scans/100,000 per year. Countries in Central Asia, Mongolia, Vietnam, Cambodia, Lao, Myanmar, Nepal, and Bhutan showed limited use or no nuclear cardiology practice. Myocardial perfusion imaging (MPI) in Asia was characterized by more frequent use of 201Tl, less use of weight-based 99mTc dosing, and a trend toward a lower rate of stress-only imaging. Accordingly, the effective dose in nuclear cardiology practices was higher than those of the rest of the world. 99Mo-99mTc generators are available in most countries, relying mainly on the global supply chain because there is little supply chain beyond countries within the region. In practice, the threshold values of left ventricular ejection fraction, end-systolic volume, and end-diastolic volume between normal and pathologic states were set based on the regional normal database in China and Japan because these values were dependent on age, gender, and body weight. The purpose of the MPI SPECT study was to evaluate myocardial ischemia in symptomatic patients with chest pain, effects of percutaneous coronary intervention and coronary artery bypass-graft, and cardiac function in patients with chronic heart failure. The ability of 99mTc-based MPI for predicting hard cardiac events was confirmed in Asian inhabitants with low risk of ischemic heart disease. Human resource development of nuclear medicine professional and public awareness of nuclear medicine is key issues to promote nuclear cardiology in Asia. International organizations such as the International Atomic Energy Agency and academic organizations in the region such as Asia Oceania Federation of Nuclear Medicine and Biology, Asia Regional Cooperative Council for Nuclear Medicine, East Asia Nuclear Medicine Association, and Arab Society of Nuclear Medicine have an important role in addition to national Societies of Nuclear Medicine in each country and region.
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Affiliation(s)
- Jun Hatazawa
- Department of Nuclear Medicine, Osaka University Hospital and Research Center for Nuclear Physics, Osaka University, Osaka, Japan.
| | - Durre Sabih
- Multan Institute of Nuclear Medicine and Radiology, Multan, Pakistan
| | - Yaming Li
- Department of Nuclear Medicine, The first Hospital of China Medical University, Shengyan, China
| | - Prasanta Kumar Pradhan
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical sciences, Lucknow, India
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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Nakajima K, Nakamura S, Hase H, Takeishi Y, Nishimura S, Kawano Y, Nishimura T. Risk stratification based on J-ACCESS risk models with myocardial perfusion imaging: Risk versus outcomes of patients with chronic kidney disease. J Nucl Cardiol 2020; 27:41-50. [PMID: 29948890 PMCID: PMC7031191 DOI: 10.1007/s12350-018-1330-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/29/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND This study aimed to validate the accuracy of major-event risk models created in the multicenter J-ACCESS prognostic study in a new cohort of patients with chronic kidney disease (CKD). METHODS AND RESULTS Three multivariable J-ACCESS risk models were created to predict major cardiac events (cardiac death, non-fatal acute coronary syndrome, and severe heart failure requiring hospitalization): Model 1, four variables of age, summed stress score, left ventricular ejection fraction and diabetes; Model 2 with five variables including estimated glomerular filtration rate (eGFR, continuous); and Model 3 with categorical eGFR. The validation data used three-year (3y) cohort of patients with CKD (n = 526, major events 11.2%). Survival analysis of low (< 3%/3y), intermediate (3% to 9%/3y), and high (> 9%/3y)-risk groups showed good stratification by all three models (actual event rates: 3.1%, 9.9%, and 15.9% in the three groups with eGFR ≥ 15 mL/min/1.73 m2, P = .0087 (Model 2). However, actual event rates were equally high across all risk groups of patients with eGFR < 15 mL/min/1.73 m2. CONCLUSION The J-ACCESS risk models can stratify patients with CKD and eGFR ≥ 15 mL/min/1.73 m2, but patients with eGFR < 15 mL/min/1.73 m2 are potentially at high risk regardless of estimated risk values.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, 920-8641 Japan
| | - Satoko Nakamura
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
- Kansai University of Welfare Sciences, Kashihara, Japan
| | - Hiroki Hase
- Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | | | - Yuhei Kawano
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Medical Technology, Teikyo University, Fukuoka, Japan
| | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawara-machi Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
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31
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Misaka T, Sugitani Y, Asato N, Matsukubo Y, Uemura M, Ashikaga R, Ishida T. Coronary artery to aortic luminal attenuation ratio in coronary CT angiography for the diagnosis of haemodynamically significant coronary artery stenosis. Br J Radiol 2020; 93:20190003. [DOI: 10.1259/bjr.20190003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: This study aimed to assess and compare the diagnostic performance of the coronary artery to aortic luminal attenuation ratio (CAR), transluminal attenuation gradient (TAG), and corrected coronary opacification (CCO) difference on coronary CT angiography (cCTA) for detecting haemodynamically significant coronary artery stenosis. Methods: 33 patients who underwent cCTA, gated SPECT myocardial perfusion imaging (MPI), and invasive coronary angiography within 3 months were included in this retrospective study. The degree of coronary stenosis on cCTA was visually assessed in all patients. Additionally, CAR, TAG, and CCO difference were analyzed and calculated in all patients. Haemodynamically significant coronary stenosis was defined as a vessel with ≥50% luminal stenosis on invasive coronary angiography and an associated abnormal perfusion defect on MPI in the same territory. Diagnostic performance was assessed on a per-vessel basis by the area under the receiver operating characteristic (ROC) curve (AUC). Results: Among 99 vessels, 12 were excluded and the remaining 87 were analyzed. 17 (19.5%) vessels were determined as haemodynamically significant coronary artery stenosis. On ROC analysis, the AUC was 0.71 for cCTA, 0.80 for CAR, 0.61 for TAG, 0.74 for CCO, 0.87 for combined CAR and cCTA, 0.77 for combined TAG and cCTA, and 0.75 for combined CCO and cCTA. The AUC for combined CAR and cCTA was significantly greater compared with cCTA alone (p < 0.01). Conclusion: Non-invasive CAR derived from 64-detector row CT was feasible and might be helpful for the detection of haemodynamically significant coronary artery stenosis. Still, further investigations such as intra- and inter-reader correlation, evaluation of larger numbers in different settings, and time efficiency are required for applying CAR in various situations. Advances in knowledge: CAR could be used as novel noninvasive technique to detect haemodynamically significant coronary artery stenosis.
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Affiliation(s)
- Tomofumi Misaka
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Radiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, Japan
| | - Yuki Sugitani
- Department of Cardiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, 630-0293, Japan
| | - Nobuyuki Asato
- Department of Radiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, Japan
| | - Yuko Matsukubo
- Department of Radiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, Japan
| | - Masanobu Uemura
- Department of Radiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, Japan
| | - Ryuichiro Ashikaga
- Department of Radiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, Japan
| | - Takayuki Ishida
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Association between abnormal myocardial scintigraphy findings and long-term outcomes for elderly patients 85 years or older: a retrospective cohort study. BMC Cardiovasc Disord 2019; 19:246. [PMID: 31694562 PMCID: PMC6833266 DOI: 10.1186/s12872-019-1240-y] [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: 04/19/2019] [Accepted: 10/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Normal findings of cardiac scintigraphy predict good outcomes. However, a paucity of the data exists for elderly patients 85 years or older. In the present study, we aimed to demonstrate the association between the abnormal findings of cardiac scintigraphy and the risk of all cause death in patients 85 years or older. Methods We enrolled 143 consecutive patients 85 years or older with known or suspected coronary artery disease who underwent stress scintigraphy under adenosine or an exercise test and a 99mTechnetium (Tc)-labeled tracer or thallium 201 (201Tl), dual tracer rest scintigraphy using 201Tl and 123I-β-methyl iodophenyl pentadecanoic acid (123I-BMIPP), or 123I-BMIPP single tracer scintigraphy. Ischemia was defined by an induced perfusion abnormality according to a provocation test with recovery at rest or decreased uptake of 123I-BMIPP despite normal perfusion at rest. Infarction was defined by perfusion abnormalities assessed by images at rest on 201Tl or 99mTc-labeled tracer. We defined these findings as abnormal when at least one of these aforementioned characteristics was observed. Results Patients in the abnormal findings group (N = 62) were more likely to have undergone prior coronary angiography and to have decreased ejection fraction than those in the normal findings group (N = 81). The median follow-up duration was 797 days (interquartile range, 635–1045 days), with follow-up rates of 90% at 1 year and 73% at 2 years. The 2-year mortality rate were significantly higher in the abnormal findings group than in the normal findings group (26.8% vs. 10.9%; p = 0.01). The risk of abnormal findings relative to normal findings remained significant for the mortality (adjusted hazard ratio, 5.99; 95% CI, 1.37–42.8; P = 0.015). Conclusion Abnormal myocardial scintigraphy findings were associated with the increased risk for mortality, even for patients 85 years or older.
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5-Year Prognostic Value of Quantitative Versus Visual MPI in Subtle Perfusion Defects: Results From REFINE SPECT. JACC Cardiovasc Imaging 2019; 13:774-785. [PMID: 31202740 DOI: 10.1016/j.jcmg.2019.02.028] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/24/2019] [Accepted: 02/22/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study compared the ability of automated myocardial perfusion imaging analysis to predict major adverse cardiac events (MACE) to that of visual analysis. BACKGROUND Quantitative analysis has not been compared with clinical visual analysis in prognostic studies. METHODS A total of 19,495 patients from the multicenter REFINE SPECT (REgistry of Fast Myocardial Perfusion Imaging with NExt generation SPECT) study (64 ± 12 years of age, 56% males) undergoing stress Tc-99m-labeled single-photon emission computed tomography (SPECT) myocardial perfusion imaging were followed for 4.5 ± 1.7 years for MACE. Perfusion abnormalities were assessed visually and categorized as normal, probably normal, equivocal, or abnormal. Stress total perfusion deficit (TPD), quantified automatically, was categorized as TPD = 0%, TPD >0% to <1%, ≤1% to <3%, ≤3% to <5%, ≤5% to ≤10%, or TPD >10%. MACE consisted of death, nonfatal myocardial infarction, unstable angina, or late revascularization (>90 days). Kaplan-Meier and Cox proportional hazards analyses were performed to test the performance of visual and quantitative assessments in predicting MACE. RESULTS During follow-up examinations, 2,760 (14.2%) MACE occurred. MACE rates increased with worsening of visual assessments, that is, the rate for normal MACE was 2.0%, 3.2% for probably normal, 4.2% for equivocal, and 7.4% for abnormal (all p < 0.001). MACE rates increased with increasing stress TPD from 1.3% for the TPD category of 0% to 7.8% for the TPD category of >10% (p < 0.0001). The adjusted hazard ratio (HR) for MACE increased even in equivocal assessment (HR: 1.56; 95% confidence interval [CI]: 1.37 to 1.78) and in the TPD category of ≤3% to <5% (HR: 1.74; 95% CI: 1.41 to 2.14; all p < 0.001). The rate of MACE in patients visually assessed as normal still increased from 1.3% (TPD = 0%) to 3.4% (TPD ≥5%) (p < 0.0001). CONCLUSIONS Quantitative analysis allows precise granular risk stratification in comparison to visual reading, even for cases with normal clinical reading.
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The difference of risk factors predicting cardiac events in patients with chronic kidney disease between with and without diabetes. Ann Nucl Med 2019; 33:532-540. [DOI: 10.1007/s12149-019-01361-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
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Toyama T, Kasama S, Sato M, Sano H, Ueda T, Sasaki T, Nakahara T, Higuchi T, Tsushima Y, Kurabayashi M. Most Important Prognostic Values to Predict Major Adverse Cardiovascular, Cerebrovascular, and Renal Events in Patients with Chronic Kidney Disease Including Hemodialysis for 2 Years. Cardiology 2019; 142:14-23. [PMID: 30865950 DOI: 10.1159/000496330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 12/17/2018] [Indexed: 11/19/2022]
Abstract
Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular/cerebrovascular events. The aim of this study is to clarify whether stress myocardial perfusion single-photon emission computed tomography (SPECT) could predict cardiovascular/cerebrovascular events. In the Gunma-CKD SPECT Study, a multicenter prospective cohort trial, 311 patients with CKD (estimated glomerular filtration rate < 60 min/mL/1.73 m2) including 50 patients on hemodialysis underwent stress 99mTc-tetrofosmin SPECT for suspected ischemic heart disease and were followed for 2 years. The primary endpoint was the occurrence of cardiac death (CD), while the secondary endpoint was major adverse cardiovascular/cerebrovascular and renal events (MACCRE). MACCRE occurred in 91 out of 286 patients (CD in 13 and other MACCRE in 78 patients). According to a multivariate Cox analysis, hemoglobin (Hb) and end-systolic volume (ESV) were associated with CD (p < 0.05), while the summed difference score, diabetes mellitus (DM), and Hb were associated with MACCRE (p < 0.05). Kaplan-Meier analysis showed that the CD-free rate was higher in patients with ESV < 105 mL (log-rank, p = 0.0013), Hb > 12 g (log-rank, p = 0.0036), and a summed stress score < 6 (log-rank, p = 0.0058). The MACCRE-free rate was higher in patients with SDS = 0 (log-rank, p = 0.0097), without DM (log-rank, p = 0.0091), and with Hb > 12 g (log-rank, p = 0.0023). Myocardial perfusion SPECT parameters as well as renal anemia and DM can be reliable prognostic markers in patients with CKD including hemodialysis.
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Affiliation(s)
- Takuji Toyama
- Toyama Cardiovascular Clinic, Maebashi, Japan, .,Department of Cardiovascular Medicine, Gunma Prefectural Cardiovascular Center, Maebashi, Japan,
| | - Shu Kasama
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Japan
| | - Makito Sato
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Internal Medicine, Tatebayashi Kosei Hospital, Tatebayashi, Japan
| | - Hirokazu Sano
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Cardiovascular Medicine, Isesaki Municipal Hospital, Isesaki, Japan
| | - Tetsuya Ueda
- Division of Cardiology, Fujioka General Hospital, Fujioka, Japan
| | - Toyoshi Sasaki
- Division of Cardiology, Takasaki General Medical Center, Takasaki, Japan
| | - Takehiro Nakahara
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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Ahmed AM, Qureshi WT, O'Neal WT, Khalid F, Al-Mallah MH. Incremental prognostic value of SPECT-MPI in chronic kidney disease: A reclassification analysis. J Nucl Cardiol 2018; 25:1658-1673. [PMID: 28050863 DOI: 10.1007/s12350-016-0756-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 12/02/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Traditional cardiovascular (CV) risk factors have limited predictive value of CV mortality in patients with chronic kidney disease (CKD, creatinine clearance less than 60 mL/minute per 1.73 m2). The aim of this study was to evaluate incremental and independent prognostic value of single-photon emission computerized tomography-myocardial perfusion imaging (SPECT-MPI) across continuum of renal function. METHODS We retrospectively studied 11,518 (mean age, 65 ± 12 years; 52% were men) patients referred for a clinical indication of SPECT-MPI between April 2004 and May 2009. Primary end point was composite of cardiac death and non-fatal myocardial infarction (CD/MI). We examined the relationship of total perfusion defect (TPD) and CD/MI in multiple Cox regression models for CV risk factors and GFR. The incremental predictive value of TPD was examined using Harrell's c-index, net reclassification index (NRI), and integrated discrimination index (IDI). RESULTS Over a median follow-up of 5 years (25th to 75th percentiles, 3.0-6.5 years), 1,692 (14.5%) patients experienced CD/MI (740 MI and 1,182 CD). In a multivariable model adjusted for traditional CV risk factors and GFR, the presence of a perfusion defect was independently associated with increased risk of CD/MI (HR = 2.10; 95% CI 1.81, 2.43, p < .001). Using Cox regression, TPD improved the discriminatory ability beyond traditional CV risk factors and GFR [from AUC = 0.725, (95% CI 0.712-0.738) to 0.784, (95% CI 0.772-0.796), p < .0001]. Furthermore, TPD improves risk stratification of CKD patients over and above traditional CV risk factors and GFR [NRI = 14%, 95% CI (12%-16%, p < .001) and relative IDI = 60%, 95% CI (51%, 66%, p < .001)]. CONCLUSIONS Across the spectrum of renal function, SPECT-MPI perfusion defects independently and incrementally reclassified patients for their risk of CD/MI, beyond traditional CV risk factors.
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Affiliation(s)
- Amjad M Ahmed
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, P.O. Box 22490, Riyadh, 11426, Saudi Arabia
| | - Waqas T Qureshi
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Wesley T O'Neal
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Fatima Khalid
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Mouaz H Al-Mallah
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, P.O. Box 22490, Riyadh, 11426, Saudi Arabia.
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.
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Nanasato M, Matsumoto N, Nakajima K, Chikamori T, Moroi M, Takehana K, Momose M, Nishina H, Kasai T, Yoda S, Kiso K, Yamamoto H, Nishimura S, Yamashina A, Kusuoka H, Hirayama A, Nishimura T. Prognostic impact of reducing myocardial ischemia identified using ECG-gated myocardial perfusion SPECT in Japanese patients with coronary artery disease: J-ACCESS 4 study. Int J Cardiol 2018; 267:202-207. [PMID: 29859707 DOI: 10.1016/j.ijcard.2018.05.090] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/12/2018] [Accepted: 05/23/2018] [Indexed: 01/09/2023]
Abstract
AIM Whether myocardial ischemia identified using myocardial perfusion imaging (MPI) can be an alternative target of coronary revascularization to reduce the incidence of cardiac events remains unclear. METHODS AND RESULTS This multicenter, prospective cohort study aimed to clarify the prognostic impact of reducing myocardial ischemia. Among 494 registered patients with possible or definite coronary artery disease (CAD), 298 underwent initial pharmacological stress 99mTc-tetrofosmin MPI before, and eight months after revascularization or medical therapy, and were followed up for at least one year. Among these, 114 with at least 5% ischemia at initial MPI were investigated. The primary endpoints were cardiac death, non-fatal myocardial infarction and hospitalization for heart failure. Ischemia was reduced ≥5% in 92 patients. Coronary revascularization reduced ischemia (n = 89) more effectively than medical therapy (n = 25). Post-stress cardiac function also improved after coronary revascularization. Ejection fraction significantly improved at stress (61.0% ± 10.7% vs. 65.4% ± 11.3%; p < 0.001) but not at rest (67.1% ± 11.3% vs. 68.3% ± 11.6%; p = 0.144), among patients who underwent revascularization. Rates of coronary revascularization and cardiac events among the 114 patients were significantly higher (13.6%, p = 0.035) and lower (1.1% p = 0.0053), respectively, in patients with, than without ≥5% ischemia reduction. Moreover, patients with complete resolution of ischemia at the time of the second MPI had a significantly better prognosis. CONCLUSIONS Reducing ischemia by ≥5% and the complete resolution of ischemia could improve the prognosis of patients with stable CAD.
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Affiliation(s)
- Mamoru Nanasato
- Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | | | - Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kazuya Takehana
- Department of Cardiology, Kansai Medical University, Hirakata, Japan
| | - Mitsuru Momose
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Tokuo Kasai
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Shunichi Yoda
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Keisuke Kiso
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Yamamoto
- Department of Cardiology, Okayama Saiseikai General Hospital, Okayama, Japan
| | | | - Akira Yamashina
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | | | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Matsuo S, Nakajima K, Takeishi Y, Nishimura T. Prognostic value of normal stress myocardial perfusion imaging and ventricular function in Japanese patients with chronic kidney disease: a study based on the J-ACCESS-3 database. Eur J Nucl Med Mol Imaging 2018; 45:1101-1107. [DOI: 10.1007/s00259-018-3956-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/19/2018] [Indexed: 01/06/2023]
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Aburadani I, Usuda K, Sumiya H, Sakagami S, Kiyokawa H, Matsuo S, Takamura M, Murai H, Takashima S, Kitano T, Okuda K, Nakajima K. Ability of the prognostic model of J-ACCESS study to predict cardiac events in a clinical setting: The APPROACH study. J Cardiol 2018; 72:81-86. [PMID: 29317133 DOI: 10.1016/j.jjcc.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/26/2017] [Accepted: 12/04/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND In patients with coronary artery disease (CAD), one of the risk models available in Japan was a multivariate risk prediction model based on a Japanese multicenter database: the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS). The aim of this study was to clinically validate the accuracy of this risk model. METHODS We evaluated the performance of the J-ACCESS model using data derived from the Assessment of the Predicted value of PROgnosis of cArdiaC events in Hokuriku (APPROACH) registry. Variables of age, summed stress score (SSS), left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), and diabetes mellitus were included. The major cardiac events were defined as cardiac death, non-fatal myocardial infarction, and heart failure that required hospitalization. The patients were followed up for three years to compare between predicted risk and actual events. RESULTS We evaluated 283 patients with suspected or confirmed CAD receiving myocardial perfusion imaging using 99mTc-tetrofosmin between March 2009 and August 2011. Mean age was 68.9±10.1 years, mean eGFR 67.4±24.3mL/min/1.73m2, mean SSS 5.2±7.2, and mean LVEF 65.4±14.0%. Fourteen (4.9%) patients experienced major cardiac events including cardiac death in 4 patients (1.4%), non-fatal myocardial infarction in 1 patient (0.3%), and severe heart failure in 9 patients (3.2%), respectively. While SSS≥8, LVEF<50%, eGFR<45mL/min/1.73m2, and event risk≥10% were significant variables in survival analysis, multivariate proportional hazard analysis showed that only LVEF and eGFR were significant. The event rate estimated from the J-ACCESS model was comparable to the actual number of major cardiac events (9 and 6, respectively, p=0.58 by Chi-square test). CONCLUSIONS The predictive ability of the J-ACCESS risk model is clinically valid among patients with CAD and could be applicable in clinical practice.
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Affiliation(s)
- Isao Aburadani
- Toyama Prefectural Central Hospital, Division of Cardiology, Department of Internal Medicine, Toyama, Japan.
| | - Kazuo Usuda
- Toyama Prefectural Central Hospital, Division of Cardiology, Department of Internal Medicine, Toyama, Japan
| | - Hisashi Sumiya
- Toyama Prefectural Central Hospital, Division of Radiology, Toyama, Japan
| | - Satoru Sakagami
- National Hospital Organization Kanazawa Medical Center, Division of Cardiology, Kanazawa, Japan
| | | | - Shinro Matsuo
- Kanazawa University, Department of Nuclear Medicine, Kanazawa, Japan
| | | | - Hisayoshi Murai
- Kanazawa University, Department of Cardiology, Kanazawa, Japan
| | | | - Teppei Kitano
- Kanazawa University, Department of Cardiology, Kanazawa, Japan
| | - Koichi Okuda
- Kanazawa Medical University, Department of Physics, Uchinada, Kahoku, Japan
| | - Kenichi Nakajima
- Kanazawa University, Department of Nuclear Medicine, Kanazawa, Japan.
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Kiriyama T, Fukushima Y, Hayashi H, Takano H, Kumita SI. Feasibility of combined risk stratification with coronary CT angiography and stress myocardial SPECT in patients with chronic coronary artery disease. Ann Nucl Med 2017; 32:22-33. [PMID: 28986773 DOI: 10.1007/s12149-017-1214-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/27/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Tomonari Kiriyama
- Department of Radiology, Graduate School of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Yoshimitsu Fukushima
- Department of Radiology, Graduate School of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiromitsu Hayashi
- Department of Radiology, Graduate School of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hitoshi Takano
- Division of Cardiology, Hepatology, Geriatrics, and Integrated Medicine, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Shin-Ichiro Kumita
- Department of Radiology, Graduate School of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Niimi T, Nanasato M, Maeda H. Quantification of Contraction Synchronicity and Contraction Work in Coronary Artery Disease. Nucl Med Mol Imaging 2017; 51:227-232. [DOI: 10.1007/s13139-017-0472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 12/28/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022] Open
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Marcassa C, Giubbini R, Acampa W, Cittanti C, Djepaxhija O, Gimelli A, Kokomani A, Medolago G, Milan E, Sciagrà R. Impact of imaging protocol on left ventricular ejection fraction using gated-SPECT myocardial perfusion imaging. J Nucl Cardiol 2017; 24:1292-1301. [PMID: 27052809 DOI: 10.1007/s12350-016-0483-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND There are limited data on the impact of the imaging protocol (single-day stress-rest, SD, vs. dual-day, DD) on the change in left ventricular (LV) ejection fraction (EF) (post-stress-rest) in relation to ischemia and on outcome. METHODS Using propensity score matching procedure, 490 of 1121 patients with known CAD, undergoing a SD or a DD in a multicenter study, were evaluated. Stress and rest gated-SPECT myocardial perfusion imaging was used to quantify LV perfusion, EF, and volumes. Outcome was assessed at an average follow-up time of 3.2 years. RESULTS Post-stress LVEF in SD and DD were comparable across all degrees of ischemia. The change in LVEF in patients with severe ischemia was, however, higher in the DD protocol, independent of the extent of CAD. At follow-up, 240 patients (49.0%) required coronary revascularization (CR) and 52 patients (10.6%) had hard events. The ischemic burden was independently associated with CR and hard-events; the post-stress LVEF was associated with CR but the change in EF was not predictive of either CR or hard events. CONCLUSIONS In patients with severe ischemia, underestimation of post-stress myocardial stunning could be observed with the SD protocol. Post-stress LVEF and the extent ischemia, but not the change in EF, are predictive of CR and hard events.
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Affiliation(s)
- C Marcassa
- Cardiology Department, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno, Veruno, Italy.
| | - R Giubbini
- Department of Medical Imaging, University and Spedali Civili, Brescia, Italy
| | - W Acampa
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - C Cittanti
- Nuclear Medicine Unit, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - O Djepaxhija
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - A Gimelli
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | - A Kokomani
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | | | - E Milan
- Nuclear Medicine Unit, San Giacomo Apostolo Hospital, Castelfranco Veneto, Italy
| | - R Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Yoneyama H, Nakajima K, Okuda K, Matsuo S, Onoguchi M, Kinuya S, Edenbrandt L. Reducing the small-heart effect in pediatric gated myocardial perfusion single-photon emission computed tomography. J Nucl Cardiol 2017; 24:1378-1388. [PMID: 27197818 DOI: 10.1007/s12350-016-0518-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND We compared two reconstruction algorisms and two cardiac functional evaluation software programs in terms of their accuracy for estimating ejection fraction (EF) of small hearts (SH). METHODS The study group consisted of 66 pediatric patients. Data were reconstructed using a filtered back projection (FBP) method without the resolution correction (RC) and an iterative method based on an ordered subset expectation maximization (OSEM) algorithm with the RC. EF was evaluated using two software programs of quantitative gated single-photon emission computed tomography (SPECT) (QGS) and cardioREPO. We compared the EF of gated myocardial perfusion SPECT to echocardiographic measurement (Echo). RESULTS Forty-eight of 66 patients had an end-systolic volume < 20 mL which was used as the criterion for being included in the SH group, and the SH effect led to an overestimation of EF. While significant differences were observed between Echo (66.9 ± 5.0%) and QGS-FBP without RC (76.9 ± 8.4%, P < .0001), QGS-OSEM with RC (76.6 ± 8.6%, P < .0001), and cardioREPO-FBP without RC (72.1 ± 10.0%, P = .0011), no significant difference was observed between Echo and cardioREPO-OSEM with RC (67.4 ± 6.1%) in SH group. CONCLUSIONS In pediatric gated myocardial perfusion SPECT, the SH effect can be significantly reduced when an OSEM algorithm is used with RC in combination with the specific cardioREPO algorithm.
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Affiliation(s)
- Hiroto Yoneyama
- Department of Radiological Technology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Kanazawa, Japan
| | - Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Masahisa Onoguchi
- Department of Health Science, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Lars Edenbrandt
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
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Yoda S, Hori Y, Hayase M, Mineki T, Hatta T, Suzuki Y, Matsumoto N, Hirayama A. Correlation between early revascularization and major cardiac events demonstrated by ischemic myocardium in Japanese patients with stable coronary artery disease. J Cardiol 2017; 71:44-51. [PMID: 28732592 DOI: 10.1016/j.jjcc.2017.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is no report on correlation between early revascularization and the occurrence of major cardiac events (MCEs) except severe heart failure in Japanese patients with stable coronary artery disease (CAD). This study aimed to determine whether early revascularization affected the incidence of MCEs in Japanese patients with stable CAD. METHODS We retrospectively investigated 3581 stable CAD patients who underwent rest 201Tl and stress 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography (SPECT) and provided three-year-prognostic data. The endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction, and unstable angina pectoris. On the basis of estimated propensity scores, patients who underwent revascularization within the first 60 days after the SPECT and those who did not were matched in a 1:1 ratio (n=450 per group). We compared MCE rates in relation to the amount of ischemic myocardium detected with the SPECT between the two groups. RESULTS The overall incidence of MCEs was not significantly different between the early-revascularization and no-early-revascularization groups (6.7% vs. 8.7%, p=0.2598). Nevertheless, the incidence of MCEs in the patients with ≤5% ischemia was significantly higher in the early-revascularization group than in the no-early-revascularization group (5.8% vs. 0.8%, p=0.0226). In contrast, the incidence of MCEs in the patients with >10% ischemia was significantly lower in the early-revascularization group than in the no-early-revascularization group (7.0% vs. 16.8%, p=0.0036). The incidence of MCEs in the patients with 6-10% ischemia, however, was not significantly different between the early-revascularization and no-early-revascularization groups (6.9% vs. 4.1%, p=0.3235). CONCLUSIONS Early revascularization possibly leads to the occurrence of MCEs related to the treatment procedure but may be a therapeutic strategy leading to improvement in prognosis in patients with moderate to severe ischemia.
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Affiliation(s)
- Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Misa Hayase
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takashi Mineki
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takumi Hatta
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
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Misaka T, Hosono M, Kudo T, Ito T, Syomura T, Uemura M, Okajima K. Influence of acquisition orbit on phase analysis of gated single photon emission computed tomography myocardial perfusion imaging for assessment of left ventricular mechanical dyssynchrony. Ann Nucl Med 2017; 31:235-244. [PMID: 28144811 DOI: 10.1007/s12149-017-1151-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/10/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The association between left ventricular (LV) dyssynchrony parameters, given by phase analysis of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and acquisition orbits is unclear. The aim of this study was to assess the dependence of LV dyssynchrony parameters on acquisition orbits. METHODS Ninety-nine patients who underwent 201Tl-gated SPECT MPI were categorized into minor hypoperfusion or major hypoperfusion groups. Forty-four patients who underwent 99mTc-tetrofosmin-gated SPECT MPI were categorized into minor hypoperfusion or major hypoperfusion groups. The major hypoperfusion group with 201Tl was divided into inferior or non-inferior wall hypoperfusion subgroups, and anteroseptal or non-anteroseptal wall hypoperfusion subgroups. Gated SPECT MPI data over a 360° acquisition orbit (360° images) and a 180° acquisition orbit (180° images) were reconstructed, and histogram bandwidth (HBW) and phase standard deviation (PSD) were compared. RESULTS Between 360° and 180° images with 201Tl, there were significant differences in HBW and PSD both globally (HBW 34.8 ± 16.6 vs. 29.1 ± 10.2; PSD 8.8 ± 4.9 vs. 7.0 ± 2.3, p < 0.05 for both) and in the inferior wall (HBW 29.5 ± 15.5 vs. 23.3 ± 9.0; PSD 7.6 ± 4.6 vs. 5.6 ± 2.4, p < 0.001 for both) in the major hypoperfusion group, and also in the inferior wall in all subgroups of the major hypoperfusion group. In contrast, no segment had any significant differences in HBW or PSD between 360° and 180° images with 99mTc. CONCLUSION Differences in acquisition orbit had a significant influence on HBW and PSD with 201Tl-gated SPECT MPI in the inferior wall in patients with major hypoperfusion myocardium.
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Affiliation(s)
- Tomofumi Misaka
- Department of Radiology, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, Japan
| | - Makoto Hosono
- Faculty of Medicine, Institute of Advanced Clinical Medicine, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Takashi Kudo
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, Nagasaki, Japan
| | - Takamichi Ito
- Department of Radiology, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, Japan
| | - Tsutomu Syomura
- Department of Radiology, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, Japan
| | - Masanobu Uemura
- Department of Radiology, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, Japan
| | - Kaoru Okajima
- Department of Radiology, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, Japan
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Chono T, Onoguchi M, Shibutani T, Hashimoto A, Nakata T, Yama N, Tsuchihashi K, Hatakenaka M. Improvement in automated quantitation of myocardial perfusion abnormality by using iterative reconstruction image in combination with resolution recovery, attenuation and scatter corrections for the detection of coronary artery disease. Ann Nucl Med 2016; 31:181-189. [DOI: 10.1007/s12149-016-1146-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
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Sakatani T, Shimoo S, Takamatsu K, Kyodo A, Tsuji Y, Mera K, Koide M, Isodono K, Tsubakimoto Y, Matsuo A, Inoue K, Fujita H. Usefulness of the novel risk estimation software, Heart Risk View, for the prediction of cardiac events in patients with normal myocardial perfusion SPECT. Ann Nucl Med 2016; 30:716-721. [PMID: 27541874 DOI: 10.1007/s12149-016-1117-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/17/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Myocardial perfusion single-photon emission-computed tomography (SPECT) can predict cardiac events in patients with coronary artery disease with high accuracy; however, pseudo-negative cases sometimes occur. Heart Risk View, which is based on the prospective cohort study (J-ACCESS), is a software for evaluating cardiac event probability. OBJECTIVES We examined whether Heart Risk View was useful to evaluate the cardiac risk in patients with normal myocardial perfusion SPECT (MPS). METHODS AND RESULTS We studied 3461 consecutive patients who underwent MPS to detect myocardial ischemia and those who had normal MPS were enrolled in this study (n = 698). We calculated cardiac event probability by Heart Risk View and followed-up for 3.8 ± 2.4 years. The cardiac events were defined as cardiac death, non-fatal myocardial infarction, and heart failure requiring hospitalization. During the follow-up period, 21 patients (3.0 %) had cardiac events. The event probability calculated by Heart Risk View was higher in the event group (5.5 ± 2.6 vs. 2.9 ± 2.6 %, p < 0.001). According to the receiver-operating characteristics curve, the cut-off point of the event probability for predicting cardiac events was 3.4 % (sensitivity 0.76, specificity 0.72, and AUC 0.85). Kaplan-Meier curves revealed that a higher event rate was observed in the high-event probability group by the log-rank test (p < 0.001). CONCLUSION Although myocardial perfusion SPECT is useful for the prediction of cardiac events, risk estimation by Heart Risk View adds more prognostic information, especially in patients with normal MPS.
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Affiliation(s)
- Tomohiko Sakatani
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan.
| | - Satoshi Shimoo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Kazuaki Takamatsu
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Atsushi Kyodo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Yumika Tsuji
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Kayoko Mera
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Masahiro Koide
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Koji Isodono
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Yoshinori Tsubakimoto
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Akiko Matsuo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Keiji Inoue
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-tyo, Kamigyo-ku, Kyoto, 602-8026, Japan
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Ueshima K, Itoh H, Kanazawa N, Komuro I, Nagai R, Takeuchi M, Yamazaki T. Rationale and Design of the Standard Versus Intensive Statin Therapy for Hypercholesterolemic Patients with Diabetic Retinopathy (EMPATHY) Study: a Randomized Controlled Trial. J Atheroscler Thromb 2016; 23:976-90. [PMID: 26961114 DOI: 10.5551/jat.33563] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIM Hyperlipidemia and diabetic retinopathy increase the risk of cardiovascular disease (CVD). The standard versus intEnsive statin therapy for hypercholesteroleMic Patients with diAbetic retinopaTHY (EMPATHY) study examines whether intensive lipid-lowering therapy is superior to standard therapy in reducing the incidence of cardiovascular events in patients with hyperlipidemia and diabetic retinopathy, but without a history of coronary artery disease. METHODS Patients who had elevated low-density lipoprotein cholesterol (LDL-C) and diabetic retinopathy without a history of coronary artery disease were eligible for the study. Patients were randomly assigned in a 1:1 ratio to receive intensive or standard therapy. Patients are being treated with monotherapy with 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor (statin) for a maximum of 5.5 years to achieve the following LDL-C target: <70 mg/dL for the intensive therapy group or ≥100 and <120 mg/dL for the standard therapy group. The primary endpoint is a composite of incidence of CVD and death from CVD. RESULTS Between May 2010 and October 2013, 5,995 patients were assessed for eligibility, and 5,144 were assigned to the study treatment (2,571 and 2,573 in the intensive and standard therapy groups, respectively), and baseline data were analyzed from 5,107 (2,550 in the intensive therapy group and 2,557 in the standard therapy group). CONCLUSIONS This is the first study assessing the benefits of intensive statin therapy in patients with hypercholesterolemia and diabetic retinopathy in a primary prevention setting. Furthermore, this study evaluates the appropriateness of the treat-to-target approach because all patients are treated to achieve specific LDL-C targets by titrating statin therapy. CLINICAL TRIAL REGISTRATION NUMBER UMIN000003486.
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Affiliation(s)
- Kenji Ueshima
- Department of EBM Research, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital
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Normal values and standardization of parameters in nuclear cardiology: Japanese Society of Nuclear Medicine working group database. Ann Nucl Med 2016; 30:188-99. [PMID: 26897008 PMCID: PMC4819542 DOI: 10.1007/s12149-016-1065-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 01/31/2016] [Indexed: 11/16/2022]
Abstract
As a 2-year project of the Japanese Society of Nuclear Medicine working group activity, normal myocardial imaging databases were accumulated and summarized. Stress-rest with gated and non-gated image sets were accumulated for myocardial perfusion imaging and could be used for perfusion defect scoring and normal left ventricular (LV) function analysis. For single-photon emission computed tomography (SPECT) with multi-focal collimator design, databases of supine and prone positions and computed tomography (CT)-based attenuation correction were created. The CT-based correction provided similar perfusion patterns between genders. In phase analysis of gated myocardial perfusion SPECT, a new approach for analyzing dyssynchrony, normal ranges of parameters for phase bandwidth, standard deviation and entropy were determined in four software programs. Although the results were not interchangeable, dependency on gender, ejection fraction and volumes were common characteristics of these parameters. Standardization of 123I-MIBG sympathetic imaging was performed regarding heart-to-mediastinum ratio (HMR) using a calibration phantom method. The HMRs from any collimator types could be converted to the value with medium-energy comparable collimators. Appropriate quantification based on common normal databases and standard technology could play a pivotal role for clinical practice and researches.
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50
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Yoda S, Nakanishi K, Tano A, Hori Y, Hayase M, Mineki T, Suzuki Y, Matsumoto N, Hirayama A. Prognostic Value of Major Cardiac Event Risk Score Estimated With Gated Myocardial Perfusion Imaging in Japanese Patients With Coronary Artery Disease. Int Heart J 2016; 57:408-16. [DOI: 10.1536/ihj.15-428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine
| | - Kanae Nakanishi
- Department of Cardiology, Nihon University School of Medicine
| | - Ayako Tano
- Department of Cardiology, Nihon University School of Medicine
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine
| | - Misa Hayase
- Department of Cardiology, Nihon University School of Medicine
| | - Takashi Mineki
- Department of Cardiology, Nihon University School of Medicine
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine
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