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Soman P, Hyafil F. Resting myocardial blood flow: To correct, or not to correct, that is the question! J Nucl Cardiol 2024; 37:101902. [PMID: 39025535 DOI: 10.1016/j.nuclcard.2024.101902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Affiliation(s)
- Prem Soman
- Division of Cardiology, University of Pittsburgh Medical Center, USA.
| | - Fabien Hyafil
- Department of Nuclear Medicine, European Hospital Georges-Pompidou, DMU IMAGINA, Assistance Publique - Hôpitaux de Paris, France; Inserm 970, University Paris-City, France
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2
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Juarez-Orozco LE. Exploring PET-derived geometric indexes in ischemic heart disease: Is more in store? J Nucl Cardiol 2024; 36:101883. [PMID: 38759920 DOI: 10.1016/j.nuclcard.2024.101883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Luis Eduardo Juarez-Orozco
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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3
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Bourque JM, Beller GA. Nuclear Cardiology: The Past, Present, and Future. Circ Cardiovasc Imaging 2024; 17:e016875. [PMID: 38771905 DOI: 10.1161/circimaging.124.016875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Jamieson M Bourque
- Division of Cardiovascular Medicine and the Cardiac Imaging Center (J.M.B., G.A.B.), University of Virginia Health System, Charlottesville
- Department of Radiology and Medical Imaging (J.M.B.), University of Virginia Health System, Charlottesville
| | - George A Beller
- Division of Cardiovascular Medicine and the Cardiac Imaging Center (J.M.B., G.A.B.), University of Virginia Health System, Charlottesville
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4
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Assante R, Zampella E, D'Antonio A, Mannarino T, Gaudieri V, Nappi C, Arumugam P, Panico M, Buongiorno P, Petretta M, Cuocolo A, Acampa W. Impact on cardiovascular outcome of coronary revascularization-induced changes in ischemic perfusion defect and myocardial flow reserve. Eur J Nucl Med Mol Imaging 2024; 51:1612-1621. [PMID: 38191816 PMCID: PMC11043198 DOI: 10.1007/s00259-023-06588-4] [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: 10/17/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE We evaluated the impact on cardiovascular outcome of coronary revascularization-induced changes in ischemic total perfusion defect (ITPD) and myocardial flow reserve (MFR) as assessed by 82Rb positron emission tomography (PET)/computed tomography (CT) imaging. METHODS The study included 102 patients referred to 82Rb PET/CT myocardial perfusion imaging before and after coronary revascularization. All patients were followed for the occurrence of cardiovascular events (cardiac death, nonfatal myocardial infarction, repeated revascularization, and heart failure) after the second imaging study. RESULTS During a median follow-up of 20 months, 21 events occurred. The clinical characteristics were comparable between patients with and without events. In the overall study population, after revascularization, there was a significant reduction (P < 0.001) of ITPD, while hyperemic myocardial blood flow (MBF) (P < 0.01) and MFR (P < 0.05) significantly improved. Event rate was higher in patients with ITPD (P < 0.005) or MFR (P < 0.001) worsening compared to those with unchanged or improved ITPD or MFR. At Cox univariable analysis, ITPD and MFR worsening resulted in predictors of events (both P < 0.05). Patients with worsening of both ITPD and MFR had the worst event-free survival (log-rank 32.9, P for trend < 0.001). CONCLUSIONS In patients with stable CAD, worsening of ITPD and MFR after revascularization procedures is associated with higher risk of cardiovascular events. Follow-up MPI with 82Rb PET/CT may improve risk stratification in patients submitted to coronary revascularization.
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Affiliation(s)
- Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Parthiban Arumugam
- Department of Nuclear Medicine, Central Manchester Foundation Trust, Manchester, UK
| | | | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
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5
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Hijazi W, Feng Y, Southern DA, Chew D, Filipchuk N, Har B, James M, Wilton S, Slomka PJ, Berman D, Miller RJH. Impact of myocardial perfusion and coronary calcium on medical management for coronary artery disease. Eur Heart J Cardiovasc Imaging 2024; 25:482-490. [PMID: 37889992 DOI: 10.1093/ehjci/jead288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/06/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023] Open
Abstract
AIMS Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) remains one of the most widely used imaging modalities for the diagnosis and prognostication of coronary artery disease (CAD). Despite the extensive prognostic information provided by MPI, little is known about how this influences the prescription of medical therapy for CAD. We evaluated the relationship between MPI with computed tomography (CT) attenuation correction and prescription of acetylsalicylic acid (ASA) and statins. METHODS AND RESULTS We performed a retrospective analysis of consecutive patients who underwent SPECT MPI at a single centre between 2015 and 2021. Myocardial perfusion abnormalities and coronary calcium burden were assessed, with attenuation correction imaging 77.8% of patients. Medication prescriptions before and within 180 days after the test were compared. Associations between abnormal perfusion and calcium burden with ASA and statin prescription were assessed using multivariable logistic regression. In total, 9908 patients were included, with a mean age 66.8 ± 11.7 years and 5337 (53.9%) males. The prescription of statins increased more in patients with abnormal perfusion (increase of 19.2 vs. 12.0%, P < 0.001). Similarly, the presence of extensive CAC led to a greater increase in statin prescription compared with no calcium (increase 12.1 vs. 7.8%, P < 0.001). In multivariable analyses, ischaemia and coronary artery calcium were independently associated with ASA and statin prescription. CONCLUSION Abnormal MPI testing was associated with significant changes in medical therapy. Both calcium burden and perfusion abnormalities were associated with increased prescriptions of medical therapy for CAD.
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Affiliation(s)
- Waseem Hijazi
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Yuanchao Feng
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Danielle A Southern
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- O'Brien Institute for Public Health, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Libin Cardiovascular Institute, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Derek Chew
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- O'Brien Institute for Public Health, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Libin Cardiovascular Institute, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Neil Filipchuk
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Bryan Har
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Matthew James
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- O'Brien Institute for Public Health, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
- Libin Cardiovascular Institute, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Stephen Wilton
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Daniel Berman
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, 1403 - 29th St. NW, Calgary, AB, T2N 2T9, Canada
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6
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Chow BJ, Galiwango P, Poulin A, Raggi P, Small G, Juneau D, Kazmi M, Ayach B, Beanlands RS, Sanfilippo AJ, Chow CM, Paterson DI, Chetrit M, Jassal DS, Connelly K, Larose E, Bishop H, Kass M, Anderson TJ, Haddad H, Mancini J, Doucet K, Daigle JS, Ahmadi A, Leipsic J, Lim SP, McRae A, Chou AY. Chest Pain Evaluation: Diagnostic Testing. CJC Open 2023; 5:891-903. [PMID: 38204849 PMCID: PMC10774086 DOI: 10.1016/j.cjco.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/01/2023] [Indexed: 01/12/2024] Open
Abstract
Chest pain/discomfort (CP) is a common symptom and can be a diagnostic dilemma for many clinicians. The misdiagnosis of an acute or progressive chronic cardiac etiology may carry a significant risk of morbidity and mortality. This review summarizes the different options and modalities for establishing the diagnosis and severity of coronary artery disease. An effective test selection algorithm should be individually tailored to each patient to maximize diagnostic accuracy in a timely fashion, determine short- and long-term prognosis, and permit implementation of evidence-based treatments in a cost-effective manner. Through collaboration, a decision algorithm was developed (www.chowmd.ca/cadtesting) that could be adopted widely into clinical practice.
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Affiliation(s)
- Benjamin J.W. Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Galiwango
- Department of Medicine, Scarborough Health Network and Lakeridge Health, University of Toronto, Toronto, Ontario, Canada
| | - Anthony Poulin
- Department of Medicine, Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Paolo Raggi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gary Small
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel Juneau
- Department of Radiology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Mustapha Kazmi
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bilal Ayach
- Department of Medicine, Lakeridge Health, Queen’s University, Kingston, Ontario, Canada
| | - Rob S. Beanlands
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Anthony J. Sanfilippo
- Department of Medicine, Lakeridge Health, Queen’s University, Kingston, Ontario, Canada
| | - Chi-Ming Chow
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - D. Ian Paterson
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael Chetrit
- Department of Cardiovascular Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Davinder S. Jassal
- Department of Physiology and Pathophysiology, Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kim Connelly
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eric Larose
- Department of Medicine, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Quebec, Canada
| | - Helen Bishop
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Malek Kass
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd J. Anderson
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Haissam Haddad
- Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John Mancini
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katie Doucet
- Peterborough Regional Health Centre, Kawartha Cardiology Clinic, Peterborough, Ontario, Canada
| | - Jean-Sebastien Daigle
- Department of Internal Medicine, Dr Everett Chalmers Hospital, Fredericton, New Brunswick, Canada
| | - Amir Ahmadi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan Leipsic
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Siok Ping Lim
- Mayfair Diagnostics, Saskatoon, Saskatchewan, Canada
| | - Andrew McRae
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Annie Y. Chou
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, St. Paul’s Hospital, Vancouver, British Columbia, Canada
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7
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Bateman TM. In 2023 PET myocardial perfusion imaging is preferred to invasive coronary angiography for the initial work-up of a symptomatic patient with a high coronary artery calcium score. J Nucl Cardiol 2023; 30:2273-2278. [PMID: 37948013 DOI: 10.1007/s12350-023-03386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Timothy M Bateman
- Cardiovascular Radiologic Imaging, Saint-Lukes Health System, University of Missouri-Kansas City, Kansas City, MO, 64111, USA.
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8
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Tavoosi A, Khetarpal R, Wells RG, Beanlands RSB, deKemp RA. Exponential dosing to standardize myocardial perfusion image quality with rubidium-82 PET. J Nucl Cardiol 2023; 30:2477-2489. [PMID: 37258955 PMCID: PMC10682245 DOI: 10.1007/s12350-023-03303-6] [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: 04/01/2022] [Accepted: 05/08/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND 82Rb PET is commonly performed using the same injected activity in all patients, resulting in lower image quality in larger patients. This study compared 82Rb dosing with exponential vs proportional functions of body weight on the standardization of myocardial perfusion image (MPI) quality. METHODS Two sequential cohorts of N = 60 patients were matched by patient weight. Rest and dipyridamole stress 82Rb PET was performed using 0.1 MBq·kg-2 exponential and 9 MBq·kg-1 proportional dosing. MPI scans were compared qualitatively with visual image quality scoring (IQS) and quantitatively using the myocardium-to-blood contrast-to-noise ratio (CNR) and blood background signal-to-noise ratio (SNR) as a function of body weight. RESULTS Average (min-max) patient body weight was 81 ± 18 kg (46-137 kg). Proportional dosing resulted in decreasing CNR, SNR, and visual IQS with increasing body weight (P < 0.05). Exponential dosing eliminated the weight-dependent decreases in these image quality metrics that were observed in the proportional dosing group. CONCLUSION 82Rb PET dosing as an exponential (squared) function of body weight produced consistent stress perfusion image quality over a wide range of patient weights. Dramatically lower doses can be used in lighter patients, with the equivalent population dose shifted toward the heavier patients to standardize diagnostic image quality.
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Affiliation(s)
- Anahita Tavoosi
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Ritika Khetarpal
- School of Interdisciplinary Science (Life Sciences), McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - R Glenn Wells
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Rob S B Beanlands
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Robert A deKemp
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
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9
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Di Carli MF. Future of Radionuclide Myocardial Perfusion Imaging: Transitioning from SPECT to PET. J Nucl Med 2023; 64:3S-10S. [PMID: 37918841 DOI: 10.2967/jnumed.122.264864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/05/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Saraste A, Knuuti J, Bengel F. Phenotyping heart failure by nuclear imaging of myocardial perfusion, metabolism, and molecular targets. Eur Heart J Cardiovasc Imaging 2023; 24:1318-1328. [PMID: 37294318 PMCID: PMC10531130 DOI: 10.1093/ehjci/jead128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
Nuclear imaging techniques can detect and quantify pathophysiological processes underlying heart failure, complementing evaluation of cardiac structure and function with other imaging modalities. Combined imaging of myocardial perfusion and metabolism can identify left ventricle dysfunction caused by myocardial ischaemia that may be reversible after revascularization in the presence of viable myocardium. High sensitivity of nuclear imaging to detect targeted tracers has enabled assessment of various cellular and subcellular mechanisms of heart failure. Nuclear imaging of active inflammation and amyloid deposition is incorporated into clinical management algorithms of cardiac sarcoidosis and amyloidosis. Innervation imaging has well-documented prognostic value with respect to heart failure progression and arrhythmias. Emerging tracers specific for inflammation and myocardial fibrotic activity are in earlier stages of development but have demonstrated potential value in early characterization of the response to myocardial injury and prediction of adverse left ventricular remodelling. Early detection of disease activity is a key for transition from broad medical treatment of clinically overt heart failure towards a personalized approach aimed at supporting repair and preventing progressive failure. This review outlines the current status of nuclear imaging in phenotyping heart failure and combines it with discussion on novel developments.
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Affiliation(s)
- Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4–8, 20520 Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, 20520 Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4–8, 20520 Turku, Finland
| | - Frank Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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11
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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12
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 180] [Impact Index Per Article: 180.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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Blach A, Kwiecinski J. The Role of Positron Emission Tomography in Advancing the Understanding of the Pathogenesis of Heart and Vascular Diseases. Diagnostics (Basel) 2023; 13:1791. [PMID: 37238275 PMCID: PMC10217133 DOI: 10.3390/diagnostics13101791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. For developing new therapies, a better understanding of the underlying pathology is required. Historically, such insights have been primarily derived from pathological studies. In the 21st century, thanks to the advent of cardiovascular positron emission tomography (PET), which depicts the presence and activity of pathophysiological processes, it is now feasible to assess disease activity in vivo. By targeting distinct biological pathways, PET elucidates the activity of the processes which drive disease progression, adverse outcomes or, on the contrary, those that can be considered as a healing response. Given the insights provided by PET, this non-invasive imaging technology lends itself to the development of new therapies, providing a hope for the emergence of strategies that could have a profound impact on patient outcomes. In this narrative review, we discuss recent advances in cardiovascular PET imaging which have greatly advanced our understanding of atherosclerosis, ischemia, infection, adverse myocardial remodeling and degenerative valvular heart disease.
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Affiliation(s)
- Anna Blach
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland
- Nuclear Medicine Department, Voxel Diagnostic Center, 40-514 Katowice, Poland
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, 04-628 Warsaw, Poland
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14
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Gaba P, Gersh BJ, Muller J, Narula J, Stone GW. Evolving concepts of the vulnerable atherosclerotic plaque and the vulnerable patient: implications for patient care and future research. Nat Rev Cardiol 2023; 20:181-196. [PMID: 36151312 DOI: 10.1038/s41569-022-00769-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/08/2022]
Abstract
Understanding the natural history of coronary artery atherosclerosis is necessary to determine prognosis and prescribe effective therapies. Traditional management of coronary artery disease has focused on the treatment of flow-limiting anatomical obstructions that lead to ischaemia. In most scenarios, revascularization of these atherosclerotic plaques has not substantially improved freedom from death or myocardial infarction, questioning the utility of contemporary revascularization strategies to improve prognosis. Advances in non-invasive and invasive imaging techniques have helped to identify the characteristics of obstructive and non-obstructive plaques that are precursors for plaque progression and future acute coronary syndromes as well as cardiac death. These 'vulnerable plaques' develop as a consequence of systemic inflammation and are prone to inducing thrombosis. Vulnerable plaques most commonly have a large plaque burden with a well-formed necrotic core and thin fibrous cap and are metabolically active. Perivascular adipose tissue might, in some patients, be used as a surrogate for coronary inflammation and predict future risk of adverse cardiac events. Vulnerable plaques can be identified in their quiescent state, offering the potential for therapeutic passivation. In this Review, we describe the biological and compositional features of vulnerable plaques, the non-invasive and invasive diagnostic modalities to characterize vulnerable plaques, the prognostic utility of identifying vulnerable plaques, and the future studies needed to explore the value of intensified pharmacological and focal treatments of vulnerable plaques.
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Affiliation(s)
- Prakriti Gaba
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - James Muller
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jagat Narula
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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15
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Alam L, Omar AMS, Patel KK. Improved Performance of PET Myocardial Perfusion Imaging Compared to SPECT in the Evaluation of Suspected CAD. Curr Cardiol Rep 2023; 25:281-293. [PMID: 36826689 DOI: 10.1007/s11886-023-01851-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE OF REVIEW Myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) has played a central role in the non-invasive evaluation of patients with obstructive coronary artery disease (CAD) for decades. In this review, we discuss the key differences and advantages of positron emission tomography (PET) MPI over SPECT MPI as it relates to the diagnosis, prognosis, as well as clinical decision-making in patients with suspected CAD. RECENT FINDINGS Stress-induced perfusion abnormalities on SPECT help estimate presence, extent, and location of ischemia and flow-limiting obstructive CAD, help with risk stratification, and serve as a gatekeeper to identify patients who will benefit from downstream revascularization versus medical management. Some of the major limitations of SPECT include soft-tissue attenuation artifacts, underestimation of ischemia due to reliance on relative perfusion assessment, and longer protocols with higher radiation dose when performed with traditional equipment. PET MPI addresses most of these limitations and offers better quality images, higher diagnostic accuracy along with shorter protocols and lower radiation dose to the patient. A special advantage of PET scanning lies in the ability to quantify absolute myocardial blood flow and assess true extent of epicardial involvement along with identifying non-obstructive phenotypes of CAD such as diffuse atherosclerosis and microvascular dysfunction. In addition, stress acquisition at/near peak stress with PET allows us to measure left ventricular ejection fraction reserve and myocardial blood flow reserve, which help with identifying patients at a higher risk of future cardiac events and optimally select candidates for revascularization. The several technical advantages of PET MPI position as a superior method to diagnose obstructive and non-obstructive phenotypes of ischemic heart disease affecting the entirety of the coronary circulation offer incremental value for risk stratification and guide post-test management strategy for patients with suspected CAD.
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Affiliation(s)
- Loba Alam
- Department of Cardiology, Mount Sinai Morningside, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alaa Mabrouk Salem Omar
- Department of Cardiology, Mount Sinai Morningside, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Krishna K Patel
- Department of Cardiology, Mount Sinai Morningside, New York, NY, USA.
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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16
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Jukema R, Maaniitty T, van Diemen P, Berkhof H, Raijmakers PG, Sprengers R, Planken RN, Knaapen P, Saraste A, Danad I, Knuuti J. Warranty period of coronary computed tomography angiography and [15O]H2O positron emission tomography in symptomatic patients. Eur Heart J Cardiovasc Imaging 2023; 24:304-311. [PMID: 36585755 DOI: 10.1093/ehjci/jeac258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/19/2022] [Indexed: 01/01/2023] Open
Abstract
AIMS Data on the warranty period of coronary computed tomography angiography (CTA) and combined coronary CTA/positron emission tomography (PET) are scarce. The present study aimed to determine the event-free (warranty) period after coronary CTA and the potential additional value of PET. METHOD AND RESULTS Patients with suspected but not previously diagnosed coronary artery disease (CAD) who underwent coronary CTA and/or [15O]H2O PET were categorized based upon coronary CTA as no CAD, non-obstructive CAD, or obstructive CAD. A hyperaemic myocardial blood flow (MBF) ≤ 2.3 mL/min/g was considered abnormal. The warranty period was defined as the time for which the cumulative event rate of death and non-fatal myocardial infarction (MI) was below 5%. Of 2575 included patients (mean age 61.4 ± 9.9 years, 41% male), 1319 (51.2%) underwent coronary CTA only and 1237 (48.0%) underwent combined coronary CTA/PET. During a median follow-up of 7.0 years 163 deaths and 68 MIs occurred. The warranty period for patients with no CAD on coronary CTA was ≥10 years, whereas patients with non-obstructive CAD had a 5-year warranty period. Patients with obstructive CAD and normal hyperaemic MBF had a 2-year longer warranty period compared to patients with obstructive CAD and abnormal MBF (3 years vs. 1 year). CONCLUSION As standalone imaging, the warranty period for normal coronary CTA is ≥10 years, whereas patients with non-obstructive CAD have a warranty period of 5 years. Normal PET yielded a 2-year longer warranty period in patients with obstructive CAD.
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Affiliation(s)
- Ruurt Jukema
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Turku 20520, Finland.,Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital and University of Turku, Turku 20520, Finland
| | - Pepijn van Diemen
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Hans Berkhof
- Department of Epidemiology & Data Science, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ralf Sprengers
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku 20520, Finland.,Heart Center, Turku University Hospital, Turku 20520, Finland
| | - Ibrahim Danad
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku 20520, Finland.,Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital and University of Turku, Turku 20520, Finland
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17
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Ahmed AI, Saad JM, Han Y, Malahfji M, Al-Mallah MH. Incremental prognostic value of positron emission tomography derived left ventricular mass. J Nucl Cardiol 2023; 30:254-263. [PMID: 35794457 DOI: 10.1007/s12350-022-03035-z] [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: 03/24/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left ventricular hypertrophy has been shown to be an independent predictor of outcomes in patients with coronary artery disease (CAD). We aimed to determine the incremental prognostic value of positron emission tomography (PET) derived left ventricular mass (LVM) to clinical variables and myocardial flow reserve (MFR). METHODS We included consecutive patients who had clinically indicated PET myocardial perfusion imaging for suspected or established CAD. Patients were followed from the date of PET imaging for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention/coronary artery bypass grafting 90 days after imaging). RESULTS A total of 2357 patients underwent PET MPI during the study period (47% female, mean age 66 ± 12 years, 87% hypertensive, 47% diabetic, 79% dyslipidemia). After a mean follow-up of 11.6 ± 6.6 months, 141 patients (6.0%, 5.1 per 1000 person-year) experienced MACE (86 D/24 MI/39 PCI/9 CABG). In nested multivariable Cox models, LVM was not independently associated with outcomes (HR 1.00, P = .157) and had no incremental prognostic value (C index: 0.75, P = .571) over MFR and clinical variables. CONCLUSION Our analysis shows that LVM provides no independent and incremental prognostic value over MFR and clinical variables.
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Affiliation(s)
| | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Yushui Han
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Maan Malahfji
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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18
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Probing the Depths: Subendocardial Ischemia and Clinical Outcomes. JACC. CARDIOVASCULAR IMAGING 2023; 16:95-97. [PMID: 36402720 DOI: 10.1016/j.jcmg.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
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19
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Xie E, Sung E, Saad E, Trayanova N, Wu KC, Chrispin J. Advanced imaging for risk stratification for ventricular arrhythmias and sudden cardiac death. Front Cardiovasc Med 2022; 9:884767. [PMID: 36072882 PMCID: PMC9441865 DOI: 10.3389/fcvm.2022.884767] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Sudden cardiac death (SCD) is a leading cause of mortality, comprising approximately half of all deaths from cardiovascular disease. In the US, the majority of SCD (85%) occurs in patients with ischemic cardiomyopathy (ICM) and a subset in patients with non-ischemic cardiomyopathy (NICM), who tend to be younger and whose risk of mortality is less clearly delineated than in ischemic cardiomyopathies. The conventional means of SCD risk stratification has been the determination of the ejection fraction (EF), typically via echocardiography, which is currently a means of determining candidacy for primary prevention in the form of implantable cardiac defibrillators (ICDs). Advanced cardiac imaging methods such as cardiac magnetic resonance imaging (CMR), single-photon emission computerized tomography (SPECT) and positron emission tomography (PET), and computed tomography (CT) have emerged as promising and non-invasive means of risk stratification for sudden death through their characterization of the underlying myocardial substrate that predisposes to SCD. Late gadolinium enhancement (LGE) on CMR detects myocardial scar, which can inform ICD decision-making. Overall scar burden, region-specific scar burden, and scar heterogeneity have all been studied in risk stratification. PET and SPECT are nuclear methods that determine myocardial viability and innervation, as well as inflammation. CT can be used for assessment of myocardial fat and its association with reentrant circuits. Emerging methodologies include the development of "virtual hearts" using complex electrophysiologic modeling derived from CMR to attempt to predict arrhythmic susceptibility. Recent developments have paired novel machine learning (ML) algorithms with established imaging techniques to improve predictive performance. The use of advanced imaging to augment risk stratification for sudden death is increasingly well-established and may soon have an expanded role in clinical decision-making. ML could help shift this paradigm further by advancing variable discovery and data analysis.
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Affiliation(s)
- Eric Xie
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eric Sung
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Elie Saad
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Natalia Trayanova
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine C. Wu
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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20
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Litmanovich D, Hurwitz Koweek LM, Ghoshhajra BB, Agarwal PP, Bourque JM, Brown RKJ, Davis AM, Fuss C, Johri AM, Kligerman SJ, Malik SB, Maroules CD, Meyersohn NM, Vasu S, Villines TC, Abbara S. ACR Appropriateness Criteria® Chronic Chest Pain-High Probability of Coronary Artery Disease: 2021 Update. J Am Coll Radiol 2022; 19:S1-S18. [PMID: 35550795 DOI: 10.1016/j.jacr.2022.02.021] [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: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Management of patients with chronic chest pain in the setting of high probability of coronary artery disease (CAD) relies heavily on imaging for determining or excluding presence and severity of myocardial ischemia, hibernation, scarring, and/or the presence, site, and severity of obstructive coronary lesions, as well as course of management and long-term prognosis. In patients with no known ischemic heart disease, imaging is valuable in determining and documenting the presence, extent, and severity of obstructive coronary narrowing and presence of myocardial ischemia. In patients with known ischemic heart disease, imaging findings are important in determining the management of patients with chronic myocardial ischemia and can serve as a decision-making tool for medical therapy, angioplasty, stenting, or surgery. This document summarizes the recent growing body of evidence on various imaging tests and makes recommendations for imaging based on the available data and expert opinion. This document is focused on epicardial CAD and does not discuss the microvascular disease as the cause for CAD. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Diana Litmanovich
- Harvard Medical School, Boston, Massachusetts; and Chief, Cardiothoracic imaging Section, Beth Israel Deaconess Medical Center.
| | - Lynne M Hurwitz Koweek
- Panel Chair, Duke University Medical Center, Durham, North Carolina; Panel Chair ACR AUG committee
| | - Brian B Ghoshhajra
- Panel Vice-Chair, Division Chief, Cardiovascular Imaging, Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Prachi P Agarwal
- Division Director of Cardiothoracic Radiology and Co-Director of Congenital Cardiovascular MR Imaging, University of Michigan, Ann Arbor, Michigan
| | - Jamieson M Bourque
- Medical Director of Nuclear Cardiology and the Stress Laboratory, University of Virginia Health System, Charlottesville, Virginia; Nuclear cardiology expert
| | - Richard K J Brown
- University of Michigan Health System, Ann Arbor, Michigan; and Vice Chair of Clinical Operations, Department of Radiology and Imaging Sciences, University of Utah
| | - Andrew M Davis
- The University of Chicago Medical Center, Chicago, Illinois; American College of Physicians; and Associate Vice-Chair for Quality, Department of Medicine, University of Chicago
| | - Cristina Fuss
- Oregon Health & Science University, Portland, Oregon; SCCT Member of the Board; Section Chief Cardiothoracic Imaging Department of Diagnostic Radiology, Oregon Health & Science University; ABR OLA Cardiac Committee; and NASCI Program Vice-Chair
| | - Amer M Johri
- Queen's University, Kingston, Ontario, Canada; Cardiology Expert; and ASE Board Member
| | | | - Sachin B Malik
- Division Chief Thoracic and Cardiovascular Imaging, Director of Cardiac MRI, Director of MRI, VA Palo Alto Health Care System, Palo Alto, California and Stanford University, Stanford, California
| | | | - Nandini M Meyersohn
- Fellowship Program Director, Massachusetts General Hospital, Boston, Massachusetts
| | - Sujethra Vasu
- Director, Cardiac MRI and Cardiac CT, Wake Forest University Health Sciences, Winston Salem, North Carolina; Society for Cardiovascular Magnetic Resonance
| | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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21
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Crișan G, Moldovean-Cioroianu NS, Timaru DG, Andrieș G, Căinap C, Chiș V. Radiopharmaceuticals for PET and SPECT Imaging: A Literature Review over the Last Decade. Int J Mol Sci 2022; 23:ijms23095023. [PMID: 35563414 PMCID: PMC9103893 DOI: 10.3390/ijms23095023] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
Positron emission tomography (PET) uses radioactive tracers and enables the functional imaging of several metabolic processes, blood flow measurements, regional chemical composition, and/or chemical absorption. Depending on the targeted processes within the living organism, different tracers are used for various medical conditions, such as cancer, particular brain pathologies, cardiac events, and bone lesions, where the most commonly used tracers are radiolabeled with 18F (e.g., [18F]-FDG and NA [18F]). Oxygen-15 isotope is mostly involved in blood flow measurements, whereas a wide array of 11C-based compounds have also been developed for neuronal disorders according to the affected neuroreceptors, prostate cancer, and lung carcinomas. In contrast, the single-photon emission computed tomography (SPECT) technique uses gamma-emitting radioisotopes and can be used to diagnose strokes, seizures, bone illnesses, and infections by gauging the blood flow and radio distribution within tissues and organs. The radioisotopes typically used in SPECT imaging are iodine-123, technetium-99m, xenon-133, thallium-201, and indium-111. This systematic review article aims to clarify and disseminate the available scientific literature focused on PET/SPECT radiotracers and to provide an overview of the conducted research within the past decade, with an additional focus on the novel radiopharmaceuticals developed for medical imaging.
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Affiliation(s)
- George Crișan
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
- Department of Nuclear Medicine, County Clinical Hospital, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | | | - Diana-Gabriela Timaru
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
| | - Gabriel Andrieș
- Department of Nuclear Medicine, County Clinical Hospital, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | - Călin Căinap
- The Oncology Institute “Prof. Dr. Ion Chiricuţă”, Republicii 34-36, 400015 Cluj-Napoca, Romania;
| | - Vasile Chiș
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
- Institute for Research, Development and Innovation in Applied Natural Sciences, Babeș-Bolyai University, Str. Fântânele 30, 400327 Cluj-Napoca, Romania
- Correspondence:
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22
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Vaccarino V, Shah AJ, Moncayo V, Nye J, Piccinelli M, Ko YA, Ma X, Murrah N, Shallenberger L, Driggers E, Levantsevych OM, Hammadah M, Lima BB, Young A, O'Neal W, Alkhalaf M, Haffar A, Raggi P, Goldberg J, Smith NL, Garcia EV, Quyyumi AA, Bremner JD. Posttraumatic Stress Disorder, Myocardial Perfusion, and Myocardial Blood Flow: A Longitudinal Twin Study. Biol Psychiatry 2022; 91:615-625. [PMID: 34865854 PMCID: PMC8918004 DOI: 10.1016/j.biopsych.2021.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The link between posttraumatic stress disorder (PTSD) and ischemic heart disease remains elusive owing to a shortage of longitudinal studies with a clinical diagnosis of PTSD and objective measures of cardiac compromise. METHODS We performed positron emission tomography in 275 twins who participated in two examinations approximately 12 years apart. At both visits, we obtained a clinical diagnosis of PTSD, which was classified as long-standing (both visit 1 and visit 2), late onset (only visit 2), and no PTSD (no PTSD at both visits). With positron emission tomography, we assessed myocardial flow reserve (MFR), which, in absence of significant coronary stenoses, indexes coronary microvascular function. We compared positron emission tomography data at visit 2 across the three categories of longitudinally assessed PTSD and examined changes between the two visits. RESULTS Overall, 80% of the twins had no or minimal obstructive coronary disease. Yet, MFR was depressed in twins with PTSD and was progressively lower across groups with no PTSD (2.13), late-onset PTSD (1.97), and long-standing PTSD (1.93) (p = .01). A low MFR (a ratio <2.0) was present in 40% of the twins without PTSD, in 56% of those with late-onset PTSD, and in 72% of those with long-standing PTSD (p < .001). Associations persisted in multivariable analysis, when examining changes in MFR between visit 1 and visit 2, and within twin pairs. Results were similar by zygosity. CONCLUSIONS Longitudinally, PTSD is associated with reduced coronary microcirculatory function and greater deterioration over time. The association is especially noted among twins with chronic, long-standing PTSD and is not confounded by shared environmental or genetic factors.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Valeria Moncayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathon Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Xin Ma
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emily Driggers
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Oleksiy M Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Muhammad Hammadah
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Bruno B Lima
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - An Young
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wesley O'Neal
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mhmtjamil Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ammer Haffar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - J Douglas Bremner
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Decatur, Georgia
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23
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Hinton J, Bashar H, Curzen N. Atheroma or ischemia: which is more important for managing patients with stable chest pain? Future Cardiol 2022; 18:417-429. [PMID: 35360934 DOI: 10.2217/fca-2021-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the evaluation and management of patients with stable chest pain/chronic coronary syndrome, cardiologists need to be able to weigh up the relative merits of managing these patients using either optimal therapy alone or optimal therapy plus revascularization. These decisions rely on an understanding of both the presence and the degree of coronary atheroma and myocardial ischemia, and the impact that these have on patients' symptoms and their prognosis. In this review the authors examine the relative impact of the anatomical and physiological assessment of patients with chronic coronary syndrome and how it can be used to achieve optimal and tailored therapy.
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Affiliation(s)
- Jonathan Hinton
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Hussein Bashar
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
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24
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Rodriguez Lozano PF, Rrapo Kaso E, Bourque JM, Morsy M, Taylor AM, Villines TC, Kramer CM, Salerno M. Cardiovascular Imaging for Ischemic Heart Disease in Women: Time for a Paradigm Shift. JACC. CARDIOVASCULAR IMAGING 2022; 15:1488-1501. [PMID: 35331658 PMCID: PMC9355915 DOI: 10.1016/j.jcmg.2022.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 10/18/2022]
Abstract
Heart disease is the leading cause of death among men and women. Women have a unique phenotype of ischemic heart disease with less calcified lesions, more nonobstructive plaques, and a higher prevalence of microvascular disease compared with men, which may explain in part why current risk models to detect obstructive coronary artery disease (CAD) may not work as well in women. This paper summarizes the sex differences in the functional and anatomical assessment of CAD in women presenting with stable chest pain and provides an approach for using multimodality imaging for the evaluation of suspected ischemic heart disease in women in accordance to the recently published American Heart Association/American College of Cardiology guidelines for the evaluation and diagnosis of chest pain. A paradigm shift in the approach to imaging ischemic heart disease women is needed including updated risk models, a more profound understanding of CAD in women where nonobstructive disease is more prevalent, and algorithms focused on the evaluation of ischemia with nonobstructive CAD and myocardial infarction with nonobstructive CAD.
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Affiliation(s)
- Patricia F Rodriguez Lozano
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Elona Rrapo Kaso
- Department of Medicine, Cardiovascular Division, Orlando VA Medical Center, Orlando, Florida, USA
| | - Jamieson M Bourque
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mohamed Morsy
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Angela M Taylor
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Todd C Villines
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA; Stanford University Medical Center, Cardiovascular Medicine, Stanford, California, USA.
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25
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Weyers JJ, Ramanan V, Javed A, Barry J, Larsen M, Nayak K, Wright GA, Ghugre NR. Myocardial blood flow is the dominant factor influencing cardiac magnetic resonance adenosine stress T2. NMR IN BIOMEDICINE 2022; 35:e4643. [PMID: 34791720 PMCID: PMC8828684 DOI: 10.1002/nbm.4643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/24/2021] [Accepted: 10/10/2021] [Indexed: 06/02/2023]
Abstract
Stress imaging identifies ischemic myocardium by comparing hemodynamics during rest and hyperemic stress. Hyperemia affects multiple hemodynamic parameters in myocardium, including myocardial blood flow (MBF), myocardial blood volume (MBV), and venous blood oxygen levels (PvO2 ). Cardiac T2 is sensitive to these changes and therefore is a promising non-contrast option for stress imaging; however, the impact of individual hemodynamic factors on T2 is poorly understood, making the connection from altered T2 to changes within the tissue difficult. To better understand this interplay, we performed T2 mapping and measured various hemodynamic factors independently in healthy pigs at multiple levels of hyperemic stress, induced by different doses of adenosine (0.14-0.56 mg/kg/min). T1 mapping quantified changes in MBV. MBF was assessed with microspheres, and oxygen consumption was determined by the rate pressure product (RPP). Simulations were also run to better characterize individual contributions to T2. Myocardial T2, MBF, oxygen consumption, and MBV all changed to varying extents between each level of adenosine stress (T2 = 37.6-41.8 ms; MBF = 0.48-1.32 mL/min/g; RPP = 6507-4001 bmp*mmHg; maximum percent change in MBV = 1.31%). Multivariable analyses revealed MBF as the dominant influence on T2 during hyperemia (significant β-values >7). Myocardial oxygen consumption had almost no effect on T2 (β-values <0.002); since PvO2 is influenced by both oxygen consumption and MBF, PvO2 changes detected by T2 during adenosine stress can be attributed to MBF. Simulations varying PvO2 and MBV confirmed that PvO2 had the strongest influence on T2, but MBV became important at high PvO2 . Together, these data suggest a model where, during adenosine stress, myocardial T2 responds predominantly to changes in MBF, but at high hyperemia MBV is also influential. Thus, changes in adenosine stress T2 can now be interpreted in terms of the physiological changes that led to it, enabling T2 mapping to become a viable non-contrast option to detect ischemic myocardial tissue.
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Affiliation(s)
- Jill J Weyers
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Venkat Ramanan
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Ahsan Javed
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, California
| | - Jennifer Barry
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Melissa Larsen
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Krishna Nayak
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, California
| | - Graham A Wright
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Nilesh R Ghugre
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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26
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Cardiovasc Comput Tomogr 2022; 16:54-122. [PMID: 34955448 DOI: 10.1016/j.jcct.2021.11.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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27
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:e187-e285. [PMID: 34756653 DOI: 10.1016/j.jacc.2021.07.053] [Citation(s) in RCA: 319] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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28
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2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:2218-2261. [PMID: 34756652 DOI: 10.1016/j.jacc.2021.07.052] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.
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29
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709879 DOI: 10.1161/cir.0000000000001029] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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30
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709928 DOI: 10.1161/cir.0000000000001030] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.
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31
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Neglia D, Liga R, Caselli C, Carpeggiani C, Lorenzoni V, Sicari R, Lombardi M, Gaemperli O, Kaufmann PA, Scholte AJHA, Underwood SR, Knuuti J. Anatomical and functional coronary imaging to predict long-term outcome in patients with suspected coronary artery disease: the EVINCI-outcome study. Eur Heart J Cardiovasc Imaging 2021; 21:1273-1282. [PMID: 31701136 DOI: 10.1093/ehjci/jez248] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/06/2019] [Accepted: 10/25/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS To investigate the prognostic relevance of coronary anatomy, coronary function, and early revascularization in patients with stable coronary artery disease (CAD). METHODS AND RESULTS From March 2009 to June 2012, 430 patients with suspected CAD (61 ± 9 years, 62% men) underwent coronary anatomical imaging by computed tomography coronary angiography (CTCA) and coronary functional imaging followed by invasive coronary angiography (ICA) if at least one non-invasive test was abnormal. Obstructive CAD was documented by ICA in 119 patients and 90 were revascularized within 90 days of enrolment. Core laboratory analysis showed that 134 patients had obstructive CAD by CTCA (>50% stenosis in major coronary vessels) and 79 significant ischaemia by functional imaging [>10% left ventricular (LV) myocardium]. Over mean follow-up of 4.4 years, major adverse events (AEs) (all-cause death, non-fatal myocardial infarction, or hospital admission for unstable angina or heart failure) or AEs plus late revascularization (LR) occurred in 40 (9.3%) and 58 (13.5%) patients, respectively. Obstructive CAD at CTCA was the only independent imaging predictor of AEs [hazard ratio (HR) 3.2, 95% confidence interval (CI) 1.10-9.30; P = 0.033] and AEs plus LR (HR 4.3, 95% CI 1.56-11.81; P = 0.005). Patients with CAD in whom early revascularization was performed in the presence of ischaemia and deferred in its absence had fewer AEs, similar to patients without CAD (HR 2.0, 95% CI 0.71-5.51; P = 0.195). CONCLUSION Obstructive CAD imaged by CTCA is an independent predictor of clinical outcome. Early management of CAD targeted to the combined anatomical and functional disease phenotype improves clinical outcome.
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Affiliation(s)
- Danilo Neglia
- Cardiovascular Department, Fondazione Toscana G. Monasterio, Via G. Moruzzi 1, 56124 Pisa, Italy.,CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy.,Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Riccardo Liga
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67, 56126 Pisa, Italy
| | - Chiara Caselli
- CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Clara Carpeggiani
- CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Valentina Lorenzoni
- Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milano, Italy
| | - Oliver Gaemperli
- Cardiology, HeartClinic Hirslanden, Witellikerstrasse 40, 8032, Zürich, Switzerland
| | - Philipp A Kaufmann
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Arthur J H A Scholte
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - S Richard Underwood
- Department of Non-Invasive Cardiac Imaging, Royal Brompton Hospital and Harefield Hospital, 250 King's Rd, Chelsea, London SW3 5UE, UK
| | - Juhani Knuuti
- PET Center, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521 Turku, Finland
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32
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Nammas W, Maaniitty T, Knuuti J, Saraste A. Cardiac perfusion by positron emission tomography. Clin Physiol Funct Imaging 2021; 41:385-400. [PMID: 33969615 DOI: 10.1111/cpf.12708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/05/2021] [Indexed: 01/16/2023]
Abstract
Myocardial perfusion imaging (MPI) with positron emission tomography (PET) is an established tool for evaluation of obstructive coronary artery disease (CAD). The contemporary 3-dimensional scanner technology and the state-of-the-art MPI radionuclide tracers and pharmacological stress agents, as well as the cutting-edge image reconstruction techniques and data analysis software, have all enabled accurate, reliable and reproducible quantification of absolute myocardial blood flow (MBF), and henceforth calculation of myocardial flow reserve (MFR) in several clinical scenarios. In patients with suspected coronary artery disease, both absolute stress MBF and MFR can identify myocardial territories subtended by epicardial coronary arteries with haemodynamically significant stenosis, as defined by invasive coronary fractional flow reserve measurement. In particular, absolute stress MBF and MFR offered incremental prognostic information for predicting adverse cardiac outcome, and hence for better patient risk stratification, over those provided by traditional clinical risk predictors. This article reviews the available evidence to support the translation of the current techniques and technologies into a useful decision-making tool in real-world clinical practice.
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Affiliation(s)
- Wail Nammas
- Heart Center, Turku University Hospital, Turku, Finland
| | - Teemu Maaniitty
- PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Heart Center, Turku University Hospital, Turku, Finland.,PET Centre, Turku University Hospital and University of Turku, Turku, Finland
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33
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Kumar A, Patel DR, Harb SC, Greenberg NL, Bhargava A, Menon V, Ellis SG, Kapadia SR, Hachamovitch R, Jaber WA, Cremer PC. Implementation of a Myocardial Perfusion Imaging Risk Algorithm to Inform Appropriate Downstream Invasive Testing and Treatment. Circ Cardiovasc Imaging 2021; 14:e011984. [PMID: 33765835 DOI: 10.1161/circimaging.120.011984] [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: 11/16/2022]
Abstract
BACKGROUND To risk stratify patients undergoing single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in accordance with appropriate use criteria for referral to coronary angiography, we developed a risk classification algorithm incorporating appropriate use criteria-defined risk features. We evaluated the association between this algorithm with downstream angiography, revascularization, and all-cause mortality. METHODS We studied consecutive patients who underwent SPECT-MPI from January 1, 2015, to December 31, 2017, and assigned a scan risk of low, intermediate, high, or indeterminate. With this stratification, we assessed referral for angiography and revascularization within 3 months of SPECT-MPI and intermediate-term mortality. RESULTS Among 12 799 patients, the mean age was 66 years, and a majority were men (56.8%). Most patients were low risk (83.6%) followed by intermediate (9.9%) and high risk (5.2%). Compared with low-risk patients, intermediate- and high-risk patients were more frequently referred for angiography (14.8% and 13.6% versus 2.0%; P<0.001) and revascularization (7.7% and 6.8% versus 0.7%; P<0.001). In 1008 propensity-matched patients, scan risk was independently associated with angiography after adjustment for ischemia, scar, or stress ejection fraction. At a mean follow-up of 2.3 years, mortality was higher with increased scan risk (high, 10.4%; intermediate, 7.1%; low, 4.1%; P<0.001). Compared with low scan risk, intermediate (hazard ratio, 1.37 [95% CI, 1.09-1.72]; P=0.008) and high scan risk (hazard ratio, 1.98 [95% CI, 1.53-2.56]; P<0.001) were associated with mortality in multivariable analysis. Similar findings were observed for those undergoing pharmacological and exercise SPECT-MPI with comparatively worse prognosis among pharmacological patients. CONCLUSIONS This appropriate use criteria-derived risk classification algorithm for SPECT-MPI guided referral for coronary angiography and revascularization and was significantly associated with mortality. This algorithm may serve as an important tool to reaffirm appropriate use criteria and direct management of patients with stable ischemic heart disease undergoing stress testing.
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Affiliation(s)
- Anirudh Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Divyang R Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Neil L Greenberg
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Ajay Bhargava
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Paul C Cremer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
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34
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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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Murthy VL, Bateman TM, Chen W, Malhotra S, Miller EJ, Ruddy TD, Dilsizian V. Impact of the ISCHEMIA Trial on Stress Nuclear Myocardial Perfusion Imaging. J Nucl Med 2020; 61:962-964. [PMID: 32611712 DOI: 10.2967/jnumed.119.245399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Venkatesh L Murthy
- Division of Cardiovascular Medicine and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Timothy M Bateman
- Mid America Heart Institute and the Saint-Luke's Health System, University of Missouri-Kansas City, Kansas City, Missouri
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health, Chicago, Illinois.,Division of Cardiology, Rush Medical College, Chicago, Illinois
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut; and
| | | | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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36
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Rrapo Kaso E, Bourque JM. Regadenoson SPECT MPI post-troponin elevation in two different patient populations: A reliable risk-stratification tool. J Nucl Cardiol 2020; 27:2332-2336. [PMID: 31041679 DOI: 10.1007/s12350-019-01726-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Elona Rrapo Kaso
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Jamieson M Bourque
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA.
- Departments of Medicine and Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Box 800662, 1215 Lee Street, Charlottesville, VA, 22908, USA.
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Harjulahti E, Maaniitty T, Nammas W, Stenström I, Biancari F, Bax JJ, Knuuti J, Saraste A. Global and segmental absolute stress myocardial blood flow in prediction of cardiac events: [ 15O] water positron emission tomography study. Eur J Nucl Med Mol Imaging 2020; 48:1434-1444. [PMID: 33174090 PMCID: PMC8113164 DOI: 10.1007/s00259-020-05093-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/26/2020] [Indexed: 12/31/2022]
Abstract
Purpose We evaluated the value of reduced global and segmental absolute stress myocardial blood flow (sMBF) quantified by [15O] water positron emission tomography (PET) for predicting cardiac events in patients with suspected obstructive coronary artery disease (CAD). Methods Global and segmental sMBF during adenosine stress were retrospectively quantified in 530 symptomatic patients who underwent [15O] water PET for evaluation of coronary stenosis detected by coronary computed tomography angiography. Results Cardiovascular death, myocardial infarction, or unstable angina occurred in 28 (5.3%) patients at a 4-year follow-up. Reduced global sMBF was associated with events (area under the receiver operating characteristic curve 0.622, 95% confidence interval (95% CI) 0.538–0.707, p = 0.006). Reduced global sMBF (< 2.2 ml/g/min) was found in 22.8%, preserved global sMBF despite segmentally reduced sMBF in 35.3%, and normal sMBF in 41.9% of patients. Compared with normal sMBF, reduced global sMBF was associated with the highest risk of events (adjusted hazard ratio (HR) 6.970, 95% CI 2.271–21.396, p = 0.001), whereas segmentally reduced sMBF combined with preserved global MBF predicted an intermediate risk (adjusted HR 3.251, 95% CI 1.030–10.257, p = 0.044). The addition of global or segmental reduction of sMBF to clinical risk factors improved risk prediction (net reclassification index 0.498, 95% CI 0.118–0.879, p = 0.010, and 0.583, 95% CI 0.203–0.963, p = 0.002, respectively). Conclusion In symptomatic patients evaluated for suspected obstructive CAD, reduced global sMBF by [15O] water PET identifies those at the highest risk of adverse cardiac events, whereas segmental reduction of sMBF with preserved global sMBF is associated with an intermediate event risk.
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Affiliation(s)
- Esa Harjulahti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Wail Nammas
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | - Iida Stenström
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Fausto Biancari
- Department of Surgery, University of Turku, Turku, Finland
- Department of Surgery, University of Oulu, Oulu, Finland
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
- Heart Center, Turku University Hospital, Turku, Finland.
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EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2020; 48:1040-1069. [PMID: 33135093 PMCID: PMC7603916 DOI: 10.1007/s00259-020-05046-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed.
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Gaba P, Gersh BJ, Ali ZA, Moses JW, Stone GW. Complete versus incomplete coronary revascularization: definitions, assessment and outcomes. Nat Rev Cardiol 2020; 18:155-168. [PMID: 33067581 DOI: 10.1038/s41569-020-00457-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/14/2022]
Abstract
Coronary artery disease is the leading cause of morbidity and mortality worldwide. Selected patients with obstructive coronary artery disease benefit from revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Many (but not all) studies have demonstrated increased survival and greater freedom from adverse cardiovascular events after complete revascularization (CR) than after incomplete revascularization (ICR) in patients with multivessel disease. However, achieving CR after PCI or CABG surgery might not be feasible owing to patient comorbidities, anatomical factors, and technical or procedural considerations. These factors also mean that comparisons between CR and ICR are subject to multiple confounders and are difficult to understand or apply to real-world clinical practice. In this Review, we summarize and critically appraise the evidence linking various types of ICR to adverse outcomes in patients with multivessel disease and stable ischaemic heart disease, non-ST-segment elevation acute coronary syndrome or ST-segment elevation myocardial infarction, with or without cardiogenic shock. In addition, we provide practical recommendations for revascularization in patients with high-risk multivessel disease to optimize their long-term clinical outcomes and identify areas requiring future clinical investigation.
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Affiliation(s)
- Prakriti Gaba
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ziad A Ali
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Jeffrey W Moses
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY, USA. .,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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40
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Ahmadi A, Klein R, Lewin HC, Beanlands RSB, deKemp RA. Rubidium-82 generator yield and efficiency for PET perfusion imaging: Comparison of two clinical systems. J Nucl Cardiol 2020; 27:1728-1738. [PMID: 32436115 PMCID: PMC7599151 DOI: 10.1007/s12350-020-02200-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/18/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Strontium-82/Rubidium-82 (82Sr/82Rb) generators are used widely for positron emission tomography (PET) imaging of myocardial perfusion. In this study, the 82Rb isotope yield and production efficiency of two FDA-approved 82Sr/82Rb generators were compared. METHODS N = 515 sequential daily quality assurance (QA) reports from 9 CardioGen-82® and 9 RUBY-FILL® generators were reviewed over a period of 2 years. A series of test elutions was performed at different flow-rates on the RUBY-FILL® system to determine an empirical correction-factor used to convert CardioGen-82® daily QA values of 82Rb activity (dose-calibrator 'maximum' of 50 mL elution at 50 mL·min-1) to RUBY-FILL® equivalent values (integrated 'total' of 35 mL elution at 20 mL·min-1). The generator yield (82Rb) and production efficiency (82Rb yield/82Sr parent activity) were measured and compared after this conversion to a common scale. RESULTS At the start of clinical use, the system reported 82Rb activity from daily QA was lower for CardioGen-82® vs RUBY-FILL® (2.3 ± 0.2 vs 3.0 ± 0.2 GBq, P < 0.001) despite having similar 82Sr activity. Dose-calibrator 'maximum' (CardioGen-82®) values were found to under-estimate the integrated 'total' (RUBY-FILL®) activity by ~ 24% at 50 mL·min-1. When these data were used to convert the CardioGen-82 values to a common measurement scale (integrated total activity) the CardioGen-82® efficiency remained slightly lower than the RUBY-FILL® system on average (88 ± 4% vs 95 ± 4%, P < 0.001). The efficiency of 82Rb production improved for both systems over the respective periods of clinical use. CONCLUSIONS 82Rb generator yield was significantly under-estimated using the CardioGen-82® vs RUBY-FILL® daily QA procedure. When generator yield was expressed as the integrated total activity for both systems, the estimated 82Rb production efficiency of the CardioGen-82® system was ~ 7% lower than RUBY-FILL® over the full period of clinical use.
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Affiliation(s)
- Ali Ahmadi
- Division of Cardiology, University of Ottawa Heart Institute, National Cardiac PET Centre, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Ran Klein
- Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Howard C Lewin
- Cardiac Imaging Nuclear Associates, Los Angeles, CA, USA
| | - Rob S B Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, National Cardiac PET Centre, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Robert A deKemp
- Division of Cardiology, University of Ottawa Heart Institute, National Cardiac PET Centre, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
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Schindler TH, Bateman TM, Berman DS, Chareonthaitawee P, De Blanche LE, Dilsizian V, Dorbala S, Gropler RJ, Shaw L, Soman P, Winchester DE, Verberne H, Ahuja S, Beanlands RS, Di Carli MF, Murthy VL, Ruddy TD, Schwartz RG. Appropriate Use Criteria for PET Myocardial Perfusion Imaging. J Nucl Med 2020; 61:1221-1265. [PMID: 32747510 DOI: 10.2967/jnumed.120.246280] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | - Daniel S Berman
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Panithaya Chareonthaitawee
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Nuclear Cardiology, Fairfax, Virginia
| | | | - Vasken Dilsizian
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Nuclear Cardiology, Fairfax, Virginia
| | - Sharmila Dorbala
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Robert J Gropler
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Leslee Shaw
- American College of Cardiology, Washington, D.C.,Society of Cardiovascular Computed Tomography, Arlington, Virginia
| | - Prem Soman
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American College of Cardiology, Washington, D.C
| | | | - Hein Verberne
- European Association of Nuclear Medicine, Vienna, Austria
| | - Sukhjeet Ahuja
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Rob S Beanlands
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Nuclear Cardiology, Fairfax, Virginia.,American College of Cardiology, Washington, D.C.,Canadian Society of Cardiovascular Nuclear and CT Imaging, Ottawa, Ontario, Canada.,Canadian Cardiovascular Society, Ottawa, Ontario, Canada; and
| | - Marcelo F Di Carli
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Heart Association, Dallas, Texas
| | | | - Terrence D Ruddy
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,Canadian Society of Cardiovascular Nuclear and CT Imaging, Ottawa, Ontario, Canada.,Canadian Cardiovascular Society, Ottawa, Ontario, Canada; and
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Benz DC, Kaufmann PA, von Felten E, Benetos G, Rampidis G, Messerli M, Giannopoulos AA, Fuchs TA, Gräni C, Gebhard C, Pazhenkottil AP, Flammer AJ, Kaufmann PA, Buechel RR. Prognostic Value of Quantitative Metrics From Positron Emission Tomography in Ischemic Heart Failure. JACC Cardiovasc Imaging 2020; 14:454-464. [PMID: 32771569 DOI: 10.1016/j.jcmg.2020.05.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the prognostic and clinical value of quantitative positron emission tomographic (PET) metrics in patients with ischemic heart failure. BACKGROUND Although myocardial flow reserve (MFR) is a strong predictor of cardiac risk in patients without heart failure, it is unknown whether quantitative PET metrics improve risk stratification in patients with ischemic heart failure. METHODS The study included 254 patients referred for stress and rest myocardial perfusion imaging and viability testing using PET. Major adverse cardiac event(s) (MACE) consisted of death, resuscitated sudden cardiac death, heart transplantation, acute coronary syndrome, hospitalization for heart failure, and late revascularization. RESULTS MACE occurred in 170 patients (67%) during a median follow-up of 3.3 years. In a multivariate Cox proportional hazards model including multiple quantitative PET metrics, only MFR predicted MACE significantly (p = 0.013). Beyond age, symptom severity, diabetes mellitus, previous myocardial infarction or revascularization, 3-vessel disease, renal insufficiency, ejection fraction, as well as presence and burden of ischemia, scar, and hibernating myocardium, MFR was strongly associated with MACE (adjusted hazard ratio per increase in MFR by 1: 0.63; 95% confidence interval: 0.45 to 0.91). Incorporation of MFR into a risk assessment model incrementally improved the prediction of MACE (likelihood ratio chi-square test [16] = 48.61 vs. chi-square test [15] = 39.20; p = 0.002). CONCLUSIONS In this retrospective analysis of a single-center cohort, quantitative PET metrics of myocardial blood flow all improved risk stratification in patients with ischemic heart failure. However, in a hypothesis-generating analysis, MFR appears modestly superior to the other metrics as a prognostic index.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Philippe A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Georgios Benetos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Georgios Rampidis
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
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Relation between pharmacological stress ECG, 13NH3-PET/CT outcome and the occurrence of cardiac events during follow-up in women with chest pain. Nucl Med Commun 2020; 41:783-789. [DOI: 10.1097/mnm.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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A Clinical Tool to Identify Candidates for Stress-First Myocardial Perfusion Imaging. JACC Cardiovasc Imaging 2020; 13:2193-2202. [PMID: 32563652 DOI: 10.1016/j.jcmg.2020.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study sought to develop a clinical model that identifies a lower-risk population for coronary artery disease that could benefit from stress-first myocardial perfusion imaging (MPI) protocols and that can be used at point of care to risk stratify patients. BACKGROUND There is an increasing interest in stress-first and stress-only imaging to reduce patient radiation exposure and improve patient workflow and experience. METHODS A secondary analysis was conducted on a single-center cohort of patients undergoing single-photon emission computed tomography (SPECT) and positron emission tomography (PET) studies. Normal MPI was defined by the absence of perfusion abnormalities and other ischemic markers and the presence of normal left ventricular wall motion and left ventricular ejection fraction. A model was derived using a cohort of 18,389 consecutive patients who underwent SPECT and was validated in a separate cohort of patients who underwent SPECT (n = 5,819), 1 internal cohort of patients who underwent PET (n=4,631), and 1 external PET cohort (n = 7,028). RESULTS Final models were made for men and women and consisted of 9 variables including age, smoking, hypertension, diabetes, dyslipidemia, typical angina, prior percutaneous coronary intervention, prior coronary artery bypass graft, and prior myocardial infarction. Patients with a score ≤1 were stratified as low risk. The model was robust with areas under the curve of 0.684 (95% confidence interval [CI]: 0.674 to 0.694) and 0.681 (95% CI: 0.666 to 0.696) in the derivation cohort, 0.745 (95% CI: 0.728 to 0.762) and 0.701 (95% CI: 0.673 to 0.728) in the SPECT validation cohort, 0.672 (95% CI: 0.649 to 0.696) and 0.686 (95% CI: 0.663 to 0.710) in the internal PET validation cohort, and 0.756 (95% CI: 0.740 to 0.772) and 0.737 (95% CI: 0.716 to 0.757) in the external PET validation cohort in men and women, respectively. Men and women who scored ≤1 had negative likelihood ratios of 0.48 and 0.52, respectively. CONCLUSIONS A novel model, based on easily obtained clinical variables, is proposed to identify patients with low probability of having abnormal MPI results. This point-of-care tool may be used to identify a population that might qualify for stress-first MPI protocols.
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Mahmarian J. A tale of two technologies: Can nuclear cardiology survive the emergence of cardiac CT the seventeenth annual Mario S. Verani lectureship. J Nucl Cardiol 2020; 27:865-890. [PMID: 32476106 DOI: 10.1007/s12350-020-02086-4] [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: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
The Mario S. Verani Lectureship has traditionally been an opportunity for presenters to reflect on the state of nuclear cardiology in clinical practice and expound on new innovations in the field. Mario Verani was a visionary who embraced change and, as a cardiologist, sought to define where other cardiac imaging techniques might complement nuclear cardiology for improving patient care. Over the last decade, nuclear cardiology and cardiac computed tomography (CT) have developed in parallel with both expanding beyond the evaluation of coronary artery disease. However, many consider cardiac CT a formidable threat to nuclear cardiology due to pivotal technical innovations and its subsequent exponential growth in recent years. It is only fitting that this year's lectureship explore the relative value of both techniques in evaluating and managing cardiac disease, their relative strengths and weaknesses, and the potential value of combining nuclear cardiology and cardiac CT imaging for enhancing patient management. To Mario, my mentor, colleague for over 20 years and friend, this lectureship is truly in honor and remembrance of you.
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Affiliation(s)
- John Mahmarian
- Houston Methodist DeBakey Cardiology Associates, 6550 Fannin, Houston, TX, 77030, USA.
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El-Tallawi KC, Aljizeeri A, Nabi F, Al-Mallah MH. Myocardial Perfusion Imaging Using Positron Emission Tomography. Methodist Debakey Cardiovasc J 2020; 16:114-121. [PMID: 32670471 PMCID: PMC7350808 DOI: 10.14797/mdcj-16-2-114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Coronary artery disease (CAD), also known as ischemic heart disease, is a major cause of morbidity and mortality worldwide, and timely noninvasive diagnosis of clinical and subclinical CAD is imperative to mitigate its burden on individual patients and populations. Positron emission tomography (PET) is a versatile tool that can perform relative myocardial perfusion imaging (MPI) with high accuracy; furthermore, it provides valuable information about the coronary microvasculature using rest and stress myocardial blood flow (MBF) and coronary flow reserve (CFR) measurements. Several radiotracers are approved by the US Food and Drug Administration to help with MPI, MBF, and CFR evaluation. A large body of evidence indicates that evaluation of the coronary microcirculation using MBF and CFR provides strong diagnostic and prognostic data in a multitude of patient populations. This review describes the technical aspects of PET compared to other modalities and discusses its clinical uses for diagnosis and prognosis of coronary arterial epicardial and microcirculatory disease.
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Affiliation(s)
- K Carlos El-Tallawi
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | | | - Faisal Nabi
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Mouaz H Al-Mallah
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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Klein R, Celiker-Guler E, Rotstein BH, deKemp RA. PET and SPECT Tracers for Myocardial Perfusion Imaging. Semin Nucl Med 2020; 50:208-218. [PMID: 32284107 DOI: 10.1053/j.semnuclmed.2020.02.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Coronary artery disease has been the leading cause of death since the 1960s, which has motivated the research and development of myocardial perfusion imaging (MPI) agents for early diagnosis and to guide treatment. MPI with SPECT has been the clinical workhorse for MPI, but over the past two decades PET MPI is experiencing growth due to enhanced image quality that results in superior diagnostic accuracy over SPECT. Furthermore, dynamic PET imaging of the tracer distribution process from time of tracer administration to tracer accumulation in the myocardium has enabled routine quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR) in absolute units. MBF and MFR incrementally improve diagnostic and prognostic accuracy over MPI alone. In some cases (eg, rubidium PET imaging with pharmacologic stress) MPI, MBF, and MFR can be acquired simultaneously without incremental cost, radiation exposure, or significant processing time. Nuclear cardiology clinics have been looking to incorporate MBF quantification into clinical routine, but traditional SPECT and MPI tracers are inadequate for this challenge. Cardiac dedicated SPECT scanners can also perform dynamic imaging and have stimulated research into MBF quantification using SPECT tracers. New perfusion tracers must be tailored for emerging clinical needs (including MBF quantification), technical capabilities of imaging instrumentation, market constraints, and supply chain feasibility. Because these conditions have been evolving, tracers previously considered inferior may be reconsidered for future applications and some recently developed tracers may be suboptimal. This article reviews current, clinically-available tracers and those under development showing greatest potential. It discusses for each tracer the rationale for development, physiological mechanism of uptake by the myocardium, published evaluation results and development state. Finally, it gauges the suitability of each tracer for clinical application. The article demonstrates an acceleration in the pace of perfusion radiotracer development due to better understanding of the relevant physiology, better chemistry tools and small animal imaging. Consequently, bad tracers may fail faster and with less wasted investment, and good tracers may translate more efficiently from bench to bedside.
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Affiliation(s)
- Ran Klein
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada; The Ottawa Hospital, Division of Nuclear Medicine, Ottawa, ON, Canada
| | - Emel Celiker-Guler
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Benjamin H Rotstein
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Robert A deKemp
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada.
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Shaw LJ, Chandrashekhar Y. Resurgence of Novel Research in Nuclear Cardiology. JACC Cardiovasc Imaging 2020; 13:892-894. [PMID: 32139038 DOI: 10.1016/j.jcmg.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Quantitative myocardial perfusion PET/CT imaging is one of the most accurate tests for diagnosis and risk stratification of patients with suspected or known CAD. The test provides a comprehensive evaluation of patients with ischemic heart disease including quantitative assessments of regional myocardial perfusion, LV volumes and ejection fraction, calcified atherosclerotic burden, and myocardial blood flow and flow reserve (MFR). A normal stress myocardial blood flow and MFR (>2.0) has a very high negative predictive value and reliably excludes high-risk obstructive CAD. A global normal MFR (>2.0) identifies patients at consistently lower clinical risk. Conversely, a severely reduced MFR (<1.5) identifies patients at high clinical risk for adverse events regardless of whether this is due to obstructive CAD, microvascular dysfunction, or a combination of the 2. On the other hand, the delineation of atherosclerotic burden with either a formal quantitative coronary calcium score or by a semiquantitative assessment of the CT transmission scan is very helpful to guide the need for intensive preventive therapies. Recent evidence suggests that patients with angiographically obstructive CAD and a severe reduction in flow reserve (<1.6) may have a prognostic advantage from revascularization. This finding awaits confirmation by randomized clinical trials.
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Affiliation(s)
- Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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