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Propafenone use in coronary artery disease patients undergoing atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 65:381-389. [PMID: 35366133 DOI: 10.1007/s10840-022-01186-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/15/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antiarrhythmic drugs (AADs) are frequently used after atrial fibrillation (AF) ablation. Class IC AAD use after AF ablation in patients with coronary artery disease (CAD) is uncertain. The aim was to evaluate propafenone use in CAD patients undergoing AF ablation and to compare propafenone with amiodarone regarding ventricular arrhythmia and mortality. METHODS In this retrospective, longitudinal cohort study, consecutive patients with mild to moderate CAD, undergoing AF ablation and receiving either propafenone (study group, n = 263) or amiodarone (control group, n = 499) in the blanking period, were included. After propensity score matching, 212 patients in each group were compared for the primary outcome defined as a composite of ventricular arrhythmic events, which included sudden cardiac death, sustained ventricular tachycardia or fibrillation, or non-sustained ventricular tachycardia (NSVT). Cardiovascular and non-cardiovascular mortality were evaluated as secondary outcomes. RESULTS Baseline variables of the study and control groups were well matched after propensity score matching. At 12-month follow up, 20 patients (4.7%) (11 in propafenone group and 9 in amiodarone group) experienced the primary outcome measure of NSVT (Gray test p = 0.645). No sustained ventricular tachycardia, ventricular fibrillation, sudden cardiac death, or cardiovascular mortality were observed. On multivariable competing analysis, age and diabetes but not propafenone use (hazard ratio 1.017; p = 0.804) were found to be independent and significant predictors of the primary outcome measure. CONCLUSION Propafenone use after AF ablation in patients with mild to moderate CAD had a safety profile similar to amiodarone and was not associated with major arrhythmic events.
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Fang W, Liu S. New 99mTc Radiotracers for Myocardial Perfusion Imaging by SPECT. Curr Radiopharm 2019; 12:171-186. [PMID: 30727939 DOI: 10.2174/1874471012666190206102214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Myocardial Perfusion Imaging (MPI) with radiotracers is an integral component in evaluation of the patients with known or suspected coronary artery diseases (CAD). 99mTc-Sestamibi and 99mTc-Tetrofosmin are commercial radiopharmaceuticals for MPI by single photon-emission computed tomography (SPECT). Despite their widespread clinical applications, they do not meet the requirements of an ideal perfusion imaging agent due to their inability to linearly track the regional myocardial blood flow rate at >2.5 mL/min/g. With tremendous development of CZT-based SPECT cameras over the past several years, the nuclear cardiology community has been calling for better perfusion radiotracers with improved extraction and biodistribution properties. METHODS This review will summarize recent research efforts on new cationic and neutral 99mTc radiotracers for SPECT MPI. The goal of these efforts is to develop a 99mTc radiotracer that can be used to detect perfusion defects at rest or under stress, determine the regional myocardial blood flow, and measure the perfusion and left ventricular function. RESULTS The advantage of cationic radiotracers (e.g. 99mTc-Sestamibi) is their long myocardial retention because of the positive molecular charge and fast liver clearance kinetics. 99mTc-Teboroxime derivatives have a high initial heart uptake (high first-pass extraction fraction) due to their neutrality. 99mTc- 3SPboroxime is the most promising radiotracer for future clinical translation considering its initial heart uptake, myocardial retention time, liver clearance kinetics, heart/liver ratios and SPECT image quality. CONCLUSION 99mTc-3SPboroximine is an excellent example of perfusion radiotracers, the heart uptake of which is largely relies on the regional blood flow. It is possible to use 99mTc-3SPboroximine for detection of perfusion defect(s), accurate quantification and determination of regional blood flow rate. Development of such a 99mTc radiotracer is of great clinical benefit for accurate diagnosis of CAD and assessing the risk of future hard events (e.g. heart attack and sudden death) in cardiac patients.
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Affiliation(s)
- Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, the National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Shuang Liu
- School of Health Sciences, Purdue University, Beijing, IN 47907, United States
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Motaleb MA, Selim AA. Dioximes: Synthesis and biomedical applications. Bioorg Chem 2019; 82:145-155. [DOI: 10.1016/j.bioorg.2018.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 12/31/2022]
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Zhao ZQ, Liu M, Fang W, Liu S. Sulfonyl-Containing Boronate Caps for Optimization of Biological Properties of 99mTc(III) Radiotracers [99mTcCl(CDO)(CDOH)2B-R] (CDOH2 = Cyclohexanedione Dioxime). J Med Chem 2017; 61:319-328. [PMID: 29186661 DOI: 10.1021/acs.jmedchem.7b01412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Zuo-Quan Zhao
- Department of
Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical
College, No.167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Min Liu
- School
of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, Indiana 47907, United States
| | - Wei Fang
- Department of
Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical
College, No.167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Shuang Liu
- School
of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, Indiana 47907, United States
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Liu M, Liu S. 99mTc-3Cboroxime: a novel 99mTc(iii) complex [99mTcCl(CDO)(CDOH)2B-3C] (CDOH2 = cyclohexanedione dioxime; 3C-B(OH)2 = 3-(carbamoylphenyl)boronic acid) with high heart uptake and long myocardial retention. Dalton Trans 2017; 46:14509-14518. [DOI: 10.1039/c7dt01292f] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this study, we found that 99mTc-3Cboroxime has the myocardial retention longer than that of 99mTc-Teboroxime, and its heart washout kinetics follows a regressive linear relationship over the 60 min period.
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Affiliation(s)
- Min Liu
- Department of Radiation Medicine and Protection
- Medical College
- Soochow University
- China
- School of Health Sciences
| | - Shuang Liu
- School of Health Sciences
- Purdue University
- USA
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Liu M, Zheng Y, Avcibasi U, Liu S. Novel 99mTc(III)-azide complexes [ 99mTc(N 3)(CDO)(CDOH) 2B-R] (CDOH 2=cyclohexanedione dioxime) as potential radiotracers for heart imaging. Nucl Med Biol 2016; 43:732-741. [PMID: 27632344 DOI: 10.1016/j.nucmedbio.2016.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In this study, novel 99mTc(III)-azide complexes [99mTc(N3)(CDO)(CDOH)2B-R] (99mTc-ISboroxime-N3: R=IS; 99mTc-MPboroxime-N3: R=MP; 99mTc-PAboroxime-N3: R=PA; 99mTc-PYboroxime-N3: R=PY; and 99mTc-Uboroxime-N3: R=5U) were evaluated as heart imaging agents. METHODS Complexes [99mTc(N3)(CDO)(CDOH)2B-R] (R=IS, MP, PA, PY and 5U) were prepared by ligand exchange between NaN3 and [99mTcCl(CDO)(CDOH)2B-R]. Biodistribution and imaging studies were carried out in Sprague-Dawley rats. Image quantification was performed to compare their initial heart uptake and myocardial retention. RESULTS 99mTc-ISboroxime-N3, 99mTc-PYboroxime-N3 and 99mTc-Uboroxime-N3 were prepared with high RCP (93-98%) while the RCP of 99mTc-MPboroxime-N3 and 99mTc-PAboroxime-N3 was 80-85%. The myocardial retention curves of 99mTc-ISboroxime-N3, 99mTc-PYboroxime-N3 and 99mTc-Uboroxime-N3 were best fitted to the bi-exponential decay function. The half-time of the fast component was 1.6±0.4min for 99mTc-ISboroxime-N3, 0.7±0.1min for 99mTc-PYboroxime-N3 and 0.9±0.4min for 99mTc-Uboroxime-N3. The 2-min heart uptake from biodistribution studies followed the ranking order of 99mTc-ISboroxime-N3 (3.60±0.68%ID/g)>99mTc-PYboroxime-N3 (2.35±0.37%ID/g)≫99mTc-Uboroxime-N3 (1.29±0.06%ID/g). 99mTc-ISboroxime-N3 had the highest 2-min heart uptake among 99mTc radiotracers revaluated in SD rats. High quality SPECT images were obtained with the right and left ventricular walls being clearly delineated. The best image acquisition window was 0-5min for 99mTc-ISboroxime-N3. CONCLUSION Both azide coligand and boronate caps had significant impact on the heart uptake and myocardial retention of complexes [99mTc(N3)(CDO)(CDOH)2B-R]. Among the radiotracers evaluated in SD rats, 99mTc-ISboroxime-N3 has the highest initial heart uptake with the heart retention comparable to that of 99mTc-Teboroxime. 99mTc-ISboroxime-N3 is a promising alternative to 99mTc-Teboroxime for SPECT MPI.
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Affiliation(s)
- Min Liu
- Department of Radiation Medicine and Protection, Medical College, Soochow University, China; School of Health Sciences, Purdue University, IN, 47907, USA
| | - Yumin Zheng
- Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing, 100037, China
| | - Ugur Avcibasi
- School of Health Sciences, Purdue University, IN, 47907, USA; Department of Chemistry, Faculty of Arts and Science, Celal Bayar University, 45040, Yunusemre/Manisa, Turkey
| | - Shuang Liu
- School of Health Sciences, Purdue University, IN, 47907, USA.
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Liu M, Fang W, Liu S. Novel 99mTc(III) Complexes [99mTcCl(CDO)(CDOH)2B–R] (CDOH2 = Cyclohexanedione Dioxime) Useful as Radiotracers for Heart Imaging. Bioconjug Chem 2016; 27:2770-2779. [DOI: 10.1021/acs.bioconjchem.6b00552] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Min Liu
- Department
of Radiation Medicine and Protection, Medical College, Soochow University, China
- School
of Health Sciences, Purdue University, Indiana 47907, United States
| | - Wei Fang
- Department
of Nuclear Medicine, Fuwai Hospital, the National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Liu
- School
of Health Sciences, Purdue University, Indiana 47907, United States
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Yang Y, Zheng Y, Tomaselli E, Fang W, Liu S. Impact of Boronate Capping Groups on Biological Characteristics of Novel99mTc(III) Complexes [99mTcCl(CDO)(CDOH)2B-R] (CDOH2= Cyclohexanedione Dioxime). Bioconjug Chem 2015; 26:316-28. [PMID: 25585053 DOI: 10.1021/bc500583k] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yong Yang
- Department of Nuclear Medicine, Cardiovascular Institute & Fu Wai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, China
- School of Health Sciences, Purdue University, West Lafayette, Indiana 47907, United States
| | - Yumin Zheng
- Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Elena Tomaselli
- School of Health Sciences, Purdue University, West Lafayette, Indiana 47907, United States
| | - Wei Fang
- Department of Nuclear Medicine, Cardiovascular Institute & Fu Wai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, China
| | - Shuang Liu
- School of Health Sciences, Purdue University, West Lafayette, Indiana 47907, United States
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Zheng Y, Ji S, Tomaselli E, Ernest C, Freiji T, Liu S. Effect of co-ligands on chemical and biological properties of (99m)Tc(III) complexes [(99m)Tc(L)(CDO)(CDOH)2BMe] (L=Cl, F, SCN and N3; CDOH2=cyclohexanedione dioxime). Nucl Med Biol 2014; 41:813-24. [PMID: 25169135 PMCID: PMC4381195 DOI: 10.1016/j.nucmedbio.2014.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/19/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION (99m)Tc-Teboroxime ([(99m)TcCl(CDO)(CDOH)2BMe]) is a member of the BATO (boronic acid adducts of technetium dioximes) class of (99m)Tc(III) complexes. This study sought to explore the impact of co-ligands on solution stability, heart uptake and myocardial retention of [(99m)Tc(L)(CDO)(CDOH)2BMe] ((99m)Tc-Teboroxime: L=Cl; (99m)Tc-Teboroxime(F): L=F; (99m)Tc-Teboroxime(SCN): L=SCN; and (99m)Tc-Teboroxime(N3): L=N3). METHODS Radiotracers (99m)Tc-Teboroxime(L) (L=F, SCN and N3) were prepared by reacting (99m)Tc-Teboroxime with NaF, NaSCN and NaN3, respectively. Biodistribution and imaging studies were carried out in Sprague-Dawley rats. Image quantification was performed to compare their heart retention and liver clearance kinetics. RESULTS Complexes (99m)Tc-Teboroxime(L) (L=F, SCN and N3) were prepared in high yield with high radiochemical purity. All new radiotracers were stable for >6h in the kit matrix. In its HPLC chromatogram, (99m)Tc-Teboroxime showed one peak at ~15.5 min, which was shorter than that of (99m)Tc-Teboroxime(F) (~16.4 min). There were two peaks for (99m)Tc-Teboroxime(SCN) at 16.5 and 18.3 min. (99m)Tc-Teboroxime(N3) appeared as a single peak at 18.4 min. Their heart retention and liver clearance curves were best fitted to the bi-exponential decay function. The half-times of fast/slow components were 1.6±0.4/60.7±8.9 min for (99m)Tc-Teboroxime, 0.8±0.2/101.7±20.7 min for (99m)Tc-Teboroxime(F), 1.2±0.3/84.8±16.6 min for (99m)Tc-Teboroxime(SCN), and 2.9±0.9/51.6±5.0 min for (99m)Tc-Teboroxime(N3). The 2-min heart uptake followed the order of (99m)Tc-Teboroxime (3.00±0.37%ID/g)>(99m)Tc-Teboroxime(N3) (2.66±0.01 %ID/g)≈(99m)Tc-Sestamibi (2.55±0.46 %ID/g)>(99m)TcN-MPO (2.38±0.15 %ID/g). (99m)Tc-Teboroxime remains the best in first-pass extraction. The best image acquisition window is 0-5 min for (99m)Tc-Teboroximine and 0-15 min for (99m)Tc-Teboroximine(N3). CONCLUSION Co-ligands had significant impact on the heart uptake and myocardial retention of complexes [(99m)Tc(L)(CDO)(CDOH)2BMe] (L=Cl, F, SCN and N3). Future studies should be directed towards minimizing the liver uptake and radioactivity accumulation in the blood vessels while maintaining their high heart uptake.
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Affiliation(s)
- Yumin Zheng
- School of Health Sciences, Purdue University, IN 47907, USA; Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Shundong Ji
- School of Health Sciences, Purdue University, IN 47907, USA
| | | | - Carley Ernest
- School of Health Sciences, Purdue University, IN 47907, USA
| | - Tom Freiji
- School of Health Sciences, Purdue University, IN 47907, USA
| | - Shuang Liu
- School of Health Sciences, Purdue University, IN 47907, USA.
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Zheng Y, Ji S, Tomaselli E, Liu S. Development of kit formulations for (99m) TcN-MPO: a cationic radiotracer for myocardial perfusion imaging. J Labelled Comp Radiopharm 2014; 57:584-92. [PMID: 25070025 DOI: 10.1002/jlcr.3221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 06/30/2014] [Accepted: 07/03/2014] [Indexed: 11/11/2022]
Abstract
The objective of this study was to develop a kit formulation for [(99m) TcN(mpo)(PNP5)](+) (MPO = 2-mercaptopyridine oxide), ((99m) TcN-MPO) to support its clinical evaluations as a SPECT radiotracer. Radiolabeling studies were performed using three different formulations (two-vial formulation and single-vial formulations with/without SnCl2 ) to explore the factors influencing radiochemical purity (RCP) of (99m) TcN-MPO. We found that the most important factor affecting the RCP of (99m) TcN-MPO was the purity of PNP5. (99m) TcN-MPO was prepared >98% RCP (n = 20) using the two-vial formulation. For single-vial formulations with/without SnCl2 , β-cyclodextrin (β-CD) is particularly useful as a stabilizer for PNP5. The RCP of (99m) TcN-MPO was 95-98% using β-CD, but its RCP was only 90-93% with γ-cyclodextrin (γ-CD). It seems that PNP5 fits better into the inner cavity of β-CD, which forms more stable inclusion complex than γ-CD in the single-vial formulations. The results from biodistribution and imaging studies in Sprague-Dawley rats clearly demonstrated biological equivalence of three different formulations. Single photon-emission computed tomography data suggested that high quality images could be obtained at 0-30-min post-injection without significant interference from the liver radioactivity. Considering the ease for (99m) Tc-labeling and high RCP of (99m) TcN-MPO, the non-SnCl2 single-vial formulation is an attractive choice for future clinical studies.
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Affiliation(s)
- Yumin Zheng
- School of Health Sciences, Purdue University, West Lafayette, IN, 47907, USA; Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
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Stirrup J, Maenhout A, Wechalekar K, Anagnostopoulos C. Radionuclide imaging in ischaemic heart failure. Br Med Bull 2009; 92:43-59. [PMID: 19710085 DOI: 10.1093/bmb/ldp029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION OR BACKGROUND Many tests are available for the investigation of patients with heart failure. The identification of the underlying aetiology of ventricular dysfunction is crucial as early treatment may limit or even reverse myocardial abnormalities. SOURCES OF DATA This article describes cardiac radionuclide imaging techniques and their applications in ischaemic ventricular dysfunction. Evidence for the role of these techniques is summarized with particular reference to current guidelines. AREAS OF AGREEMENT Both positron emission tomography (PET) and single photon emission computed tomography (SPECT) techniques are widely validated for the detection of myocardial viability and their use is recommended in both national and international guidelines. AREAS OF CONTROVERSY Although assessments of ventricular phase and myocardial innervation hold promise for the stratification of patients to cardiac resynchronization therapy, the poor performance of echocardiographic predictors of response in the recently published PROSPECT trial suggest that these techniques face a tough challenge. GROWING POINTS The use of integrated multimodality imaging techniques such as PET/computed tomography to assess for ischaemic causes of left ventricular dysfunction is an area that is currently under investigation, as is the role of nuclear techniques in the assessment of stem cell retention, distribution and function when used in patients with heart failure. AREAS TIMELY FOR DEVELOPING RESEARCH Ongoing developments in radionuclide molecular imaging for assessment of angiogenesis, apoptosis and interstitial alterations during cardiac remodeling may have important implications for the prognosis and treatment of patients with heart failure.
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Affiliation(s)
- James Stirrup
- Department of Nuclear Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Saint Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
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