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Yu W, Yang L, Zhang F, Liu B, Shi Y, Wang J, Shao X, Chen Y, Yang X, Wang Y. Machine learning to predict hemodynamically significant CAD based on traditional risk factors, coronary artery calcium and epicardial fat volume. J Nucl Cardiol 2023; 30:2593-2606. [PMID: 37434084 DOI: 10.1007/s12350-023-03333-0] [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: 01/31/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023]
Abstract
We sought to establish an explainable machine learning (ML) model to screen for hemodynamically significant coronary artery disease (CAD) based on traditional risk factors, coronary artery calcium (CAC) and epicardial fat volume (EFV) measured from non-contrast CT scans. 184 symptomatic inpatients who underwent Single Photon Emission Computed Tomography/Myocardial Perfusion Imaging (SPECT/MPI) and Invasive Coronary Angiography (ICA) were enrolled. Clinical and imaging features (CAC and EFV) were collected. Hemodynamically significant CAD was defined when coronary stenosis severity ≥ 50% with a matched reversible perfusion defect in SPECT/MPI. Data was randomly split into a training cohort (70%) on which five-fold cross-validation was done and a test cohort (30%). The normalized training phase was preceded by the selection of features using recursive feature elimination (RFE). Three ML classifiers (LR, SVM, and XGBoost) were used to construct and choose the best predictive model for hemodynamically significant CAD. An explainable approach based on ML and the SHapley Additive exPlanations (SHAP) method was deployed to generate individual explanation of the model's decision. In the training cohort, hemodynamically significant CAD patients had significantly higher age, BMI and EFV, higher proportions of hypertension and CAC comparing with controls (P all < .05). In the test cohorts, hemodynamically significant CAD had significantly higher EFV and higher proportion of CAC. EFV, CAC, diabetes mellitus (DM), hypertension, and hyperlipidemia were the highest ranking features by RFE. XGBoost produced better performance (AUC of 0.88) compared with traditional LR model (AUC of 0.82) and SVM (AUC of 0.82) in the training cohort. Decision Curve Analysis (DCA) demonstrated that XGBoost model had the highest Net Benefit index. Validation of the model also yielded a favorable discriminatory ability with the AUC, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 0.89, 68.0%, 96.8%, 94.4%, 79.0% and 83.9% in the XGBoost model. A XGBoost model based on EFV, CAC, hypertension, DM and hyperlipidemia to assess hemodynamically significant CAD was constructed and validated, which showed favorable predictive value. ML combined with SHAP can offer a transparent explanation of personalized risk prediction, enabling physicians to gain an intuitive understanding of the impact of key features in the model.
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Affiliation(s)
- Wenji Yu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Le Yang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Bao Liu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Jianfeng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Yongjun Chen
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaoyu Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China.
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Takahashi K, Kajiya T, Ishihara M. Proposal for a Display Method for Myocardial Single Photon Emission Computed Tomography Based on Left Ventricular Volume. Int Heart J 2023; 64:993-1001. [PMID: 37967986 DOI: 10.1536/ihj.23-251] [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] [Indexed: 11/17/2023]
Abstract
Bull's eye view for the display of myocardial single-photon emission computed tomography (SPECT) 3-D perfusion maps does not reflect left ventricular (LV) volume, an important parameter. We created and evaluated a myocardial SPECT display method that reflects the LV volume.Using Digital Imaging and Communications in Medicine data, short-axis slices from the apex to the base were reconstructed and interpolated into 0.5-mm thickness. We obtained the radial lengths at 1° intervals throughout 360°, and calculated the length of the LV long axis and half circumference (1/2 circ). Myocardial perfusion was displayed as 2 ellipsoidal developments that exhibited the left anterior descending coronary artery (LAD) and non-LAD regions. We created a system that can display these processes on a personal computer. Myocardial SPECT data from 526 individuals without heart disease were analyzed. The long axis and 1/2 circ were compared with the body size, LV end-diastolic diameter (LVDd) obtained by echocardiography, and the end-diastolic volume (EDV) obtained by electrocardiogram-gated SPECT analysis. The 1/2 circle correlated with the LVDd and EDV. The images obtained allowed a diagnosis comparable to that made using the conventional coordinate display system.The new myocardial display reflects ischemia and LV volume within a single image, which cannot be achieved with conventional SPECT image display. Additional studies of this display system are required to allow its application to patients with heart disease.
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Affiliation(s)
- Keiko Takahashi
- Department of Patient Safety and Quality Management, School of Medicine, Hyogo Medical University
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University
| | | | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University
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Horgan S, Sanghani R, Miller S, Al-Mallah M, Bateman T, Beanlands R, Calnon D, Chareonthaitawee P, Di Carli M, Patel KK, Soman P, Thompson R, Winchester D, Heller G. ASNC model coverage policy: 2023 cardiac positron emission tomography. J Nucl Cardiol 2023; 30:2114-2185. [PMID: 37670174 DOI: 10.1007/s12350-023-03355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/07/2023]
Affiliation(s)
| | | | - Sue Miller
- Molecular Imaging Services, Inc., Newark, DE, USA
| | - Mouaz Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Timothy Bateman
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Rob Beanlands
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Dennis Calnon
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | | | | | | | - Prem Soman
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - David Winchester
- Malcom Randall VA Medical Center, University of Florida College of Medicine, Gainesville, FL, USA
| | - Gary Heller
- Morristown Medical Center, Morristown, NJ, USA
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Mohebi M, Amini M, Alemzadeh-Ansari MJ, Alizadehasl A, Rajabi AB, Shiri I, Zaidi H, Orooji M. Post-revascularization Ejection Fraction Prediction for Patients Undergoing Percutaneous Coronary Intervention Based on Myocardial Perfusion SPECT Imaging Radiomics: a Preliminary Machine Learning Study. J Digit Imaging 2023; 36:1348-1363. [PMID: 37059890 PMCID: PMC10407007 DOI: 10.1007/s10278-023-00820-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/16/2023] Open
Abstract
In this study, the ability of radiomics features extracted from myocardial perfusion imaging with SPECT (MPI-SPECT) was investigated for the prediction of ejection fraction (EF) post-percutaneous coronary intervention (PCI) treatment. A total of 52 patients who had undergone pre-PCI MPI-SPECT were enrolled in this study. After normalization of the images, features were extracted from the left ventricle, initially automatically segmented by k-means and active contour methods, and finally edited and approved by an expert radiologist. More than 1700 2D and 3D radiomics features were extracted from each patient's scan. A cross-combination of three feature selections and seven classifier methods was implemented. Three classes of no or dis-improvement (class 1), improved EF from 0 to 5% (class 2), and improved EF over 5% (class 3) were predicted by using tenfold cross-validation. Lastly, the models were evaluated based on accuracy, AUC, sensitivity, specificity, precision, and F-score. Neighborhood component analysis (NCA) selected the most predictive feature signatures, including Gabor, first-order, and NGTDM features. Among the classifiers, the best performance was achieved by the fine KNN classifier, which yielded mean accuracy, AUC, sensitivity, specificity, precision, and F-score of 0.84, 0.83, 0.75, 0.87, 0.78, and 0.76, respectively, in 100 iterations of classification, within the 52 patients with 10-fold cross-validation. The MPI-SPECT-based radiomic features are well suited for predicting post-revascularization EF and therefore provide a helpful approach for deciding on the most appropriate treatment.
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Affiliation(s)
- Mobin Mohebi
- Department of Biomedical Engineering, Tarbiat Modares University, Tehran, Iran
| | - Mehdi Amini
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva 4, Switzerland
| | | | - Azin Alizadehasl
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Bitarafan Rajabi
- Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva 4, Switzerland
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva 4, Switzerland
- Geneva University Neuro Center, Geneva University, Geneva, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Mahdi Orooji
- Department of Biomedical Engineering, Tarbiat Modares University, Tehran, Iran
- Department of Electrical and Computer Engineering, University of California–Davis, Davis, CA USA
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Meng X, Gao J, Zhang K, Jun W, Wang JJ, Wang XL, Wang YGS, Zheng JL, Liu YP, Song JJ, Yang J, Zheng YT, Li C, Wang WY, Shao C, Tang YD. The triglyceride-glucose index as a potential protective factor for hypertrophic obstructive cardiomyopathy without diabetes: evidence from a two-center study. Diabetol Metab Syndr 2023; 15:143. [PMID: 37386489 DOI: 10.1186/s13098-023-01084-z] [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: 04/12/2023] [Accepted: 05/09/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the relationship between the TyG (Triglyceride-glucose index) and the prognosis of patients with HOCM (hypertrophic obstructive cardiomyopathy) without diabetes. RESEARCH DESIGN AND METHODS A total of 713 eligible patients with HOCM were enrolled in this study and divided into two groups based on treatment: an invasive treatment group (n = 461) and a non-invasive treatment group (n = 252). The patients in both two groups were then divided into three groups based on their TyG index levels. The primary endpoints of this study were Cardiogenic death during long-term follow-up. Kaplan-Meier analysis was used to study the cumulative survival of different groups. Restricted cubic spline was used to model nonlinear relationships between the TyG index and primary endpoints. Myocardial perfusion imaging/Myocardial metabolic imaging examinations were performed to assess glucose metabolism in the ventricular septum of the HOCM patients. RESULTS The follow-up time of this study was 41.47 ± 17.63 months. The results showed that patients with higher TyG index levels had better clinical outcomes (HR, 0.215; 95% CI 0.051,0.902; P = 0.036, invasive treatment group; HR, 0.179; 95% CI 0.063,0.508; P = 0.001, non-invasive treatment group). Further analysis showed that glucose metabolism in the ventricular septum was enhanced in HOCM patients. CONCLUSIONS The findings of this study suggest that the TyG index may serve as a potential protective factor for patients with HOCM without diabetes. The enhanced glucose metabolism in the ventricular septum of HOCM patients may provide a potential explanation for the relationship between the TyG index and HOCM prognosis.
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Affiliation(s)
- Xiangbin Meng
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, China
| | - Jun Gao
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, China
| | - Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Wen Jun
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jing-Jia Wang
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, China
| | - Xu-Liang Wang
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, China
| | - Yuan-Geng-Shuo Wang
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, China
| | - Ji-Lin Zheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yu-Peng Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jing-Jing Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jie Yang
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, China
| | - Yi-Tian Zheng
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, China
| | - Chen Li
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, China
| | - Wen-Yao Wang
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, China.
| | - Chunli Shao
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, China.
| | - Yi-Da Tang
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No.49 Huayuanbei Road, Beijing, 100191, China.
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Prieto Canalejo MA, Palau San Pedro A, Geronazzo R, Minsky DM, Juárez-Orozco LE, Namías M. Synthetic Attenuation Correction Maps for SPECT Imaging Using Deep Learning: A Study on Myocardial Perfusion Imaging. Diagnostics (Basel) 2023; 13:2214. [PMID: 37443608 DOI: 10.3390/diagnostics13132214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: The CT-based attenuation correction of SPECT images is essential for obtaining accurate quantitative images in cardiovascular imaging. However, there are still many SPECT cameras without associated CT scanners throughout the world, especially in developing countries. Performing additional CT scans implies troublesome planning logistics and larger radiation doses for patients, making it a suboptimal solution. Deep learning (DL) offers a revolutionary way to generate complementary images for individual patients at a large scale. Hence, we aimed to generate linear attenuation coefficient maps from SPECT emission images reconstructed without attenuation correction using deep learning. (2) Methods: A total of 384 SPECT myocardial perfusion studies that used 99mTc-sestamibi were included. A DL model based on a 2D U-Net architecture was trained using information from 312 patients. The quality of the generated synthetic attenuation correction maps (ACMs) and reconstructed emission values were evaluated using three metrics and compared to standard-of-care data using Bland-Altman plots. Finally, a quantitative evaluation of myocardial uptake was performed, followed by a semi-quantitative evaluation of myocardial perfusion. (3) Results: In a test set of 66 test patients, the ACM quality metrics were MSSIM = 0.97 ± 0.001 and NMAE = 3.08 ± 1.26 (%), and the reconstructed emission quality metrics were MSSIM = 0.99 ± 0.003 and NMAE = 0.23 ± 0.13 (%). The 95% limits of agreement (LoAs) at the voxel level for reconstructed SPECT images were: [-9.04; 9.00]%, and for the segment level, they were [-11; 10]%. The 95% LoAs for the Summed Stress Score values between the images reconstructed were [-2.8, 3.0]. When global perfusion scores were assessed, only 2 out of 66 patients showed changes in perfusion categories. (4) Conclusion: Deep learning can generate accurate attenuation correction maps from non-attenuation-corrected cardiac SPECT images. These high-quality attenuation maps are suitable for attenuation correction in myocardial perfusion SPECT imaging and could obviate the need for additional imaging in standalone SPECT scanners.
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Affiliation(s)
| | | | - Ricardo Geronazzo
- Fundación Centro Diagnóstico Nuclear (FCDN), Buenos Aires C1417CVE, Argentina
| | - Daniel Mauricio Minsky
- Centro Atómico Constituyentes, Comisión Nacional de Energía Atómica, San Martín B1650LWP, Argentina
| | | | - Mauro Namías
- Fundación Centro Diagnóstico Nuclear (FCDN), Buenos Aires C1417CVE, Argentina
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Higaki A, Kawaguchi N, Kurokawa T, Okabe H, Kazatani T, Kido S, Aono T, Matsuda K, Tanaka Y, Hosokawa S, Kosaki T, Kawamura G, Shigematsu T, Kawada Y, Hiasa G, Yamada T, Okayama H. Content-based image retrieval for the diagnosis of myocardial perfusion imaging using a deep convolutional autoencoder. J Nucl Cardiol 2023; 30:540-549. [PMID: 35802346 DOI: 10.1007/s12350-022-03030-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) plays a crucial role in the optimal treatment strategy for patients with coronary heart disease. We tested the feasibility of feature extraction from MPI using a deep convolutional autoencoder (CAE) model. METHODS Eight hundred and forty-three pairs of stress and rest myocardial perfusion images were collected from consecutive patients who underwent cardiac scintigraphy in our hospital between December 2019 and February 2022. We trained a CAE model to reproduce the input paired image data, so as the encoder to output a 256-dimensional feature vector. The extracted feature vectors were further dimensionally reduced via principal component analysis (PCA) for data visualization. Content-based image retrieval (CBIR) was performed based on the cosine similarity of the feature vectors between the query and reference images. The agreement of the radiologist's finding between the query and retrieved MPI was evaluated using binary accuracy, precision, recall, and F1-score. RESULTS A three-dimensional scatter plot with PCA revealed that feature vectors retained clinical information such as percent summed difference score, presence of ischemia, and the location of scar reported by radiologists. When CBIR was used as a similarity-based diagnostic tool, the binary accuracy was 81.0%. CONCLUSION The results indicated the utility of unsupervised feature learning for CBIR in MPI.
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Affiliation(s)
- Akinori Higaki
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan.
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon, Japan.
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Tsukasa Kurokawa
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Hikaru Okabe
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Takuro Kazatani
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Shinsuke Kido
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Tetsuya Aono
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Kensho Matsuda
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Yuta Tanaka
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Saki Hosokawa
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Tetsuya Kosaki
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Go Kawamura
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Tatsuya Shigematsu
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Yoshitaka Kawada
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Go Hiasa
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Tadakatsu Yamada
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, 790-0024, Japan
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Verrecchia-Ramos E, Morel O, Beauchat V, Denet S, Djibo Sidikou A, Ginet M, Pfletschinger E, Teodor L, Trombowsky M, Verdier J, Vère C, Retif P, Mahmoud SB. Personalization of 99mTc-sestamibi activity in SPECT/CT myocardial perfusion imaging with the cardiofocal SmartZoom® collimator. EJNMMI Phys 2023; 10:23. [PMID: 36959483 PMCID: PMC10036680 DOI: 10.1186/s40658-023-00545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/14/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Patient radioprotection in myocardial perfusion imaging (MPI)-SPECT is important but difficult to optimize. The aim of this study was to adjust injected activity according to patient size-weight or BMI-by using a cardiofocal collimator camera. METHODS The correlation equation between size and observed counts in image was determined in patients who underwent stress Tc-99m-sestamibi MPI-SPECT/CT with a cardiofocal collimator-equipped conventional Anger SPECT/CT system. Image quality analyses by seven nuclear physicians were conducted to determine the minimum patient size-independent observed count threshold that yielded sufficient image quality for perfusion-defect diagnosis. These data generated an equation that can be used to calculate personalized activity for patients according to their size. RESULTS Analysis of consecutive patients (n = 294) showed that weight correlated with observed counts better than body mass index. The correlation equation was used to generate the equation that expressed the relationship between observed counts, patient weight, and injected activity. Image quality analysis with 50 images yielded an observed count threshold of 22,000 counts. Using this threshold means that the injected activity in patients with < 100 kg would be reduced (e.g., by 67% in 45-kg patients). Patients who are heavier than 100 kg would also benefit from the use of the threshold because although the injected activity would be higher (up to 78% for 150-kg patients), good image quality would be obtained. CONCLUSIONS This study provided a method for determining the optimal injected activity according to patient weight without compromising the image quality of conventional Anger SPECT/CT systems equipped with a cardiofocal collimator. Personalized injected activities for each patient weight ranging from 45 to 150 kg were generated, to standardize the resulting image quality independently of patient attenuation. This approach improves patient/staff radioprotection because it reduces the injected activity for < 100-kg patients (the majority of patients).
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Affiliation(s)
- Emilie Verrecchia-Ramos
- CHR Metz-Thionville, Department of Medical Physics, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France.
| | - Olivier Morel
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Valérie Beauchat
- CHR Metz-Thionville, Department of Nuclear Medicine, Bel-Air Hospital, 1, Rue du Friscaty, 57100, Thionville, France
| | - Sylvie Denet
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Abdourahamane Djibo Sidikou
- CHR Metz-Thionville, Department of Medical Physics, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Merwan Ginet
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Estelle Pfletschinger
- CHR Metz-Thionville, Department of Medical Physics, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Luminita Teodor
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Maud Trombowsky
- CHR Metz-Thionville, Department of Medical Physics, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Jeany Verdier
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
| | - Christelle Vère
- CHR Metz-Thionville, Department of Nuclear Medicine, Bel-Air Hospital, 1, Rue du Friscaty, 57100, Thionville, France
| | - Paul Retif
- CHR Metz-Thionville, Department of Medical Physics, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
- Université de Lorraine, CNRS, CRAN, 54000, Nancy, France
| | - Sinan Ben Mahmoud
- CHR Metz-Thionville, Department of Nuclear Medicine, Mercy Hospital, 1, Allée du Château, 57530, Ars-Laquenexy, France
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A Comprehensive Review: Epidemiological strategies, Catheterization and Biomarkers used as a Bioweapon in Diagnosis and Management of Cardio Vascular Diseases. Curr Probl Cardiol 2023; 48:101661. [PMID: 36822564 DOI: 10.1016/j.cpcardiol.2023.101661] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023]
Abstract
Coronary artery disease (CAD) is a serious health problem that causes a considerable number of mortality in a number of affluent nations throughout the world. The estimated death encountered in many developed countries includes including Pakistan, reached 111,367 and accounted for 9.87% of all deaths, despite the mortality rate being around 7.2 million deaths per year, or 12% of all estimated deaths accounted annually around the globe, with improved health systems. Atherosclerosis progressing causes the coronary arteries to become partially or completely blocked, which results in CAD. Additionally, smoking, diabetes mellitus, homocystinuria, hypertension, obesity, hyperlipidemia, and psychological stress are risk factors for CAD. The symptoms of CAD include angina which is described as a burning, pain or discomfort in the chest, nausea, weakness, shortness of breath, lightheadedness, and pain or discomfort in the arms or shoulders. Atherosclerosis and thrombosis are the two pathophysiological pathways most frequently involved in acute coronary syndrome (ACS). Asymptomatic plaque disruption, plaque bleeding, symptomatic coronary blockage, and myocardial infarction are the prognoses for CAD. In this review, we will focus on medicated therapy which is being employed for the relief of angina linked with CAD including antiplatelet medicines, nitrates, calcium antagonists, blockers, catheterization, and the frequency of recanalized infarct-related arteries in patients with acute anterior wall myocardial infarction (AWMI). Furthermore, we have also enlightened the importance of biomarkers that are helpful in the diagnosis and management of CAD.
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10
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Jiang Q, Liu B, Yang L, Wang Y, Yu W, Zhang F, Shi Y, Wang Y. The value of regional and global CACS combined with SPECT MPI in detecting obstructive CAD: a retrospective real-world comparative study. BMC Cardiovasc Disord 2023; 23:12. [PMID: 36631747 PMCID: PMC9832744 DOI: 10.1186/s12872-023-03051-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Previous studies have shown that global coronary artery calcium score (CACS) can improve single photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) to detect obstructive coronary artery disease (CAD). Whether regional CACS can improve SPECT MPI to detect obstructive CAD remains unclear. The aim of this study was to verify whether regional CACS has additional diagnostic value for obstructive CAD in suspected patients, compared to SPECT MPI and global CACS. METHODS The study included 321 suspected CAD patients who underwent one-stop rest-stress SPECT MPI and low-dose computed tomography (CT) scan. All patients underwent coronary angiography within one month after examination. MPI images were visually analyzed by 2 experienced nuclear cardiologists. The regional CACS of left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), right coronary artery (RCA) and global CACS were calculated. Obstructive CAD was defined as ≥ 70% narrowing of the inner diameter of the LAD, LCX, RCA or their main branches and ≥ 50% narrowing of the left main coronary artery (LM). RESULTS Among the 321 patients, 86 (26.8%, 86/321) had obstructive CAD. With the increased in global and regional CACS, there was an increasing trend of patients with obstructive CAD (P for trend < 0.001). Regional CACS had a better diagnostic performance in RCA territories (AUC 0.856, P < 0.001) compared with LAD, LCX territories (AUC 0.690, 0.674, respectively). The AUC of combined regional CACS and MPI was significantly higher than that of MPI alone (0.735 vs. 0.600, P < 0.001). However, based on MPI, the AUC of combined regional CACS was not significantly higher than that of global CACS (0.735 vs. 0.732, P = 0.898). The sensitivity and specificity of regional CACS combined with MPI for detecting obstructive CAD were 64.0% and 72.8%, respectively. CONCLUSIONS Regional CACS was effective in detecting obstructive CAD in RCA territory. Based on SPECT MPI, regional CACS improved the detection of obstructive CAD, but was not superior to global CACS.
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Affiliation(s)
- Qi Jiang
- grid.452253.70000 0004 1804 524XDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003 Jiangsu Province China ,grid.268415.cYangzhou University, Yangzhou, Jiangsu Province China
| | - Bao Liu
- grid.452253.70000 0004 1804 524XDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003 Jiangsu Province China
| | - Le Yang
- grid.452253.70000 0004 1804 524XDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003 Jiangsu Province China
| | - Yufeng Wang
- grid.452253.70000 0004 1804 524XDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003 Jiangsu Province China
| | - Wenji Yu
- grid.452253.70000 0004 1804 524XDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003 Jiangsu Province China
| | - Feifei Zhang
- grid.452253.70000 0004 1804 524XDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003 Jiangsu Province China
| | - Yunmei Shi
- grid.452253.70000 0004 1804 524XDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003 Jiangsu Province China
| | - Yuetao Wang
- grid.452253.70000 0004 1804 524XDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003 Jiangsu Province China ,grid.268415.cYangzhou University, Yangzhou, Jiangsu Province China
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11
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Farooque A, Osman F, Carroll CB, Ewer S, Lee-Miller C, Tevaarwerk A, Pophali PA. Pre-Treatment Left Ventricular Ejection Fraction Assessment and Long-Term Cardiovascular Outcomes in Adolescent and Young Adult Lymphoma Survivors. J Adolesc Young Adult Oncol 2022. [PMID: 36067076 DOI: 10.1089/jayao.2022.0062] [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: 11/12/2022] Open
Abstract
Purpose: Anthracyclines can cause long-term cardiovascular (CV) morbidity, especially in long-term Adolescent and Young Adult (AYA) lymphoma survivors. Pre-treatment left ventricular ejection fraction (LVEF) evaluation is recommended, although its utility in AYA is not established. We sought to determine the pre-treatment LVEF assessment practices in AYA lymphoma survivors treated with anthracyclines and factors associated with long-term cardiotoxicity. Methods: Through an electronic health records review, we retrospectively identified AYA lymphoma survivors with ≥5 years of follow-up postanthracycline treatment. Pre-treatment and follow-up data were abstracted. CV health conditions were defined as risk factors for CV disease and confirmed CV diagnoses. Survivors who had new CV health conditions at follow-up were compared to those who were not using descriptive statistics and logistic regression. Results: One hundred fifteen AYA lymphoma survivors met the study criteria. Pre-treatment LVEF assessment did not affect chemotherapy decisions. Survivors with pre-treatment CV evaluation had mean follow-up since diagnosis of 8 ± 3.3 years, while survivors without it had 10.3 ± 4.2 years, p < 0.05. Survivors with pre-treatment LVEF assessment received lower cumulative anthracycline dose (240.4 mg/m2 vs. 280.1 mg/m2, p < 0.05) and fewer cycles of chemotherapy (4.8 ± 1.5 vs. 5.6 ± 1.2, p < 0.05). Body mass index (BMI) category at diagnosis and follow-up, in addition to age were associated with development of new CV health conditions, pre-treatment LVEF evaluation was not. Conclusion: Pre-treatment LVEF assessment for AYA lymphoma survivors does not impact oncologic treatment decisions or development of CV health conditions. It may be more valuable to assess and modify CV risk factors such as BMI for CV disease prevention.
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Affiliation(s)
- Alma Farooque
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fauzia Osman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Cibele B Carroll
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Steven Ewer
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Cathy Lee-Miller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Priyanka A Pophali
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
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12
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Ahmed R, Carver C, Foley JRJ, Fent GJ, Garg P, Ripley DP. Cardiovascular imaging techniques for the assessment of coronary artery disease. Br J Hosp Med (Lond) 2022; 83:1-11. [DOI: 10.12968/hmed.2022.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coronary artery disease continues to be the leading cause of morbidity and mortality worldwide. Recent clinical trials have not demonstrated any mortality benefit of percutaneous coronary intervention compared to medical management alone in the treatment of stable angina. While invasive coronary angiography remains the gold standard for diagnosing coronary artery disease, it comes with significant risks, including myocardial infarction, stroke and death. There have been significant advances in imaging techniques to diagnose coronary artery disease in haemodynamically stable patients. The latest National Institute for Health and Care Excellence and European College of Cardiology guidelines emphasise the importance of using these imaging techniques first to inform diagnosis. This review discusses these guidelines and imaging techniques, alongside their benefits and drawbacks.
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Affiliation(s)
- Raheel Ahmed
- Cardiology Department, Royal Brompton Hospital, London, UK
| | - Caleb Carver
- Department of Acute Internal Medicine, Northumbria Healthcare NHS Foundation Trust, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | - James RJ Foley
- Department of Cardiology, Pinderfields General Hospital, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Graham J Fent
- Department of Cardiology, Northern General Hospital, Sheffield, UK
| | - Pankaj Garg
- Department of Cardiology, University of East Anglia, Norwich, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals, Norwich, UK
| | - David P Ripley
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
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13
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Multimodality Imaging to Detect Rejection, and Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients—An Illustrative Review. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology3030025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The three most common modalities of graft surveillance in pediatric heart transplant (HT) recipients include echocardiography, coronary angiography, and endomyocardial biopsy (EMB). The survival outcomes after HT in children have improved considerably in recent years. However, allograft rejection and cardiac allograft vasculopathy remain the leading cause of death or re-transplantation. The routine surveillance by EMB and coronary angiography are invasive and risky. Newer noninvasive echocardiographic techniques, including tissue Doppler imaging (TDI), 2-D speckle tracking echocardiography, CT coronary angiography (CTCA), cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET) and invasive techniques such as intravascular ultrasound (IVUS), functional flow reserve (CFR) of coronary arteries, optical coherence tomography (OCT), have emerged as powerful tools which may help early recognition of sub-clinical rejection, response to treatment, early detection, and progression of CAV. The multimodality imaging approach, including noninvasive and invasive tests, is the future for the transplanted heart to detect dysfunction, rejections, and early CAV. This review illustrates noninvasive and invasive imaging techniques currently used or could be considered for clinical use in detecting heart transplant rejection, dysfunction, and CAV in children.
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14
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Hachiya S, Kosuge H, Fujita Y, Hida S, Chikamori T. Performance of Hybrid Imaging in the Diagnosis of Coronary Artery Disease. Am J Cardiol 2022; 174:34-39. [PMID: 35379453 DOI: 10.1016/j.amjcard.2022.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Abstract
Single-photon emission computed tomography (SPECT) and computed tomography coronary angiography (CTCA) are usually performed independently in patients with suspected coronary artery disease. We assessed the hypothesis that hybrid SPECT/CTCA imaging results in higher diagnostic accuracy than either method alone, particularly in cases presenting with high levels of coronary calcification. A total of 243 major coronary vessels in 81 patients with known or suspected coronary artery disease were screened using SPECT with semiconductor detectors and CTCA with 256-detector row computed tomography. Patients who were diagnosed with myocardial ischemia underwent coronary angiography. Coronary angiography results were defined as positive for stenosis when the stenosis diameter was >70% or fractional flow reserve was <0.8. These data were then compared with a fused image of the SPECT and CTCA datasets generated using a dedicated workstation. To detect significant coronary artery stenosis, the respective sensitivity, specificity, and accuracy were 73%, 61%, and 67% with SPECT alone, 96%, 44%, and 67% with CTCA alone, and 95%, 75%, and 84% with hybrid imaging. Moreover, hybrid imaging allowed the accurate diagnosis of 47 vessels with severe calcification that CTCA alone could not evaluate correctly. Hybrid imaging shows greater diagnostic accuracy than single-modality evaluation through more comprehensive information on potential coronary stenosis and its hemodynamic significance.
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Affiliation(s)
- Shoko Hachiya
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Hisanori Kosuge
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
| | - Yasuhiro Fujita
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Satoshi Hida
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
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15
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Liu B, Yu W, Wang J, Shao X, Zhang F, Zhou M, Shi Y, Wang B, Xu Y, Wang Y. A model combining rest-only ECG-gated SPECT myocardial perfusion imaging and cardiovascular risk factors can effectively predict obstructive coronary artery disease. BMC Cardiovasc Disord 2022; 22:268. [PMID: 35705898 PMCID: PMC9202088 DOI: 10.1186/s12872-022-02712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022] Open
Abstract
Objective The rest-only single photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) had low sensitivity in diagnosing obstructive coronary artery disease (CAD). Improving the efficacy of resting MPI in diagnosing CAD has important clinical significance for patients with contraindications to stress. The purpose of this study was to develop and validate a model predicting obstructive CAD in suspected CAD patients, based on rest-only MPI and cardiovascular risk factors. Methods A consecutive retrospective cohort of 260 suspected CAD patients who underwent rest-only gated SPECT MPI and coronary angiography was constructed. All enrolled patients had stress MPI contraindications. Clinical data such as age and gender were collected. Automated quantitative analysis software QPS and QGS were used to evaluate myocardial perfusion and function parameters. The least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression were used to select the variables and build the prediction model. Results Among the enrolled 260 patients with suspected CAD, there were 95 (36.5%, 95/260) patients with obstructive CAD. The prediction model was presented in the form of a nomogram and developed based on selected predictors, including age, sex, SRS ≥ 4, SMS ≥ 2, STS ≥ 2, hypertension, diabetes, and hyperlipidemia. The AUC of the prediction model was 0.795 (95% CI: 0.741–0.843), which was better than the traditional models. The AUC calculated by enhanced bootstrapping validation (500 bootstrap resamples) was 0.785. Subsequently, the calibration curve (intercept = − 0.106; slope = 0.843) showed a good calibration of the model. The decision curve analysis (DCA) shows that the constructed clinical prediction model had good clinical applications. Conclusions In patients with suspected CAD and contraindications to stress MPI, a prediction model based on rest-only ECG-gated SPECT MPI and cardiovascular risk factors have been developed and validated to predict obstructive CAD effectively.
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Affiliation(s)
- Bao Liu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
| | - Wenji Yu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
| | - Jianfeng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
| | - Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
| | - Mingge Zhou
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
| | - Bing Wang
- The Nuclear Medicine and Molecular Imaging Clinical Translation Institute of Soochow University, Changzhou, Jiangsu Province, China
| | - Yiduo Xu
- The Nuclear Medicine and Molecular Imaging Clinical Translation Institute of Soochow University, Changzhou, Jiangsu Province, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China.
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16
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Myocardial Viability – An Important Decision Making Factor in the Treatment Protocol for Patients with Ischemic Heart Disease. ACTA MEDICA BULGARICA 2022. [DOI: 10.2478/amb-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Ischemic heart disease (IHD) affects > 110 million individuals worldwide and represents an important contributor to the rise in the prevalence of heart failure and the associated mortality and morbidity. Despite modern therapies, up to one-third of patients with acute myocardial infarction would develop heart failure. IHD is a pathologic condition of the myocardium resulting from the imbalance in a given moment between its oxygen demands and the actual perfusion. Acute and chronic forms of the disease may potentially lead to extensive and permanent damage of the cardiac muscle. From a clinical point of view, determination of the still viable extent of myocardium is crucial for the therapeutic protocol – since ischemia is the underlying cause, then revascularization should provide for a better prognosis. Different methods for evaluation of myocardial viability have been described – each one presenting some advantages over the others, being, in the same time, inferior in some respects. The review offers a relatively comprehensive overview of methods available for determining myocardial viability.
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17
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Kozuma K, Chikamori T, Hashimoto J, Honye J, Ikeda T, Ishiwata S, Kato M, Kondo H, Matsubara K, Matsumoto K, Matsumoto N, Motoyama S, Obunai K, Sakamoto H, Soejima K, Suzuki S, Abe K, Amano H, Hioki H, Iimori T, Kawai H, Kosuge H, Nakama T, Suzuki Y, Takeda K, Ueda A, Yamashita T, Hirao K, Kimura T, Nagai R, Nakamura M, Shimizu W, Tamaki N. JCS 2021 Guideline on Radiation Safety in Cardiology. Circ J 2022; 86:1148-1203. [DOI: 10.1253/circj.cj-21-0379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ken Kozuma
- Division of Cardiology, Teikyo University Hospital
| | | | - Jun Hashimoto
- Department of Radiology, Tokai University School of Medicine
| | - Junko Honye
- Department of Cardiology, Kikuna Memorial Hospital
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | - Mamoru Kato
- Department of Radiology, Akita Cerebrospinal and Cardiovascular Center
| | | | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Kazuma Matsumoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | | | | | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital
| | - Shigeru Suzuki
- Department of Radiology, Totsuka Kyouritsu Daini Hospital
| | - Koichiro Abe
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University
| | - Hideo Amano
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | | | - Hideki Kawai
- Department of Cardiology, Fujita Health University
| | | | | | | | | | - Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
| | | | - Kenzo Hirao
- Division of Cardiovascular Medicine, AOI Universal Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Ryozo Nagai
- Department of Cardiovascular Medicine, Jichi Medical University
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine
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Nuclear cardiology for a cardiothoracic surgeon. Indian J Thorac Cardiovasc Surg 2022; 38:268-282. [PMID: 35529010 PMCID: PMC9023643 DOI: 10.1007/s12055-021-01311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022] Open
Abstract
Cardiac surgeons are commonly faced with issues regarding the balance between the potential risk and the potential benefit of a surgical procedure. Nuclear cardiology procedures such as single-photon emission computed tomography and positron emission tomography provide the surgeon with objective information that augments standard clinical and angiographic assessments related to the diagnosis, prognosis, and potential benefit from any intervention. Myocardial perfusion is imaged with the use of radiopharmaceuticals that accumulate rapidly in the myocardium in proportion to the myocardial blood flow. Radionuclide lung imaging most commonly involves the demonstration of pulmonary perfusion using technetium-99 m macro aggregate albumin (Tc-99 m MAA), as well as the assessment of ventilation using inspired inert gas, usually xenon, or Tc-99 m-labelled aerosols. Nuclear cardiology is extensively used as a part of the work-up of ischemic heart disease and cardiac failure in deciding the optimal therapeutic strategy with its ability to predict the severity of the disease. It has also proved extremely useful in the management of congenital heart disease and the diagnosis of pulmonary embolism, among many other applications. Myocardial perfusion imaging is a basic adjunct to the noninvasive assessment of patients with stable angina, baseline electrocardiogram (ECG) abnormalities, post-revascularisation assessment, and heart failure. This review article covers a summary of basic concepts of nuclear cardiology about what a cardiac surgeon should be aware of. To many, it is just a perfusion test, but the versatility, reliability, and future of the technology are without a doubt.
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Li J, Guo L, Liu J, Fang W, Sun X, He Z. Sex-specific reference limits of left ventricular ejection fraction and volumes estimated by gated myocardial perfusion imaging for low-risk patients in China: a comparison between three quantitative algorithms. Quant Imaging Med Surg 2022; 12:144-158. [PMID: 34993067 DOI: 10.21037/qims-21-347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Establishing appropriate reference value limits of left ventricular (LV) functional parameters is fundamental for the assessment of cardiac function. At present, there are no reports aimed at establishing reference limits using gated myocardial perfusion imaging (MPI) in mainland China. METHODS A total of 175 consecutive patients who were defined as low-risk coronary artery disease patients underwent stress Technetium-99m sestamibi (99mTc-MIBI)-gated myocardial perfusion single-photon emission computed tomography (SPECT) imaging. The LV ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volume (ESV) were obtained by 3 quantitative algorithms: quantitative-gated SPECT, emory cardiac toolbox, and 4-dimensional model SPECT, respectively. The threshold values were obtained using Gaussian distribution or percentiles. The influence of gender, age, and weight on cardiac functional parameters was analyzed by multiple regressions for linear models. RESULTS For males, the lower reference limits of EF were 52%, 63%, and 58%, respectively; and the upper limits of EDV/ESV were 106/45, 152/55, and 135/55 mL, respectively. For females, the lower reference limits of EF were 58%, 66%, and 65%, respectively; and the upper limits of EDV/ESV were 73/27, 105/31, and 88/29 mL, respectively. Compared to females, males had greater cardiac volume values and lower mean EF values. Bland-Altman plots revealed that the cardiac function parameters calculated by the three quantitative algorithms were in high agreement. CONCLUSIONS In this study, the reference limits of cardiac parameters calculated by the 3 methods based on single-center data in China were preliminarily established. The threshold values determined by three quantitative algorithms were not interchangeable but were highly correlated.
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Affiliation(s)
- Jiajun Li
- Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Department of Nuclear Medicine, First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Lin Guo
- Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingzhe Liu
- Department of Nuclear Medicine, First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxin Sun
- Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Zuoxiang He
- Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
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20
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Okudan B, Seven B, Gülaldı NCM, Çapraz M, Açıkgöz Y. The Value of 99mTc-MIBI SPECT/CT in the Postoperative Assessment of Patients with Differentiated Thyroid Carcinoma. Curr Med Imaging 2021; 18:404-408. [PMID: 34749623 DOI: 10.2174/1573405617666211108154028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/24/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The therapeutic approaches of differentiated thyroid carcinoma (DTC) are surgery, ablation therapy with the postoperative use of radioiodine-131 (131I), and thyroid-stimulating hormone (TSH) suppression therapy. After the surgical therapy, the patient should be assessed for remnants/metastases. OBJECTIVE The purpose of this research was to investigate the role of technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT) in the postoperative management of patients with DTC. METHODS The study comprised 22 DTC patients (13 women, 9 men; mean age 46.55 ± 13.27 y) who underwent a total thyroidectomy previously. All patients were investigated for thyroid remnants/metastases by 99mTc-MIBI SPECT/CT, posttherapy 131I whole-body scan (WBS) and ultrasound (US). Serum TSH, thyroglobulin and anti-Tg antibody levels were measured. Results of imaging modalities and laboratory measurements were compared with each other. RESULTS 99mTc-MIBI SPECT/CT, 131I WBS and US respectively demonstrated thyroid remnants in 15 (68.18%), 22 (100%) and 14 (63.63%) of the all patients and metastatic lymph nodes in 8 (100%), 6 (75%) and 6 (75%) of the 8 patients with lymph node metastases. 99mTc-MIBI SPECT/CT also demonstrated lung metastases in 2 patients (9.09% of all patients). The same result was obtained with 131I WBS. CONCLUSION The findings of this study show that 99mTc-MIBI SPECT/CT can be effective for detecting metastases in patients with DTC who underwent surgery prior to 131I therapy.
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Affiliation(s)
- Berna Okudan
- Department of Nuclear Medicine, Ankara City Hospital, University of Health Sciences, Ankara. Turkey
| | - Bedri Seven
- Department of Nuclear Medicine, Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya. Turkey
| | - Nedim C M Gülaldı
- Department of Nuclear Medicine, Ankara City Hospital, Ankara. Turkey
| | - Mustafa Çapraz
- Department of Internal Medicine, School of Medicine, University of Amasya, Amasya. Turkey
| | - Yusuf Açıkgöz
- Division of Medical Oncology, Department of Internal Medicine, Ankara City Hospital, Ankara. Turkey
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21
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Xu J, Cai F, Geng C, Wang Z, Tang X. Diagnostic Performance of CMR, SPECT, and PET Imaging for the Identification of Coronary Artery Disease: A Meta-Analysis. Front Cardiovasc Med 2021; 8:621389. [PMID: 34026862 PMCID: PMC8138058 DOI: 10.3389/fcvm.2021.621389] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/23/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Myocardial perfusion imaging modalities, such as cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET), are well-established non-invasive diagnostic methods to detect hemodynamically significant coronary artery disease (CAD). The aim of this meta-analysis is to compare CMR, SPECT, and PET in the diagnosis of CAD and to provide evidence for further research and clinical decision-making. Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched. Studies that used CMR, SPECT, and/or PET for the diagnosis of CAD were included. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio with their respective 95% confidence interval, and the area under the summary receiver operating characteristic (SROC) curve were calculated. Results: A total of 203 articles were identified for inclusion in this meta-analysis. The pooled sensitivity values of CMR, SPECT, and PET were 0.86, 0.83, and 0.85, respectively. Their respective overall specificity values were 0.83, 0.77, and 0.86. Results in subgroup analysis of the performance of SPECT with 201Tl showed the highest pooled sensitivity [0.85 (0.82, 0.88)] and specificity [0.80 (0.75, 0.83)]. 99mTc-tetrofosmin had the lowest sensitivity [0.76 (0.67, 0.82)]. In the subgroup analysis of PET tracers, results indicated that 13N had the lowest pooled sensitivity [0.83 (0.74, 0.89)], and the specificity was the highest [0.91 (0.81, 0.96)]. Conclusion: Our meta-analysis indicates that CMR and PET present better diagnostic performance for the detection of CAD as compared with SPECT.
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Affiliation(s)
- Jianfeng Xu
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China.,JYAMS PET Research and Development Limited, Nanjing, China
| | - Fei Cai
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China.,JYAMS PET Research and Development Limited, Nanjing, China
| | - Changran Geng
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zheng Wang
- JYAMS PET Research and Development Limited, Nanjing, China
| | - Xiaobin Tang
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
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22
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Liu B, Yu W, Wang J, Shao X, Zhang F, Yang M, Yang X, Wu Z, Li S, Shi Y, Wang B, Xu Y, Wang Y. Incremental value of regional wall motion abnormalities for detecting obstructive coronary artery disease by rest-only electrocardiogram-gated single-photon emission computerized tomography myocardial perfusion imaging in suspected coronary artery disease patients. Nucl Med Commun 2021; 42:276-283. [PMID: 33252509 DOI: 10.1097/mnm.0000000000001335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether regional wall motion (WM) abnormalities by rest-only 99mtechnetium-sestamibi (99mTc-MIBI) electrocardiogram (ECG)-gated single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) had incremental diagnostic value for detecting obstructive coronary artery disease (CAD) in suspected CAD patients. METHODS This study retrospectively studied 255 consecutive suspected CAD patients who underwent rest-only ECG-gated SPECT MPI and were performed coronary angiography within 3 months. Obstructive CAD was defined as ≥70% narrowing of the inner diameter of the left anterior descending coronary artery, left circumflex coronary artery and right coronary artery or their main branches and ≥50% narrowing of the left main coronary artery. QPS and QGS were used to assess rest perfusion and WM. Summed rest score ≥4 and summed motion score ≥2 exhibited in two consecutive segments in one territory was considered abnormal. RESULTS The sensitivity of the combination of perfusion and regional WM abnormalities was significantly higher than perfusion alone for detecting obstructive CAD (46.8% vs. 30.9%; P < 0.001), with similar specificity (91.9% vs. 95.0; P = 0.063). The global chi-square value of combination of perfusion and WM increased from 31.40 to 50.71 (P < 0.001) compared to perfusion. The sensitivity of combination of perfusion and WM for detecting obstructive CAD in patients with multivessel disease was higher than single-vessel disease (56.1% vs. 25.0%; P < 0.001), with similar specificity. CONCLUSION Regional WM abnormalities at rest, as shown by rest-only 99mTc-MIBI ECG-gated SPECT MPI, have additional diagnostic value over perfusion alone for detecting obstructive CAD in suspected CAD patients.
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Affiliation(s)
- Bao Liu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province
| | - Wenji Yu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province
| | - Jianfeng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province
| | - Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province
| | - Minfu Yang
- Department of Nuclear Medicine, Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing
| | - Xiaoyu Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province
| | - Zhifang Wu
- Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Sijin Li
- Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province
| | - Bing Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province
| | - Yiduo Xu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province
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23
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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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24
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Effect of data conserving respiratory motion compensation on left ventricular functional parameters assessed in gated myocardial perfusion SPECT. EJNMMI Phys 2021; 8:7. [PMID: 33475904 PMCID: PMC7818343 DOI: 10.1186/s40658-021-00355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Respiratory motion compromises image quality in myocardial perfusion (MP) single-photon emission computed tomography (SPECT) imaging and may affect analysis of left ventricular (LV) functional parameters, including phase analysis-quantified mechanical dyssynchrony parameters. In this paper, we investigate the performance of two algorithms, respiratory blur modeling (RBM) and joint motion-compensated (JMC) ordered-subsets expectation maximization (OSEM), and the effects of motion compensation on cardiac-gated MP-SPECT studies. Methods Image acquisitions were carried out with a dual-detector SPECT/CT system in list-mode format. A cardiac phantom was imaged as stationary and under respiratory motion. The images were reconstructed with OSEM, RBM-OSEM, and JMC-OSEM algorithms, and compared in terms of mean squared error (MSE). Subsequently, MP-SPECT data of 19 patients were binned into dual-gated (respiratory and cardiac gating) projection images. The images of the patients were analyzed with Quantitative Gated SPECT (QGS) 2012 program (Cedars-Sinai Medical Center, USA). The parameters of interest were LV volumes, ejection fraction, wall motion, wall thickening, phase analysis, and perfusion parameters. Results In phantom experiment, compared to the stationary OSEM reconstruction, the MSE values for OSEM, RBM-OSEM, and JMC-OSEM were 8.5406·10−5,2.7190·10−5, and 2.0795·10−5, respectively. In the analysis of LV function, use of JMC had a small but statistically significant (p < 0.05) effect on several parameters: it increased LV volumes and standard deviation of phase angle histogram, and it decreased ejection fraction, global wall motion, and lateral, septal, and apical perfusion. Conclusions Compared to standard OSEM algorithm, RBM-OSEM and JMC-OSEM both improve image quality under motion. Motion compensation has a minor effect on LV functional parameters. Supplementary Information The online version contains supplementary material available at (10.1186/s40658-021-00355-w).
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25
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Abstract
PURPOSE OF REVIEW Myocardial viability is an important pathophysiologic concept which may have significant clinical impact in patients with left ventricular dysfunction due to ischemic heart disease. Understanding the imaging modalities used to assess viability, and the clinical implication of their findings, is critical for clinical decision-making in this population. RECENT FINDINGS The ability of dobutamine echocardiography, single-photon emission computed tomography, positron emission tomography, and cardiac magnetic resonance imaging to predict functional recovery following revascularization is well-established. Despite different advantages and disadvantages for each imaging modality, each modality has demonstrated reasonable performance characteristics in identifying viable myocardium. Recent data, however, has called into question whether this functional recovery leads to improved clinical outcomes. Although the assessment of viability can be used to aid in clinical decision-making prior to revascularization, its broad application to all patients is limited by a lack of data confirming improvement in clinical outcomes. Thus, viability assessments may be best applied to select patients (such as those with increased surgical risk) and integrated with clinical, laboratory, and imaging data to guide clinical care. Future research efforts should be aimed at establishing the impact of viability on clinical outcomes.
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Affiliation(s)
- Kinjan Parikh
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA
| | - Alana Choy-Shan
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA
- Division of Cardiology, VA Harbor Medical Center, Manhattan Campus, 423 E 23rd Street, 12 West, Cardiology, New York, NY, 10010, USA
| | - Munir Ghesani
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA.
- Division of Cardiology, VA Harbor Medical Center, Manhattan Campus, 423 E 23rd Street, 12 West, Cardiology, New York, NY, 10010, USA.
- Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA.
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26
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Elevations in High-Sensitive Cardiac Troponin T and N-Terminal Prohormone Brain Natriuretic Peptide Levels in the Serum Can Predict the Development of Anthracycline-Induced Cardiomyopathy. Am J Ther 2020; 27:e142-e150. [PMID: 30648987 DOI: 10.1097/mjt.0000000000000930] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anthracyclines remain the cornerstone of the treatment in many cancers including lymphomas, leukemia and sarcomas, and breast cancer. The cardiomyopathy that develops from anthracyclines can lead to heart failure and decreased survival. Multiple mechanisms are involved in the pathophysiology of anthracycline-induced heart failure. STUDY QUESTION We hypothesize that anthracycline-induced cardiac (AIC) pathology can be monitored using a panel of blood biomarkers including high-sensitive cardiac troponin T (hs-cTnT) for myocyte necrosis and N-terminal prohormone brain natriuretic peptide (NT-proBNP) for parietal stress. STUDY DESIGN A prospective, institutionally approved study recruited all patients with cancer scheduled to start anthracycline chemotherapy in the Transylvania University cancer clinics. MEASURES AND OUTCOMES Transthoracic 2D echocardiography and the measurements of NT-proBNP and hs-cTnT plasma levels were performed at the beginning of the study and 3 months and 6 months after anthracycline treatment initiation. RESULTS The plasma levels of hs-cTnT at 3 months (rho = 0.439, P = 0.0001) and 6 months (rho = 0.490, P = 0.0001) are correlated with AIC occurrence. For a cutoff value of hs-cTnT at 3 months > 0.008 ng/mL, we obtained 66.7% sensitivity and 67.9% specificity for developing AIC at 6 months, with a 54.5% positive predictive value and a 87.8% negative predictive value. The NT-proBNP serum levels at 3 months (rho = 0.495, P = 0.0001) and 6 months (rho = 0.638, P = 0.0001) are correlated with an AIC diagnosis at 6 months. For a cutoff value of NT-proBNP at 3 months >118.5 pg/mL, we obtained 80% sensitivity and 79.2% specificity for evolution to AIC at 6 months, with 52.2% positive predictive value and 93.3% negative predictive value. CONCLUSIONS In anthracycline-treated cancer patients, the increase in plasma levels of NT-proBNP and of hs-cTnT can predict the development of anthracycline-induced cardiomyopathy. Early identification of at-risk patients will potentially allow for targeted dose reductions and will diminish the number of patients developing cardiac pathology.
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27
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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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28
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Garcia MJ, Kwong RY, Scherrer-Crosbie M, Taub CC, Blankstein R, Lima J, Bonow RO, Eshtehardi P, Bois JP. State of the Art: Imaging for Myocardial Viability: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2020; 13:e000053. [PMID: 32833510 DOI: 10.1161/hci.0000000000000053] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A substantial proportion of patients with acute myocardial infarction develop clinical heart failure, which remains a common and major healthcare burden. It has been shown that in patients with chronic coronary artery disease, ischemic episodes lead to a global pattern of cardiomyocyte remodeling and dedifferentiation, hallmarked by myolysis, glycogen accumulation, and alteration of structural proteins. These changes, in conjunction with an impaired global coronary reserve, may eventually become irreversible and result in ischemic cardiomyopathy. Moreover, noninvasive imaging of myocardial scar and hibernation can inform the risk of sudden cardiac death. Therefore, it would be intuitive that imaging of myocardial viability is an essential tool for the proper use of invasive treatment strategies and patient prognostication. However, this notion has been challenged by large-scale clinical trials demonstrating that, in the modern era of improved guideline-directed medical therapies, imaging of myocardial viability failed to deliver effective guidance of coronary bypass surgery to a reduction of adverse cardiac outcomes. In addition, current available imaging technologies in this regard are numerous, and they target diverse surrogates of structural or tissue substrates of myocardial viability. In this document, we examine these issues in the current clinical context, collect current evidence of imaging technology by modality, and inform future directions.
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29
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AlBadri A, Piccinelli M, Cho SG, Lee JM, Jaber W, De Cecco CN, Samady H, Koo BK, Bom HS, Garcia EV. Rationale and design of the quantification of myocardial blood flow using dynamic PET/CTA-fused imagery (DEMYSTIFY) to determine physiological significance of specific coronary lesions. J Nucl Cardiol 2020; 27:1030-1039. [PMID: 32026327 PMCID: PMC7332386 DOI: 10.1007/s12350-020-02052-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronary physiology assessments have been shown by multiple trials to add clinical value in detecting significant coronary artery disease and predicting cardiovascular outcomes. Fractional flow reserve (FFR) obtained during invasive coronary angiography (ICA) has become the new reference standard for hemodynamic significance detection. Absolute myocardial blood flow (MBF) quantification by means of dynamic positron emission tomography (dPET) has high diagnostic and prognostic values. FFR is an invasive measure and as such cannot be applied broadly, while MBF quantification is commonly performed on standard vascular territories intermixing normal flow from normal regions with abnormal flow from abnormal regions and consequently limiting its diagnostic power. OBJECTIVE The aim of this study is to provide physicians with reliable software tools for the non-invasive assessment of lesion-specific physiological significance for the entire coronary tree by combining PET-derived absolute flow data and coronary computed tomography angiography (CTA)-derived anatomy and coronary centerlines. METHODS The dynamic PET/CTA myocardial blood flow assessment with fused imagery (DEMYSTIFY) study is an observational prospective clinical study to develop algorithms and software tools to fuse coronary anatomy data obtained from CTA with dPET data to non-invasively measure absolute MBF, myocardial flow reserve, and relative flow reserve across specific coronary lesions. Patients (N = 108) will be collected from 4 institutions (Emory University Hospital, USA; Chonnam National University Hospital, South Korea; Samsung Medical Center, South Korea; Seoul National University Hospital, South Korea). These results will be compared to those obtained invasively in the catheterization laboratory and to a relatively novel non-invasive technique to estimate FFR based on CTA and computational fluid dynamics. CONCLUSIONS Success of these developments should lead to the following benefits: (1) eliminate unnecessary invasive coronary angiography in patients with no significant lesions, (2) avoid stenting physiologically insignificant lesions, (3) guide percutaneous coronary interventions process to the location of significant lesions, (4) provide a flow-color-coded 3D roadmap of the entire coronary tree to guide bypass surgery, and (5) use less radiation and lower the cost from unnecessary procedures. TRIAL REGISTRY The DEMYSTIFY study has been registered on ClinicalTrials.gov with registration number NCT04221594.
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Affiliation(s)
- Ahmed AlBadri
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, Korea
| | - Wissam Jaber
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Carlo N De Cecco
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Quantification of late gadolinium enhancement cardiovascular MRI in patients with coronary artery chronic total occlusion. Clin Radiol 2020; 75:643.e19-643.e26. [PMID: 32418670 DOI: 10.1016/j.crad.2020.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/19/2020] [Indexed: 01/25/2023]
Abstract
AIM To determine the most accurate and reproducible semi-automated greyscale thresholding technique for quantifying late gadolinium enhancement (LGE) in cardiovascular magnetic resonance imaging (CMRI), by using positron-emission tomography (PET) as the reference standard in patients with coronary artery chronic total occlusion (CTO). MATERIALS AND METHODS LGE in CMRI, single-photon-emission computed tomography (SPECT), and PET were performed within 1 week in each of 63 patients with known CTO. The presence and quantity of LGE were determined with greyscale thresholds of 2, 4, 5, 6, and 8 standard deviations (SDs) above the mean signal intensity for normal remote myocardium and full width at half maximum (FWHM). The infarcted myocardium was delineated by PET. RESULTS Sixty-three patients and 1,008 segments were analysed. Based on patient analysis, with PET as the reference standard, the 5 SD method yielded the strongest correlation (r=0.85, p<0.0001) compared with the 2 SDs (r=0.42), 4 SDs (r=0.73), 6 SDs (r=0.81), 8 SDs (r=0.71), and FWHM (r=0.69; p<0.001 for all comparisons). The 5 SDs threshold quantification showed high interobserver and intra-observer agreement (intraclass correlation coefficient [ICC]=0.90, p<0.0001; ICC=0.93, p<0.0001, respectively). CONCLUSIONS Semi-automated LGE CMRI greyscale thresholding with 5 SDs above the mean signal intensity for normal remote myocardium yields the strongest correlation to the extent of LGE identified using PET and is highly reproducible in patients with CTO.
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Abstract
Nuclear cardiology for patients with ischemic heart disease and cardiac failure is expanding in Asia, although quite heterogeneously. In Asia, Israel showed the highest utilization with more than 1000 scans/100,000 inhabitants a year followed by Korea, Japan, UAE, Turkey, Australia (250-999 scans/100,000). Saudi Arabia, Kuwait, Jordan, Lebanon, Iran, and Pakistan practiced 60-99 scans/100,000. Most of South East Asian countries, China, India, and Bangladesh practiced 1-50 scans/100,000 per year. Countries in Central Asia, Mongolia, Vietnam, Cambodia, Lao, Myanmar, Nepal, and Bhutan showed limited use or no nuclear cardiology practice. Myocardial perfusion imaging (MPI) in Asia was characterized by more frequent use of 201Tl, less use of weight-based 99mTc dosing, and a trend toward a lower rate of stress-only imaging. Accordingly, the effective dose in nuclear cardiology practices was higher than those of the rest of the world. 99Mo-99mTc generators are available in most countries, relying mainly on the global supply chain because there is little supply chain beyond countries within the region. In practice, the threshold values of left ventricular ejection fraction, end-systolic volume, and end-diastolic volume between normal and pathologic states were set based on the regional normal database in China and Japan because these values were dependent on age, gender, and body weight. The purpose of the MPI SPECT study was to evaluate myocardial ischemia in symptomatic patients with chest pain, effects of percutaneous coronary intervention and coronary artery bypass-graft, and cardiac function in patients with chronic heart failure. The ability of 99mTc-based MPI for predicting hard cardiac events was confirmed in Asian inhabitants with low risk of ischemic heart disease. Human resource development of nuclear medicine professional and public awareness of nuclear medicine is key issues to promote nuclear cardiology in Asia. International organizations such as the International Atomic Energy Agency and academic organizations in the region such as Asia Oceania Federation of Nuclear Medicine and Biology, Asia Regional Cooperative Council for Nuclear Medicine, East Asia Nuclear Medicine Association, and Arab Society of Nuclear Medicine have an important role in addition to national Societies of Nuclear Medicine in each country and region.
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Affiliation(s)
- Jun Hatazawa
- Department of Nuclear Medicine, Osaka University Hospital and Research Center for Nuclear Physics, Osaka University, Osaka, Japan.
| | - Durre Sabih
- Multan Institute of Nuclear Medicine and Radiology, Multan, Pakistan
| | - Yaming Li
- Department of Nuclear Medicine, The first Hospital of China Medical University, Shengyan, China
| | - Prasanta Kumar Pradhan
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical sciences, Lucknow, India
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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Megna R, Petretta M, Alfano B, Cantoni V, Green R, Daniele S, Acampa W, Nappi C, Gaudieri V, Assante R, Zampella E, Mazziotti E, Mannarino T, Buongiorno P, Cuocolo A. A New Relational Database Including Clinical Data and Myocardial Perfusion Imaging Findings in Coronary Artery Disease. Curr Med Imaging 2020; 15:661-671. [PMID: 32008514 DOI: 10.2174/1573405614666180807110829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/28/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to test a relational database including clinical data and imaging findings in a large cohort of subjects with suspected or known Coronary Artery Disease (CAD) undergoing stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging. METHODS We developed a relational database including clinical and imaging data of 7995 subjects with suspected or known CAD. The software system was implemented by PostgreSQL 9.2, an open source object-relational database, and managed from remote by pgAdmin III. Data were arranged according to a logic of aggregation and stored in a schema with twelve tables. Statistical software was connected to the database directly downloading data from server to local personal computer. RESULTS There was no problem or anomaly for database implementation and user connections to the database. The epidemiological analysis performed on data stored in the database demonstrated abnormal SPECT findings in 46% of male subjects and 19% of female subjects. Imaging findings suggest that the use of SPECT imaging in our laboratory is appropriate. CONCLUSION The development of a relational database provides a free software tool for the storage and management of data in line with the current standard.
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Affiliation(s)
- Rosario Megna
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Mario Petretta
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Bruno Alfano
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Stefania Daniele
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Valeria Gaudieri
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuela Mazziotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Mastrocola LE, Amorim BJ, Vitola JV, Brandão SCS, Grossman GB, Lima RDSL, Lopes RW, Chalela WA, Carreira LCTF, Araújo JRND, Mesquita CT, Meneghetti JC. Update of the Brazilian Guideline on Nuclear Cardiology - 2020. Arq Bras Cardiol 2020; 114:325-429. [PMID: 32215507 PMCID: PMC7077582 DOI: 10.36660/abc.20200087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Barbara Juarez Amorim
- Universidade Estadual de Campinas (Unicamp), Campinas, SP - Brazil
- Sociedade Brasileira de Medicina Nuclear (SBMN), São Paulo, SP - Brazil
| | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brazil
- Clínica Cardionuclear, Porto Alegre, RS - Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Fonte Imagem Medicina Diagnóstica, Rio de Janeiro, RJ - Brazil
- Clínica de Diagnóstico por Imagem (CDPI), Grupo DASA, Rio de Janeiro, RJ - Brazil
| | | | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | | | | | - José Claudio Meneghetti
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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Abdeltawab A, Mansour H, Rayan M. Testing Real-World Application of Appropriateness Criteria of Single Photon Emission Computed Tomography (SPECT) In Two Egyptian Hospitals. Egypt Heart J 2020; 72:3. [PMID: 31925577 PMCID: PMC6954165 DOI: 10.1186/s43044-019-0022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The American College of Cardiology pioneered appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging in 2005 to account for evidence-based clinical relevance of stress perfusion imaging. Our aim was to assess and compare appropriateness use criteria in in Kobry al Kobba military hospital and Ain Shams University hospitals. METHODS All patients were subjected to thorough history taking, calculation of pretest probability and Framingham risk score, determination of appropriateness use criteria and stress-rest Tc 99m imaging to detect the presence of ischemia and one day Tc 99m imaging to detect viability. RESULTS The study included 442 patients with mean age of 56.5 years, with male predominance (77%), 38% were diabetics and 58% had hypertension. Seventy-eight percent of patients had appropriate tests, uncertain tests in 12% and 10% inappropriate studies. 47% of appropriate tests show positive results of SPECT. CONCLUSION We concluded that appropriateness criteria are effective in identifying appropriateness of SPECT in a diverse patient population.
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Affiliation(s)
- Adham Abdeltawab
- Cardiology Department, Ain Shams University Hospitals, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, P.O. 11381, Egypt.
| | - Hazem Mansour
- Cardiology Department, Ain Shams University Hospitals, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, P.O. 11381, Egypt
| | - Mona Rayan
- Cardiology Department, Ain Shams University Hospitals, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, P.O. 11381, Egypt
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Changes in ventricular depolarisation vectors during exercise caused by regional myocardial ischaemia. Sci Rep 2019; 9:16365. [PMID: 31705009 PMCID: PMC6841927 DOI: 10.1038/s41598-019-52869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 10/14/2019] [Indexed: 11/08/2022] Open
Abstract
Research at the Aga Khan University for several years has been directed to find a reliable, low-cost, portable, non-invasive method for identification of coronary artery disease, its location and extent. A new method has been devised to measure the magnitude and direction of cardiac electrical vectors in three perpendicular planes during physical exercise to identify reduction in myocardial excitability as the electrophysiological marker of hypoxia. This report shows that changes in electrical forces due to exercise-induced regional hypoxia serve as indicators of reversible myocardial ischaemia. Changes in the magnitude and direction of vectors at stages of the Bruce protocol were measured in healthy volunteers, and patients undergoing the same exercise protocol for distribution of a radioactive tracer injected intravenously at peak exercise and after recovery (myocardial perfusion scan). Alterations in the magnitude and direction of resultant vectors during exercise were scored to enable analysis. Analysis identified slow progression of myocardial depolarisation as the electrophysiological marker of regional hypoxia relative to physical work. Compared with myocardial perfusion scan the sensitivity and specificity of electrical vectors for identification of ischaemia were 88% and 71%, respectively. Accuracy of ischaemia shown by electrical vectors is being assessed in patients undergoing elective coronary angiography.
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Haro Alonso D, Wernick MN, Yang Y, Germano G, Berman DS, Slomka P. Prediction of cardiac death after adenosine myocardial perfusion SPECT based on machine learning. J Nucl Cardiol 2019; 26:1746-1754. [PMID: 29542015 PMCID: PMC6138585 DOI: 10.1007/s12350-018-1250-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/19/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND We developed machine-learning (ML) models to estimate a patient's risk of cardiac death based on adenosine myocardial perfusion SPECT (MPS) and associated clinical data, and compared their performance to baseline logistic regression (LR). We demonstrated an approach to visually convey the reasoning behind a patient's risk to provide insight to clinicians beyond that of a "black box." METHODS We trained multiple models using 122 potential clinical predictors (features) for 8321 patients, including 551 cases of subsequent cardiac death. Accuracy was measured by area under the ROC curve (AUC), computed within a cross-validation framework. We developed a method to display the model's rationale to facilitate clinical interpretation. RESULTS The baseline LR (AUC = 0.76; 14 features) was outperformed by all other methods. A least absolute shrinkage and selection operator (LASSO) model (AUC = 0.77; p = .045; 6 features) required the fewest features. A support vector machine (SVM) model (AUC = 0.83; p < .0001; 49 features) provided the highest accuracy. CONCLUSIONS LASSO outperformed LR in both accuracy and simplicity (number of features), with SVM yielding best AUC for prediction of cardiac death in patients undergoing MPS. Combined with presenting the reasoning behind the risk scores, our results suggest that ML can be more effective than LR for this application.
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Affiliation(s)
- David Haro Alonso
- Medical Imaging Research Center, Illinois Institute of Technology, 3440 S. Dearborn St., Suite 100, Chicago, IL, 60616, USA
| | - Miles N Wernick
- Medical Imaging Research Center, Illinois Institute of Technology, 3440 S. Dearborn St., Suite 100, Chicago, IL, 60616, USA.
| | - Yongyi Yang
- Medical Imaging Research Center, Illinois Institute of Technology, 3440 S. Dearborn St., Suite 100, Chicago, IL, 60616, USA
| | - Guido Germano
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Wu D, Zhang Z, Ma R, Guo F, Wang L, Fang W. Comparison of CZT SPECT and conventional SPECT for assessment of contractile function, mechanical synchrony and myocardial scar in patients with heart failure. J Nucl Cardiol 2019; 26:443-452. [PMID: 28623525 DOI: 10.1007/s12350-017-0952-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
AIM The aim of this study was to compare CZT-SPECT (CZT SPECT) to conventional SPECT (C-SPECT) in the assessment of left ventricular myocardial scar, contractile function, and mechanical synchrony in patients with heart failure (HF). METHODS Fifty-nine patients with HF who were referred for myocardial perfusion/metabolism imaging were enrolled. All patients underwent resting 99mTc-MIBI gated myocardial perfusion imaging using a CZT SPECT camera and a C-SPECT camera, respectively, and 18F-FDG PET myocardial metabolism imaging within three days. Summed rest score (SRS) and total perfusion defect (TPD) (as indices of perfusion abnormality), left ventricular (LV), end diastolic volume (EDV), end systolic volume (ESV), and ejection fraction (EF) (as indices of LV systolic function), and histogram band width (BW) and standard deviation (SD) (as indices of mechanical synchrony) were analyzed by automated software while the perfusion/metabolism patterns were analyzed visually. RESULTS There was a good correlation between CZT SPECT and C-SPECT for SRS and TPD. CZT SPECT tended to underestimate SRS and TPD compared to C-SPECT. CZT-SPECT and C-SPECT showed excellent agreement in assessing the perfusion/metabolism pattern though a small proportion of normal segments (6.6%) identified by CZT/PET exhibited mismatch pattern on C-SPECT/PET. CZT SPECT also showed excellent correlation with C-SPECT in measuring EDV, ESV, and EF. Finally, BW and SD measured by CZT SPECT correlated well with C-SPECT but CZT SPECT tended to overestimate BW and SD compared to C-SPECT. CONCLUSION CZT SPECT provided comparable data to C-SPECT for measuring LV scar, function and synchrony at a considerable reduction in imaging time. CZT SPECT holds a promise for comprehensive evaluation of myocardial performance in patients with HF.
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Affiliation(s)
- Dayong Wu
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Zongyao Zhang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rongzheng Ma
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Guo
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Fathala A, Aboulkheir M, Shoukri MM, Alsergani H. Diagnostic accuracy of 13N-ammonia myocardial perfusion imaging with PET-CT in the detection of coronary artery disease. Cardiovasc Diagn Ther 2019; 9:35-42. [PMID: 30881875 DOI: 10.21037/cdt.2018.10.12] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background 13N-ammonia positron emission tomography-computed tomography (PET-CT) is being increasingly used as a non-invasive imaging modality for evaluating patients with known or suspected coronary artery disease (CAD), but information about the diagnostic accuracy of PET-MPI is sparse. Objectives: Our objective was to determine the accuracy of 13N-ammonia PET-CT myocardial perfusion imaging (MPI) for detecting CAD. Methods We retrospectively evaluated 383 patients with suspected CAD who underwent rest-stress 13N- ammonia PET-CT MPI. Invasive coronary angiography (ICA) was performed within 60 days for all patients with abnormal PET-MPI findings and for selected patients with normal PET-MPI findings. Results The mean age of the patients was 64±11 years, and the mean body mass index was 32±7 kg/m2. Stress perfusion defects were identified in 147 (34%) out of a total of 383 patients. ICA was performed in 213 patients (145 patients with abnormal PET and 68 patients with normal PET). The sensitivity of PET-MPI for detection of obstructive CAD based on ≥50% stenosis was 90%; specificity, 90%; positive predictive value, 96%; negative predictive value, 76%; and diagnostic accuracy, 80%. Conclusions PET-MPI with 13N-ammonia affords high sensitivity and overall accuracy for detecting CAD. The addition of coronary artery calcium score (CACS) can improve CAD risk stratification.
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Affiliation(s)
- Ahmed Fathala
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mervat Aboulkheir
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Taibah University, Madinah, Saudi Arabia
| | - Mohamamed M Shoukri
- Department of Cell Biology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Hani Alsergani
- King Faisal Heart Institute, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Peddi P, Master SR, Dwary AD, Ravipati HP, Patel AH, Pasam A, Katikaneni PK, Shi R, Burton GV, Chu QD. Utility of routine pretreatment evaluation of left ventricular ejection fraction in breast cancer patients receiving anthracyclines. Breast J 2019; 25:62-68. [DOI: 10.1111/tbj.13182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/09/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Prakash Peddi
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Samip R. Master
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Ashish D. Dwary
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Hari P. Ravipati
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Abhishek H. Patel
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Avinash Pasam
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Pavan K. Katikaneni
- Department of Medicine Division of Cardiology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Runhua Shi
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Gary V. Burton
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Quyen D. Chu
- Department of Surgery Division of Surgical Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
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Abstract
Computed tomography is an established tool in the assessment of cardiac anatomy and function. As demonstrated by single photon emission computed tomography, positron emission tomography, and magnetic resonance, the noninvasive evaluation of coronary hemodynamics is an important step in guiding clinical management. Nevertheless, no single modality has been shown to accurately quantify coronary artery stenosis, evaluate an atherosclerotic plaque's composition for embolic risk stratification, and assess myocardial perfusion. Although not a novel technology, dual-energy computed tomography has undergone significant advancements that have increased interest in this modality's potential clinical cardiac applications. Albeit still in the early stages of development, one can expect additional clinical studies to further develop this important tool for cardiac imaging as more institutions acquire dual-energy compatible scanners.
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Affiliation(s)
- Matthew Lempel
- From the Department of Medicine, Yale-Waterbury Hospital, Waterbury, CT
| | - William H Frishman
- Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
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Allam AHA, Thompson RC, Eskander MA, Mandour Ali MA, Sadek A, Rowan CJ, Sutherland ML, Sutherland JD, Frohlich B, Michalik DE, Finch CE, Narula J, Thomas GS, Samuel Wann L. Is coronary calcium scoring too late? Total body arterial calcium burden in patients without known CAD and normal MPI. J Nucl Cardiol 2018; 25:1990-1998. [PMID: 28547671 DOI: 10.1007/s12350-017-0925-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with normal myocardial perfusion imaging (MPI) have a good prognosis. However, pre-clinical coronary and extracoronary atherosclerosis may exist in the absence of myocardial ischemia. METHODS 154 Egyptian patients (mean age 53 years) underwent whole-body non-contrast CT following normal MPI. RESULTS Atherosclerosis in the form of calcification was observed in ≥1 vascular bed in 115 of 154 (75%) patients. This included the iliofemoral (62%), abdominal aorta (53%), thoracic aorta (47%), coronary (47%), and carotid (25%) vascular beds. Mean total body calcium score was 3172 ± 530 AU. Extracoronary atherosclerosis in patients with a zero coronary artery calcium (CAC) score was common, occurring in the above-listed beds 42%, 36%, 29%, and 7% of the time, respectively. CAC was rarely present without iliofemoral or abdominal aortic calcification. CONCLUSION Quantitative assessment of calcification in different vascular beds demonstrates that extracoronary atherosclerosis is common in patients who have normal MPI. Atherosclerotic calcifications are most common in the iliofemoral arteries and abdominal aorta, which typically predate coronary calcifications. An imaging strategy to detect extracoronary atherosclerosis could lead to greater understanding of the natural history of atherosclerosis in its long pre-clinical phase and possibly to earlier preventive strategies.
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Affiliation(s)
- Adel H A Allam
- Al Azhar University, Cairo, Egypt
- Alpha Scan, 45 Anas Ibn Malik Street, Mohandseen, Giza, Egypt
| | - Randall C Thompson
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | | | | | - Chris J Rowan
- Renown Institute for Heart and Vascular Health, Reno, NV, USA
| | | | | | - Bruno Frohlich
- National Museum of Natural History Smithsonian Institution, Washington, DC, DC, USA
| | - David E Michalik
- University of California, Irvine School of Medicine, Irvine, CA, USA
- Miller Women's and Children's Hospital, Long Beach, CA, USA
| | - Caleb E Finch
- Leonard Davis School of Gerontology and Dornsife College, University of Southern California, Los Angeles, CA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gregory S Thomas
- Long Beach Memorial, Long Beach, CA, USA
- University of California, Irvine, Orange, CA, USA
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Sharir T, Kovalski G. Absolute myocardial blood flow vs relative myocardial perfusion: Which one is better? J Nucl Cardiol 2018; 25:1629-1632. [PMID: 28477313 DOI: 10.1007/s12350-017-0909-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/24/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Center, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel.
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Kim SJ, Lee SW, Jeong SY, Pak K, Kim K. Diagnostic Performance of Technetium-99m Methoxy-Isobutyl-Isonitrile for Differentiation of Malignant Thyroid Nodules: A Systematic Review and Meta-Analysis. Thyroid 2018; 28:1339-1348. [PMID: 30129898 DOI: 10.1089/thy.2018.0072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The purpose of the current study was to investigate the diagnostic performance of technetium-99m (Tc-99m) methoxy-isobutyl-isonitrile (MIBI) for differentiation of malignant thyroid nodules (TN) through a systematic review and meta-analysis. METHODS The MEDLINE/PubMed and EMBASE database, from the earliest available date of indexing through January 31, 2018, were searched for studies evaluating the diagnostic performance of Tc-99m MIBI for TN. The sensitivities and specificities were determined across studies, positive and negative likelihood ratios (LR+ and LR-) were calculated, and summary receiver operating characteristic curves were constructed. RESULTS Across 22 studies (2421 patients), the pooled sensitivity for Tc-99m MIBI thyroid scan was 0.87 [confidence interval (CI) 0.76-0.93] with heterogeneity (I2 = 92.3) and a pooled specificity of 0.78 [CI 0.67-0.86] with heterogeneity (I2 = 96.4). LR syntheses gave an overall LR+ of 4.0 [CI 2.5-6.3] and LR- of 0.17 [CI 0.09-0.32]. The pooled diagnostic odds ratio was 24 [CI 63-176]. The hierarchical summary receiver operating characteristic curve indicates that the area under the curve was 0.90 [CI 0.87-0.92]. In meta-regression analysis, no definite variable was the source of the study heterogeneity. CONCLUSION The current meta-analysis shows a moderate sensitivity and specificity of Tc-99m MIBI thyroid scan for differentiation of malignant TN. However, the diagnostic odds ratio was relatively low and the LR scattergram indicated that Tc-99m MIBI thyroid scan is not useful for confirming the presence of malignant TN or for its exclusion. Therefore, Tc-99m MIBI thyroid scans should be used restrictively and interpreted cautiously when assessing TN for malignancy.
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Affiliation(s)
- Seong-Jang Kim
- 1 Department of Nuclear Medicine, Pusan National University Yangsan Hospital , Yangsan, Korea
- 2 BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan, Korea
- 3 Department of Nuclear Medicine, College of Medicine, Pusan National University , Yangsan, Korea
| | - Sang-Woo Lee
- 4 Department of Nuclear Medicine, Kyungpook National University Medical Center and School of Medicine , Daegu, Korea
| | - Shin Young Jeong
- 4 Department of Nuclear Medicine, Kyungpook National University Medical Center and School of Medicine , Daegu, Korea
| | - Kyoungjune Pak
- 5 Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Korea
| | - Keunyoung Kim
- 5 Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Korea
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Utility of Left Ventricular Ejection Fraction Measurements Before the Administration of Doxorubicin-Based Chemotherapy in Patients With Diffuse Large B-Cell Lymphoma. Mayo Clin Proc Innov Qual Outcomes 2018; 2:277-285. [PMID: 30225461 PMCID: PMC6132212 DOI: 10.1016/j.mayocpiqo.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 01/11/2023] Open
Abstract
Objective To determine the utility of routine measurements of left ventricular ejection fraction (LVEF) before the administration of doxorubicin-based chemotherapy (DOX) in patients with diffuse large B-cell lymphoma (DLBCL). Patients and Methods We investigated the frequency of LVEF measurements before the initiation of therapy in 291 patients with DLBCL at our institution from January 1, 2001, through December 31, 2013, and reviewed whether LVEF varied in patients with an underlying risk of cardiac disease (CD), the relationship between LVEF and subsequent DLBCL treatment, and congestive heart failure (CHF) occurrence in DOX-treated patients. Results Left ventricular ejection fraction was measured in 258 patients before the administration of chemotherapy and was not associated with underlying CHF risk (P=.94). Left ventricular ejection fraction was normal in 243 patients (94%) and low in 15 patients. Doxorubicin-based chemotherapy was administered to 206 patients with normal LVEF (85%) vs 8 patients with low LVEF (53%) (P=.006). However, when previous CD was factored out, LVEF did not influence subsequent treatment decisions (P=.51). Congestive heart failure occurred in 18 patients, and the risk was similar in patients treated with and without DOX. For all patients who had LVEF measured, CHF incidence did not differ between patients who received DOX and those who did not (P>.99). Moreover, there was no difference in CHF incidence after receiving DOX between those who had normal and low LVEF results (P=.45). Conclusion The decision to administer DOX was influenced by LVEF status only when previous CD was factored out. Furthermore, CHF incidence posttreatment did not differ between patients who did and did not receive DOX. These preliminary findings challenge the practice of performing cardiac screening before DOX for patients with DLBCL.
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Coronary artery disease in post-menopausal women: are there appropriate means of assessment? Clin Sci (Lond) 2018; 132:1937-1952. [DOI: 10.1042/cs20180067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 01/08/2023]
Abstract
The recognition of sex differences in cardiovascular disease, particularly the manifestations of coronary artery disease (CAD) in post-menopausal women, has introduced new challenges in not only understanding disease mechanisms but also identifying appropriate clinical means of assessing the efficacy of management strategies. For example, the majority of treatment algorithms for CAD are derived from the study of males, focus on epicardial stenoses, and inadequately account for the small intramyocardial vessel disease in women. However, newer investigational modalities, including stress perfusion cardiac magnetic resonance imaging and positron emission tomography are providing enhanced diagnostic accuracy and prognostication for women with microvascular disease. Moreover, these investigations may soon be complemented by simpler screening tools such as retinal vasculature imaging, as well as novel biomarkers (e.g. heat shock protein 27). Hence, it is vital that robust, sex-specific cardiovascular imaging modalities and biomarkers continue to be developed and are incorporated into practice guidelines that are used to manage women with CAD, as well as gauge the efficacy of any new treatment modalities. This review provides an overview of some of the sex differences in CAD and highlights emerging advances in the investigation of CAD in post-menopausal women.
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Sico JJ, Baye F, Myers LJ, Concato J, Ferguson J, Cheng EM, Jadbabaie F, Yu Z, Arling G, Zillich AJ, Reeves MJ, Williams LS, Bravata DM. Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality. Neurol Clin Pract 2018; 8:192-200. [PMID: 30105158 PMCID: PMC6075977 DOI: 10.1212/cpj.0000000000000465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 03/16/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND American Heart Association/American Stroke Association expert consensus guidelines recommend consideration of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a high-risk Framingham Cardiac Risk Score (FCRS). Whether this guideline is being implemented in routine clinical practice, and the association of its implementation with mortality, is less clear. METHODS Study participants were Veterans with stroke/TIA (n = 11,306) during fiscal year 2011 who presented to a VA Emergency Department or who were admitted. Patients were excluded (n = 6,915) based on prior CHD/angina/chest pain history, receipt of cardiac stress testing within 18 months prior to cerebrovascular event, death within 90 days of discharge, discharge to hospice, transfer to a non-VA acute care facility, or missing/unknown race. FCRS ≥20% was classified as high risk for CHD. ICD-9 and Common Procedural Terminology codes were used to identify receipt of any cardiac stress testing. RESULTS Among 4,391 eligible patients, 62.8% (n = 2,759) had FCRS ≥20%. Cardiac stress testing was performed infrequently and in similar proportion among high-risk (4.5% [123/2,759]) vs low/intermediate-risk (4.4% [72/1,632]) patients (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.54-1.10). Receipt of stress testing was not associated with reduced 1-year mortality (aOR 0.59, CI 0.26-1.30). CONCLUSIONS In this observational cohort study of patients with cerebrovascular disease, cardiac screening was relatively uncommon and was not associated with 1-year mortality. Additional work is needed to understand the utility of CHD screening among high-risk patients with cerebrovascular disease.
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Affiliation(s)
- Jason J Sico
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - Fitsum Baye
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - Laura J Myers
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - John Concato
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - Jared Ferguson
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - Eric M Cheng
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - Farid Jadbabaie
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - Zhangsheng Yu
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - Gregory Arling
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - Alan J Zillich
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - Mathew J Reeves
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - Linda S Williams
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
| | - Dawn M Bravata
- Neurology Service (JJS), Clinical Epidemiology Research Center (CERC) (JJS, JC), and Medical Service (JC, FJ), VA Connecticut Healthcare System, West Haven; Department of Neurology (JJS), Center for Neuroepidemiological and Clinical Research (JJS), and Department of Internal Medicine (JJS, JC, JF, FJ), Yale School of Medicine, New Haven, CT; VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) (FB, LJM, JF, LSW, DMB) and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI) (FB, LJM, JF, LSW, DMB), Richard L. Roudebush VA Medical Center, Indianapolis; Departments of Biostatistics (FB, ZY), Internal Medicine (LJM, DMB), and Neurology (LSW, DMB), Indiana University School of Medicine, Indianapolis; Department of Neurology (EMC), VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles; College of Health and Human Services (GA), Purdue University School of Nursing; Department of Pharmacy Practice (AJZ), Purdue University College of Pharmacy, West Lafayette, IN; Department of Epidemiology and Biostatistics (MJR), Michigan State University, East Lansing; and Regenstrief Institute (LSW, DMB), Indianapolis, IN
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Dong W, Li J, Mi H, Song X, Jiao J, Li Q. Relationship between collateral circulation and myocardial viability of 18F-FDG PET/CT subtended by chronic total occluded coronary arteries. Ann Nucl Med 2018; 32:197-205. [PMID: 29380138 DOI: 10.1007/s12149-018-1234-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To analyze the relationship between the collateral flow of coronary chronic total occlusion (CTO) and myocardial viability detected by 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging. METHODS A prospective analysis of 104 patients diagnosed by coronary angiography. All patients underwent resting myocardial perfusion imaging and PET/CT within 1 week. The collateral circulation was graded with Rentrop classification as no or poor collateral circulation in 16 CTO vessels, moderate collateral circulation in 34 CTO vessels, and good collateral circulation in 69 CTO vessels. Myocardial viability was determined with myocardial perfusion imaging and PET. The patterns were interpreted as mismatch, match and normal perfusion and 18F-FDG uptake. RESULTS There was no significant correlation between the severity and extent of perfusion defect, myocardial viability and collateral circulation grade. The myocardial viability was normal in mild and moderate hypokinetic regions and decreased in severe hypokinetic and akinesis-dyskinesis regions. The presence of collateral circulation was a sensitive (89%) but not a specific (31%) sign of myocardial viability. CONCLUSIONS In patients with CTO, collateral circulation does not seem to be an effective way for predicting myocardial viability. Further analysis of PET patterns of viable myocardium is needed to guide further revascularization and predict functional improvement and survival benefit.
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Affiliation(s)
- Wei Dong
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen road, Chaoyang District, Beijing, 100029, China
| | - Jianan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen road, Chaoyang District, Beijing, 100029, China
| | - Hongzhi Mi
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen road, Chaoyang District, Beijing, 100029, China.
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen road, Chaoyang District, Beijing, 100029, China.
| | - Jian Jiao
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen road, Chaoyang District, Beijing, 100029, China
| | - Quan Li
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen road, Chaoyang District, Beijing, 100029, China
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Chia PL, Chiang K, Snyder R, Dowling A. The utility of routine pre-chemotherapy screening with cardiac gated blood pool scan for patients at low risk of anthracycline toxicity. J Oncol Pharm Pract 2017; 24:264-271. [PMID: 29284360 DOI: 10.1177/1078155217697487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Anthracycline-based chemotherapy is used in many malignancies. Current recommendations by several groups suggest cardiac monitoring prior to and during anthracycline therapy. We aim to review the usefulness of baseline cardiac screening for left ventricular ejection fraction to assess if it had any impact on chemotherapy decisions in patients to be treated with anthracycline-based regimens or any beneficial effect upon outcomes. Methods We conducted a retrospective three-year audit of cancer patients who underwent GBPS prior to anthracycline (doxorubicin) chemotherapy. Subjects were identified via records from the Department of Nuclear Medicine. Pharmacy dispensing records identified those who received doxorubicin. Patient demographics, cancer type, cardiac risk factors, GBPS ejection fraction (EF), and cumulative anthracycline dose were collected. Results From 1 August 2009 to 31 July 2012, 179 patients underwent GBPS pre-doxorubicin chemotherapy. The mean age was 59 years (range 21-89 years), with 51% being males. Only two patients (1.1%) had an abnormal EF < 50%, while 33 patients (18%) had an EF 51-59% and 144 patients (80%) had EF ≥ 60%. The two patients with reduced baseline EF still received anthracycline-based chemotherapy. All 135 patients without any known cardiovascular risk factors had normal EFs. The total number of patients who received anthracycline chemotherapy during the same period was 207. Thus 28 patients (13%) commenced anthracycline without a prior GBPS. Conclusion Only 1.1% of the screened patients had EF < 50%. These two patients still received doxorubicin chemotherapy despite a compromised EF, as their treating clinicians believed that the benefits of chemotherapy outweighed the risk of potential cardiac toxicity. Our audit questions the practice of routine cardiac evaluation pre-anthracycline screening with GBPS. We propose that routine screening only be requested if cardiac risk factors are present.
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Affiliation(s)
- Puey Ling Chia
- 1 Department of Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Australia.,2 Department of Medical Oncology, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia
| | - K Chiang
- 3 Department of Pharmacy, St Vincent's Hospital Melbourne, Australia
| | - R Snyder
- 1 Department of Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - A Dowling
- 1 Department of Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Australia
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Kim DA, Farrell MB, Jerome SD. It's about time we think about lowering radiation dose in obese patients too. J Nucl Cardiol 2017; 24:1922-1925. [PMID: 27541046 DOI: 10.1007/s12350-016-0636-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Daniel A Kim
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Scott D Jerome
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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