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Jiang M, Zhang G, Li L, He Y, Li G, Yu J, Feng J, Liu X. Case Report: A case report of myocardial fibrosis activation assessment after unstable angina using 68Ga-FAPI-04 PET/CT. Front Cardiovasc Med 2024; 11:1332307. [PMID: 38322772 PMCID: PMC10844421 DOI: 10.3389/fcvm.2024.1332307] [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: 11/02/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
Myocardial ischemia may induce myocardial fibrosis, a condition that progressively leads to ventricular remodeling, heightening the risk of heart failure. The timely detection of myocardial fibrosis is crucial for intervention and improved outcomes. 68Ga-FAPI-04 PET/CT shows promise in assessing fibroblast activation in patients with early myocardial infarction characterized by prolonged myocardial ischemia. However, there is a notable absence of data regarding patients with short-term myocardial ischemia, such as those experiencing unstable angina (UA). In this report, we evaluated a 49-year-old male with UA and severe stenosis in multiple coronary arteries using 68Ga-FAPI-04 PET/CT. The results demonstrated tracer-specific uptake (SUVmax = 4.6) in the left anterior descending artery (LAD) territory, consistent with myocardial anterior wall ischemia indicated by the electrocardiogram. Following vascular recanalization therapy and regular medication treatment, the patient remained free of angina recurrence. A subsequent review at 2 months revealed a significant reduction in myocardial tracer uptake (SUVmax = 1.8). This case illustrates the validity of 68Ga-FAPI-04 PET/CT in assessing the extent of early myocardial fibroblast activation in patients with UA. This approach offers valuable insights for early detection and visual evidence, providing information on disease progression and treatment response.
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Affiliation(s)
| | | | | | | | | | | | | | - Xing Liu
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Moran B, Bryan S, Farrar T, Salud C, Visser G, Decuba R, Renelus D, Buckley T, Dressing M, Peterkin N, Coris E. Diagnostic Evaluation of Nontraumatic Chest Pain in Athletes. Curr Sports Med Rep 2017; 16:84-94. [PMID: 28282354 DOI: 10.1249/jsr.0000000000000342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article is a clinically relevant review of the existing medical literature relating to the assessment and diagnostic evaluation for athletes complaining of nontraumatic chest pain. The literature was searched using the following databases for the years 1975 forward: Cochrane Database of Systematic Reviews; CINAHL; PubMed (MEDLINE); and SportDiscus. The general search used the keywords chest pain and athletes. The search was revised to include subject headings and subheadings, including chest pain and prevalence and athletes. Cross-referencing published articles from the databases searched discovered additional articles. No dissertations, theses, or meeting proceedings were reviewed. The authors discuss the scope of this complex problem and the diagnostic dilemma chest pain in athletes can provide. Next, the authors delve into the vast differential and attempt to simplify this process for the sports medicine physician by dividing potential etiologies into cardiac and noncardiac conditions. Life-threatening causes of chest pain in athletes may be cardiac or noncardiac in origin, which highlights the need for the sports medicine physician to consider pathology in multiple organ systems simultaneously. This article emphasizes the importance of ruling out immediately life threatening diagnoses, while acknowledging the most common causes of noncardiac chest pain in young athletes are benign. The authors propose a practical algorithm the sports medicine physician can use as a guide for the assessment and diagnostic work-up of the athlete with chest pain designed to help the physician arrive at the correct diagnosis in a clinically efficient and cost-effective manner.
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Affiliation(s)
- Byron Moran
- 1Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL; 2Department of Orthopedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL; 3The University of South Carolina School of Medicine, Greenville, SC; 4Primary Care Sports Medicine Fellowship, University of South Florida-Morton Plant Mease, Clearwater, FL; 5Baycare Medical Group Primary Care, St. Petersburg, FL; 6Premiere Med Family and Sports Medicine, Ocoee, FL; 7Family Medicine Residency Program, University of South Florida-Morton Plant Mease, Clearwater, FL; 8Bayfront Primary Care Sports Medicine Fellowship, St. Petersburg, FL; 9Morsani College of Medicine, University of South Florida, Tampa, FL; 10Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL; and 11Baptist Primary Care, Jacksonville, FL; and 12Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
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Examining a hypothetical quantitative model for better approximation of culprit coronary artery and site of stenosis on 99mTc-sestamibi gated myocardial perfusion SPECT. Nucl Med Commun 2016; 37:1102-8. [PMID: 27258991 DOI: 10.1097/mnm.0000000000000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A hypothetical quantitative model of analyzing gated myocardial perfusion SPECT is proposed and examined for the feasibility of its use as a predictor of diseased coronary artery and approximating the site of stenosis to determine whether it could serve as a useful noninvasive complement for coronary angiography. The extent and severity of perfusion defects on rest gated myocardial perfusion imaging SPECT-images were assessed on a five-point scale in a standard 17-segment model and total perfusion deficit was quantified by automated software. The first step was to locate the diseased coronary artery using a quantitative method: for this, the score of each segment belonging to a particular coronary artery was determined using a systematic presumptive approach. After determination of specific coronary artery segments, the scores of the contiguous segments in three short axis slices (apical, middle, and basal) were summed for six subdivisions (anterior, anterolateral, inferolateral, inferior, anteroseptal, and inferoseptal). The site of stenosis was determined from (a) the initial approximation of the involved segments with a defect score of 2-4 and (b) subsequent calculation of the defect score of each of the six subdivisions and allocating the site through a preassigned number for each coronary artery. For each coronary artery, only the subdivision with the highest defect score was considered. Proximal, middle, and distal segments of left anterior descending artery (LAD) were considered to be represented when the summed value of a subdivision within a particular arterial territory was more than or equal to 7, between 5 and 7, 5 and 3, respectively. For the left circumflex and right coronary artery, summed scores (of respective subdivisions) of more than or equal to 5 and between 3 and 5 were preassigned to proximal and distal stenosis, respectively. The results were then correlated with the coronary angiographic data. On coronary angiography, proximal LAD occlusion was considered when the site of occlusion occurred proximal to the first diagonal branch and a mid-LAD occlusion from the first diagonal branch to the next diagonal branch. Proximal left circumflex artery occlusion is considered as those located before the first relevant marginal branch and distal left circumflex artery occlusion is beyond the first marginal branch. From the ostium to the origin of the first acute marginal artery was considered the proximal segment of the right coronary artery and thereafter was designated as distal. The result obtained by the quantitative model was compared with the angiographic data along with statistical analysis. The unweighted κ-value was 0.803 and 95% confidence interval was between 0.716 and 0.890. Both the proposed quantitative myocardial perfusion imaging model and the angiographic results were in strong agreement; however, this model needs to be examined in a larger number of patients in a prospective setting to explore its pitfalls and define its practical applicability in future.
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Correlation of Angina Pectoris and Perfusion Decrease by Collateral Circulation in Single-Vessel Coronary Chronic Total Occlusion Using Myocardial Perfusion Single-Photon Emission Computed Tomography. Nucl Med Mol Imaging 2015; 50:54-62. [PMID: 26941860 DOI: 10.1007/s13139-015-0365-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/12/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the perfusion decrease in donor myocardium by collateral circulation and its correlation with angina pectoris in patients with chronic total occlusion (CTO) using myocardial perfusion single-photon emission computed tomography (MPS). MATERIALS AND METHODS Thirty-six patients with single-vessel CTO without any other stenosis were included. All patients underwent MPS and coronary angiography (CAG) within 2 months. Total 72 donor arteries were evaluated for the grades of collaterals to the CTO artery using the Rentrop grading system on CAG. Perfusion defects and perfusion scores in donor and CTO territories were analyzed on MPS. Myocardial perfusion of donor and CTO territories were evaluated according to the presence of angina pectoris and the grades of collateral circulation. RESULTS When the CTO territory was ischemic, symptomatic patients showed higher summed difference scores in the CTO territory compared to asymptomatic patients (3.5 ± 2.4 vs. 1.5 ± 0.8 for symptomatic and asymptomatic groups respectively; p = 0.034). However, when the CTO territory was nonischemic, symptomatic patients showed higher summed stress scores (SSS, 4.3 ± 2.9 vs. 1.6 ± 1.2; p = 0.032) and summed rest scores (SRS, 4.2 ± 2.5 vs. 1.5 ± 1.1; p = 0.003) in the donor territories. On the per-vessel analysis, perfusion defects in donor territories were more frequent (0 % vs. 53 % vs. 86 % for Rentrop 0, Rentrop 1-2 and Rentrop 3, respectively; p < 0.001) and showed higher SSS (0.0 ± 0.0, 1.3 ± 1.6 and 2.1 ± 1.1 for Rentrop 0, Rentrop 1-2 and Rentrop 3, respectively; p = 0.001) and SRS (0.0 ± 0.0, 1.0 ± 1.4 and 1.7 ± 1.2; p = 0.003) at higher Rentrop grades, but their patterns were variable. CONCLUSION Angina pectoris was related to either ischemia of the myocardium beyond CTO or a perfusion decrease in the donor myocardium. The perfusion decrease in donor myocardium positively correlated with the collateral grades.
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Dose reduction in dynamic CT stress myocardial perfusion imaging: comparison of 80-kV/370-mAs and 100-kV/300-mAs protocols. Eur Radiol 2013; 24:748-55. [PMID: 24272224 DOI: 10.1007/s00330-013-3063-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/16/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the effect of reduced 80-kV tube voltage with increased 370-mAs tube current on radiation dose, image quality and estimated myocardial blood flow (MBF) of dynamic CT stress myocardial perfusion imaging (CTP) in patients with a normal body mass index (BMI) compared with a 100-kV and 300-mAs protocol. METHODS Thirty patients with a normal BMI (<25 kg/m(2)) with known or suspected coronary artery disease underwent adenosine-stress dual-source dynamic CTP. Patients were randomised to 80-kV/370-mAs (n = 15) or 100-kV/300-mAs (n = 15) imaging. Maximal enhancement and noise of the left ventricular (LV) cavity, contrast-to-noise ratio (CNR) and MBF of the two groups were compared. RESULTS Imaging with 80-kV/370-mAs instead of 100-kV/300-mAs was associated with 40% lower radiation dose (mean dose-length product, 359 ± 66 vs 628 ± 112 mGy[Symbol: see text]cm; P < 0.001 ) with no significant difference in CNR (34.5 ± 13.4 vs 33.5 ± 10.4; P = 0.81) or MBF in non-ischaemic myocardium (0.95 ± 0.20 vs 0.99 ± 0.25 ml/min/g; P = 0.66). Studies obtained using 80-kV/370-mAs were associated with 30.9% higher maximal enhancement (804 ± 204 vs 614 ± 115 HU; P < 0.005), and 31.2% greater noise (22.7 ± 3.5 vs 17.4 ± 2.6; P < 0.001). CONCLUSIONS Dynamic CTP using 80-kV/370-mA instead of 100-kV/300-mAs allowed 40% dose reduction without compromising image quality or MBF. Tube voltage of 80-kV should be considered for individuals with a normal BMI. KEY POINTS • CT stress perfusion imaging (CTP) is increasingly used to assess myocardial function. • Dynamic CTP is feasible at 80-kV in patients with normal BMI. • An 80-kV/370-mAs protocol allows 40% dose reduction compared with 100-kV/300-mAs. • Contrast-to-noise ratio and myocardial blood flow of the two protocols were comparable.
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Comparison of MR and CT for the Assessment of the Significance of Coronary Artery Disease: a Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-012-9186-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bettencourt N, Chiribiri A, Schuster A, Ferreira N, Sampaio F, Pires-Morais G, Santos L, Melica B, Rodrigues A, Braga P, Azevedo L, Teixeira M, Leite-Moreira A, Silva-Cardoso J, Nagel E, Gama V. Direct comparison of cardiac magnetic resonance and multidetector computed tomography stress-rest perfusion imaging for detection of coronary artery disease. J Am Coll Cardiol 2013; 61:1099-107. [PMID: 23375929 DOI: 10.1016/j.jacc.2012.12.020] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/04/2012] [Accepted: 12/26/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to compare the diagnostic performance of a multidetector computed tomography (MDCT) integrated protocol (IP) including coronary angiography (CTA) and stress-rest perfusion (CTP) with cardiac magnetic resonance myocardial perfusion imaging (CMR-Perf) for detection of functionally significant coronary artery disease (CAD). BACKGROUND MDCT stress-rest perfusion methods were recently described as adjunctive tools to improve CTA accuracy for detection of functionally significant CAD. However, only a few studies compared these MDCT-IP with other clinically validated perfusion techniques like CMR-Perf. Furthermore, CTP has never been validated against the invasive reference standard, fractional flow reserve (FFR), in patients with suspected CAD. METHODS 101 symptomatic patients with suspected CAD (62 ± 8.0 years, 67% males) and intermediate/high pre-test probability underwent MDCT, CMR and invasive coronary angiography. Functionally significant CAD was defined by the presence of occlusive/subocclusive stenoses or FFR measurements ≤ 0.80 in vessels >2mm. RESULTS On a patient-based model, the MDCT-IP had a sensitivity, specificity, positive and negative predictive values of 89%, 83%, 80% and 90%, respectively (global accuracy 85%). These results were closely related with those achieved by CMR-Perf: 89%, 88%, 85% and 91%, respectively (global accuracy 88%). When comparing test accuracies using noninferiority analysis, differences greater than 11% in favour of CMR-Perf can be confidently excluded. CONCLUSIONS MDCT protocols integrating CTA and stress-rest perfusion detect functionally significant CAD with similar accuracy as CMR-Perf. Both approaches yield a very good accuracy. Integration of CTP and CTA improves MDCT performance for the detection of relevant CAD in intermediate to high pre-test probability populations.
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Affiliation(s)
- Nuno Bettencourt
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
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Caycedo R. Diagnóstico fractal aplicado a la cardiología. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70139-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Taşçı C, Özçelik N. An Overview on Coronary Heart Disease (A Comparative Evaluation of Turkey and Europe) and Cost-effectiveness of Diagnostic Strategies. Mol Imaging Radionucl Ther 2011; 20:75-93. [PMID: 23487016 PMCID: PMC3590955 DOI: 10.4274/mirt.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 10/14/2011] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Coronary heart disease (CHD) is the leading cause of death for men and women in Turkey as it is in Europe and US. The prevalence of the disease is 3.8% in Turkey and 200,000 patients are added to the pool of CHD annually Because of genetic predisposition and high proportions of physical inactivity, smoking habit, and obesity, CHD is encountered in earlier ages in our country So, the economic burden of the disease is expected to be relatively high, but the amount of health expenditure is not always parallel to the prevalence of a disease in the community. This article was written to overview CHD statistics to make a comparison between Turkey and some European countries and to investigate the value of myocardial perfusion scan (MPS) as a gatekeeper in diagnosing CHD before invasive coronary angiography (ICA). The consequences were evaluated for Turkey In diagnosis; noninvasive testing gains importance in connection with the new approaches in treatment strategies, because a direct ICA strategy results in higher rates of revascularization without improvement in clinical outcomes. A "gatekeeper" is needed to select the patients who are not required to undergo angiography. MPS with its proved power in diagnosis and predicting prognosis, provides a cost-effective solution, and is accepted in some extensive analyses as a "gatekeeper" particularly in intermediate and high risk patients and in patients with known CHD. In conclusion, MPS may provide an optimal solution better than the ongoing situation in Turkey as well, when it is approved as a "gatekeeper in an algorithm before ICA. CONFLICT OF INTEREST None declared.
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Affiliation(s)
- Cengiz Taşçı
- Gama Medical Center, Derpartment of Nuclear Medicine, Gaziantep, Turkey
| | - Nihat Özçelik
- Gama Medical Center, Derpartment of Nuclear Medicine, Gaziantep, Turkey
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Bettencourt N, Rocha J, Ferreira N, Pires-Morais G, Carvalho M, Leite D, Melica B, Santos L, Rodrigues A, Braga P, Teixeira M, Simões L, Leite-Moreira A, Cardoso S, Nagel E, Gama V. Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease. J Cardiovasc Comput Tomogr 2011; 5:392-405. [PMID: 22146498 DOI: 10.1016/j.jcct.2011.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 10/08/2011] [Accepted: 10/19/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Preliminary studies have shown the potential of myocardial computed tomography perfusion (CTP) analysis for ischemia detection in both animals and humans. OBJECTIVE To provide validation data on stress-rest CTP protocols as additive tools to improve the accuracy of multidetector computed tomography (MDCT) for coronary artery disease (CAD) in symptomatic patients. METHODS Ninety symptomatic patients with suspected CAD (62 ± 8 years, 66% males) underwent both MDCT and invasive coronary angiography (XA). The MDCT protocol included a prospective calcium score acquisition, a helical acquisition with retrospective gating during infusion of adenosine (140 μg/kg/min) and a prospective scan for computed tomography angiography (CTA) at rest (total effective radiation dose: 5.1 ± 0.8 mSv). Significant and higher-grade CADs were defined by the presence of ≥50% or ≥70% stenosis in at least one coronary artery, as evaluated by quantitative coronary angiography (QCA) using XA images. RESULTS On a patient-based model, CTA sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) to detect ≥50% or ≥70% stenosis were 98%, 71%, 80%, and 97% (global accuracy 86%) and 100%, 60%, 64%, and 100% (accuracy 77%), respectively. An integrative approach of CTA and CTP results had the best performance for detection of CAD with sensitivity of 83%, specificity of 98%, PPV of 98%, and NPV of 84% (accuracy 84%) for detection of 50% stenosis and 97%, 90%, 88%, and 98% (accuracy 93%), respectively, for the 70% threshold. The integration of results had the best overall performance in all scenarios but was particularly advantageous in the prediction of higher-grade CAD, with an area under the curve of 0.93, compared with 0.80 for isolated CTA and 0.82 for CTP and in patients with severe calcifications (sensitivity 92%, specificity 87%, overall accuracy of 90%). CONCLUSIONS The integration of functional and morphological data using CTA and CTP improved MDCT accuracy for detection of clinically relevant CAD at both thresholds of 50% and 70% in this intermediate to high pretest probability population.
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Affiliation(s)
- Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal.
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