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Hoff CM, Sørensen J, Kero T, Bouchelouche K, Harms HJ, Frøkiær J, Gormsen LC, Tolbod LP. Quantitative and qualitative comparison of Rubidium-82 and Oxygen-15 water cardiac PET. J Nucl Cardiol 2024; 32:101796. [PMID: 38278706 DOI: 10.1016/j.nuclcard.2024.101796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Differences in tracer characteristics may influence the interpretation of positron emission tomography myocardial perfusion imaging (MPI). We compare the reading of MPIs with a low-extraction retention tracer (82Rb) and a high-extraction non-retention tracer (15O-water) in a selected cohort of patients with known coronary artery disease (CAD). METHODS Thirty-nine patients with known CAD referred to 82Rb MPI due to angina underwent rest and stress imaging with both tracers and experienced MPI readers provided blinded consensus reads of all studies. In addition, a comparison of regional and global quantitative measures of perfusion was performed. RESULTS The results showed 74 % agreement in the reading of 82Rb and 15O-water MPI for regional reversible ischemia and global disease, and 82 % agreement for regional irreversible ischemia. The 15O-water MPI identified more cases of global disease (n = 12 (15O-water) vs n = 4 (82Rb), p = 0.03), whereas differences in reversible ischemia (n = 22 vs n = 16, p = 0.11) and, irreversible ischemia (n = 8 vs n = 11, p = 0.45) were not significant. The correlation between myocardial blood flow measured using the two tracers was similar to previous studies (R2 = 0.78) with wide limits of agreement (-0.93 to 0.84 ml/g/min). CONCLUSIONS Agreement between consensus readings of 82Rb and 15O-water MPI was good in patients with known CAD. In this limited size study, no significant differences in the identification of reversible and irreversible ischemia found, whereas 15O-water MPI had a higher positive rate for suspected global disease.
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Affiliation(s)
- Camilla Molich Hoff
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Nuclear Medicine & PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Kero
- Nuclear Medicine & PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Frøkiær
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars C Gormsen
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars P Tolbod
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Harms HJ, Bravo PE, Bajaj NS, Zhou W, Gupta A, Tran T, Taqueti VR, Hainer J, Bibbo C, Dorbala S, Blankstein R, Mehra M, Sörensen J, Givertz MM, Di Carli MF. Cardiopulmonary transit time: A novel PET imaging biomarker of in vivo physiology for risk stratification of heart transplant recipients. J Nucl Cardiol 2022; 29:1234-1244. [PMID: 33398793 PMCID: PMC8254830 DOI: 10.1007/s12350-020-02465-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 10/12/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Myocardial blood flow (MBF) can be quantified using dynamic PET studies. These studies also inherently contain tomographic images of early bolus displacement, which can provide cardiopulmonary transit times (CPTT) as measure of cardiopulmonary physiology. The aim of this study was to assess the incremental prognostic value of CPTT in heart transplant (OHT) recipients. METHODS 94 patients (age 56 ± 16 years, 78% male) undergoing dynamic 13N-ammonia stress/rest studies were included, of which 68 underwent right-heart catherization. A recently validated cardiac allograft vasculopathy (CAV) score based on PET measures of regional perfusion, peak MBF and left-ventricular (LV) ejection fraction (LVEF) was used to identify patients with no, mild or moderate-severe CAV. Time-activity curves of the LV and right ventricular (RV) cavities were obtained and used to calculate the difference between the LV and RV bolus midpoint times, which represents the CPTT and is expressed in heartbeats. Patients were followed for a median of 2.5 years for the occurrence of major adverse cardiac events (MACE), including cardiovascular death, hospitalization for heart failure or acute coronary syndrome, or re-transplantation. RESULTS CPTT was significantly correlated with cardiac filling pressures (r = .434, P = .0002 and r = .439, P = .0002 for right atrial and pulmonary wedge pressure), cardiac output (r = - .315, P = .01) and LVEF (r = - .513, P < .0001). CPTT was prolonged in patients with MACE (19.4 ± 6.0 vs 14.5 ± 3.0 heartbeats, P < .001, N = 15) with CPTT ≥ 17.75 beats showing optimal discriminatory value in ROC analysis. CPTT ≥ 17.75 heartbeats was associated with a 10.1-fold increased risk (P < .001) of MACE and a 7.3-fold increased risk (P < .001) after adjusting for PET-CAV, age, sex and time since transplant. CONCLUSION Measurements of cardiopulmonary transit time provide incremental risk stratification in OHT recipients and enhance the value of multiparametric dynamic PET imaging, particularly in identifying high-risk patients.
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Affiliation(s)
- H J Harms
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
- Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - P E Bravo
- Division of Cardiovascular Medicine, Department of Medicine; and Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - N S Bajaj
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - W Zhou
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - A Gupta
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - T Tran
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - V R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - J Hainer
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - C Bibbo
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - S Dorbala
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - R Blankstein
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - M Mehra
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - J Sörensen
- Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - M M Givertz
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA
| | - M F Di Carli
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, USA.
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3
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Harms HJ, Lubberink M. Cardiac software repeatability beyond correlations: Clinical outcomes matter. J Nucl Cardiol 2021; 28:2758-2760. [PMID: 32424680 DOI: 10.1007/s12350-020-02194-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Affiliation(s)
- H J Harms
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark.
| | - M Lubberink
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
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4
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Hansen KB, Sörensen J, Hansson NH, Nielsen R, Larsen AH, Frøkiær J, Tolbod LP, Gormsen LC, Harms HJ, Wiggers H. Myocardial efficiency in patients with different aetiologies and stages of heart failure. Eur Heart J Cardiovasc Imaging 2021; 23:328-337. [PMID: 34751738 DOI: 10.1093/ehjci/jeab227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/15/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Myocardial external efficiency (MEE) is the ratio of cardiac work in relation with energy expenditure. We studied MEE in patients with different aetiologies and stages of heart failure (HF) to discover the role and causes of deranged MEE. In addition, we explored the impact of patient characteristics such as sex, body mass index (BMI), and age on myocardial energetics. METHODS AND RESULTS Cardiac energetic profiles were assessed with 11C-acetate positron emission tomography (PET) and left ventricular ejection fraction (LVEF) was acquired with echocardiography. MEE was studied in 121 participants: healthy controls (n = 20); HF patients with reduced (HFrEF; n = 25) and mildly reduced (HFmrEF; n = 23) LVEF; and patients with asymptomatic (AS-asymp; n = 38) and symptomatic (AS-symp; n = 15) aortic stenosis (AS). Reduced MEE coincided with symptoms of HF irrespective of aetiology and declined in tandem with deteriorating LVEF. Patients with AS-symp and HFmrEF had reduced MEE as compared with controls (22.2 ± 4.9%, P = 0.041 and 20.0 ± 4.2%, P < 0.001 vs. 26.1 ± 5.8% in controls) and a further decline was observed in patients with HFrEF (14.7 ± 6.3%, P < 0.001). Disproportionate left ventricular hypertrophy was a major cause of reduced MEE. Female sex (P < 0.001), a lower BMI (P = 0.001), and advanced age (P = 0.03) were associated with a lower MEE. CONCLUSION MEE was reduced in patients with HFrEF, HFmrEF, and HF due to pressure overload and MEE may therefore constitute a treatment target in HF. Patients with LVH, advanced age, female sex, and low BMI had more pronounced reduction in MEE and personalized treatment within these patient subgroups could be relevant.
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Affiliation(s)
- Kristoffer Berg Hansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus N, Denmark
| | - Jens Sörensen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus N, Denmark.,Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus N, Denmark.,Department of Surgical Sciences, Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Nils Henrik Hansson
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Anders Hostrup Larsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Jørgen Frøkiær
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus N, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Christian Gormsen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus N, Denmark.,Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus N, Denmark
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Sorensen J, Bergsten J, Baron T, Orndahl LH, Kero T, Bjerner T, Hedin E, Harms HJ, Flacshkampf FA. Myocardial efficiency in severe asymptomatic primary mitral regurgitation: relation to quantitative measures of regurgitation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To study the association of myocardial external efficiency (MEE) in mitral regurgitation (MR) towards routinely used quantitative indicators of disease severity and progression.
Background
Quantitative assessment of LV function and regurgitation in asymptomatic severe primary MR is crucial for management. MEE is a load-independent indicator of mechano-energetic coupling and can be measured non-invasively using 11C-acetate positron emission tomography (PET). The role of MEE in this setting has not been studied.
Methods
48 asymptomatic patients with severe primary mitral regurgitation underwent PET, echo, and CMR on the same day. MEE was automatically derived from PET as the ratio of cardiac work (cardiac output * mean arterial pressure) and total left ventricular (LV) oxygen consumption (mean MVO2 * LV mass). LV function and mitral regurgitant volumes (RegVol) were measured by echo and CMR. MEE in MR was compared to healthy volunteers (n=9). MEE and parameters of regurgitation severity and of LV volumes and function were studied as predictors of outcome (valve surgery or death).
Results
MEE was reduced in MR (21.5±4.2%) vs healthy volunteers (32.0±5.6%, p<0.001) and showed weak but significant correlations (r2<0.25) with regurgitation severity and LV volumes. There were 23 cardiac events (valve surgery: 22; cardiovascular death: 1) during follow-up (median 2.7 years, IQR 1.9–3.2). Univariate Cox models showed that MEE, echocardiographic left atrial volume as well as RegVol and LV ventricular volumes from both echo and CMR were significant outcome predictors (all p<0.05), while LVEF and NT-pro-BNP were not (p>0.05). Prediction by MEE was not affected by age, sex or BMI. When categorically divided by the median MEE was a strong predictor in Kaplan-Meier analysis (log-rank p=0.0004, figure 1) and remained independently significant, compared to all other univariate predictors in bivariate Cox models.
Conclusions
This study suggests an important role of energetic insufficiency in progression of asymptomatic severe primary MR. Reduced MEE was linked to outcome independently of standard functional measures of regurgitation severity or left ventricular size and function. Strategies for improvement of myocardial energetics in MR are warranted.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Heart-Lung Foundation Figure 1
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Affiliation(s)
- J Sorensen
- Uppsala University, Surgical Sciences, Nuclear Medicine, Uppsala, Sweden
| | - J Bergsten
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - T Baron
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - L H Orndahl
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - T Kero
- Uppsala University, Surgical Sciences, Nuclear Medicine, Uppsala, Sweden
| | | | - E Hedin
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - H J Harms
- Uppsala University, Surgical Sciences, Nuclear Medicine, Uppsala, Sweden
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Hansen KB, Sorensen J, Hansson NH, Nielsen R, Larsen AH, Frokiaer J, Tolbod LP, Gormsen LC, Harms HJ, Wiggers H. Mechanoenergetic coupling in heart failure with preserved, mid-range and reduced left ventricular ejection fraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Heart failure (HF) classification based on left ventricular ejection fraction (LVEF) can vary because of changes in filling pressures, afterload, and contractile function. 11C-acetate positron emission tomography (PET) provides a load-independent measure of myocardial external efficiency (MEE) by simultaneous assessment of myocardial oxygen consumption (MVO2), cardiac work, left ventricular mass (LVM), end-systolic wall stress (ESWS), and myocardial blood flow (MBF).
Purpose
We aimed to characterize mechanoenergetic derangements in patients with HF and to study its interrelation with age, sex and obesity.
Methods
MEE was measured in 121 participants with 11C-acetate PET, and LVEF was acquired with echocardiography. We investigated healthy controls (n=20) and patients with HF and reduced LVEF <40% (HFrEF; n=25), mid-range LVEF 40–49% (HFmrEF; n=23), as well as patients with asymptomatic aortic valve stenosis (AS) and LVEF ≥50% (AS-asymp; n=38), and symptomatic AS and LVEF ≥50% (defined as HF with preserved LVEF (HFpEF); n=15).
Results
MEE declined in tandem with reduced LVEF from HFpEF and HFmrEF to HFrEF (p=0.041, p<0.001, and p<0.001 versus control, respectively; Figure 1). Impaired MEE was aggravated with increasing LVM (p=0.001) due to a disproportionate increase in overall left ventricular MVO2. In a multivariate analysis, female sex (p<0.001), a lower body mass index (p<0.001), and advanced age (p=0.01) were associated with a lower MEE (Figure 2). HFpEF, HFmrEF, and HFrEF patients had distinct energetic profiles involving MEE, MVO2, MBF, ESWS, and LVM (Figure 2).
Conclusions
Mechanoenergetic uncoupling was evident in every clinical state within the HF syndrome and associated with left ventricular hypertrophy and progressive systolic dysfunction. Sex, age, and obesity impacted myocardial energetics. To date, the present study is the largest investigation of mechanoenergetic coupling across several categories of patients with heart failure. 11C-acetate PET extends our pathophysiological comprehension of the HF syndrome beyond LVEF.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart FoundationThe Lundbeck Foundation Relationship between LVEF and MEEMyocardial energetics in heart failure
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Affiliation(s)
- K B Hansen
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - J Sorensen
- Uppsala University, Department of Surgical Sciences, Nuclear Medicine, Uppsala, Sweden
| | - N H Hansson
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - R Nielsen
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - A H Larsen
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - J Frokiaer
- Aarhus University, Department of Clinical Medicine, Faculty of Health, Aarhus, Denmark
| | - L P Tolbod
- Aarhus University Hospital, Department of Nuclear Medicine & PET Centre, Aarhus, Denmark
| | - L C Gormsen
- Aarhus University Hospital, Department of Nuclear Medicine & PET Centre, Aarhus, Denmark
| | - H J Harms
- Aarhus University Hospital, Department of Nuclear Medicine & PET Centre, Aarhus, Denmark
| | - H Wiggers
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
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Lindstrom E, Dahlgren D, Mehic A, Sigfridsson J, Kero T, Sorensen J, Harms HJ, Lubberink M. Myocardial blood flow values based on 15O-water PET are insensitive to image reconstruction settings. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
For 15O-water PET, a cutoff hyperemic myocardial blood flow (MBF) value of 2.3 mL/g/min for significant ischemia has been established (1). For other tracers, different studies show a wide range of proposed cutoff values. The use of uniform absolute cutoff values for pathological hyperemic MBF or flow reserve in clinical decision making requires robust quantification of MBF, with comparable values across scanners, centres, and reconstruction methods.
Purpose
The aim of the present work was to assess the effect of different reconstruction methods on quantitative MBF values based on 15O-water PET.
Methods 20 patients referred for assessment of ischemia underwent 4 min dynamic stress PET scans starting simultaneously with automated bolus injection of 400 MBq 15O-water on a digital PET/CT scanner. Images were reconstructed using 17 different reconstruction methods, with the clinical reconstruction used as reference: time-of-flight (TOF) ordered subsets expectation maximization (OSEM) with 3 iterations and 16 subsets, including point spread function recovery (PSF) and a 5 mm gaussian post-filter. Parameters that were varied were number of iterations (1-6), filter (3, 5 or 8 mm), exclusion of TOF and PSF, and using regularized reconstruction with 7 different values of the regularization parameter beta. Images were analyzed fully automatically using aQuant software, resulting in parametric MBF images and polar maps as well as regional MBF values. Correlation and agreement of MBF values based on each reconstruction were compared using regression and Bland-Altman analysis as well as Wilcoxon tests.
Results
Whole left ventricle MBF values ranged from 1.1 to 3.9 mL/g/min. Visually, there were only small differences in MBF images or polar maps between methods (Figure 1). Correlation between whole left ventricle MBF values based on the various reconstruction algorithms was high (r > 0.99). At the regional level, correlation coefficients were always > 0.94 (Figure 2). No significant bias was found between any of the reconstruction methods and the standard method (p > 0.65). Regression slopes relative to the standard method ranged from 0.993 to 1.080. Changes in reconstruction settings did not alter diagnosis in any patient.
Conclusion
Changes in reconstruction settings such as filter size, number of iterations, inclusion of time-of-flight or resolution recovery, and regularization, have negligible impact on MBF values based on 15O-water PET analyzed using the automated software. This is likely due to the fact that MBF is determined by the clearance rate of 15O-water rather than its uptake rate such as for other PET tracers, in addition to the used segmentation routines. These results also indicate that quantitative MBF measurements using 15O-water are likely to be robust across different types of PET scanners and hospitals, which is highly important for reliable clinical use of cut-off values for ischemia.
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Affiliation(s)
| | | | - A Mehic
- Uppsala University, Uppsala, Sweden
| | | | - T Kero
- Uppsala University, Uppsala, Sweden
| | | | - HJ Harms
- Aarhus University, Aarhus, Denmark
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8
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Nielsen R, Møller N, Gormsen LC, Tolbod LP, Hansson NH, Sorensen J, Harms HJ, Frøkiær J, Eiskjaer H, Jespersen NR, Mellemkjaer S, Lassen TR, Pryds K, Bøtker HE, Wiggers H. Cardiovascular Effects of Treatment With the Ketone Body 3-Hydroxybutyrate in Chronic Heart Failure Patients. Circulation 2020; 139:2129-2141. [PMID: 30884964 PMCID: PMC6493702 DOI: 10.1161/circulationaha.118.036459] [Citation(s) in RCA: 264] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Myocardial utilization of 3-hydroxybutyrate (3-OHB) is increased in patients with heart failure and reduced ejection fraction (HFrEF). However, the cardiovascular effects of increased circulating plasma-3-OHB levels in these patients are unknown. Consequently, the authors’ aim was to modulate circulating 3-OHB levels in HFrEF patients and evaluate: (1) changes in cardiac output (CO); (2) a potential dose-response relationship between 3-OHB levels and CO; (3) the impact on myocardial external energy efficiency (MEE) and oxygen consumption (MVO2); and (4) whether the cardiovascular response differed between HFrEF patients and age-matched volunteers. Methods: Study 1: 16 chronic HFrEF patients (left ventricular ejection fraction: 37±3%) were randomized in a crossover design to 3-hour of 3-OHB or placebo infusion. Patients were monitored invasively with a Swan-Ganz catheter and with echocardiography. Study 2: In a dose-response study, 8 HFrEF patients were examined at increasing 3-OHB infusion rates. Study 3 to 4: 10 HFrEF patients and 10 age-matched volunteers were randomized in a crossover design to 3-hour 3-OHB or placebo infusion. MEE and MVO2 were evaluated using 11C-acetate positron emission tomography. Results: 3-OHB infusion increased circulating levels of plasma 3-OHB from 0.4±0.3 to 3.3±0.4 mM (P<0.001). CO rose by 2.0±0.2 L/min (P<0.001) because of an increase in stroke volume of 20±2 mL (P<0.001) and heart rate of 7±2 beats per minute (bpm) (P<0.001). Left ventricular ejection fraction increased 8±1% (P<0.001) numerically. There was a dose-response relationship with a significant CO increase of 0.3 L/min already at plasma-3-OHB levels of 0.7 mM (P<0.001). 3-OHB increased MVO2 without altering MEE. The response to 3-OHB infusion in terms of MEE and CO did not differ between HFrEF patents and age-matched volunteers. Conclusions: 3-OHB has beneficial hemodynamic effects in HFrEF patients without impairing MEE. These beneficial effects are detectable in the physiological concentration range of circulating 3-OHB levels. The hemodynamic effects of 3-OHB were observed in both HFrEF patients and age-matched volunteers. 3-OHB may potentially constitute a novel treatment principle in HFrEF patients.
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Affiliation(s)
- Roni Nielsen
- Department of Cardiology (R.N., N.H.H., H.E., N.R.J., S.R., T.R.L., K.P., H.E.B., H.W.), Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology and Metabolism (R.N., N.M.), Aarhus University Hospital, Aarhus, Denmark
| | - Niels Møller
- Department of Endocrinology and Metabolism (R.N., N.M.), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark (N.M., L.C.G., N.R.J., T.R.L., K.P., H.E.B., H.W.)
| | - Lars C. Gormsen
- Department of Nuclear Medicine & PET Centre (L.C.G., L.P.T., J.S., H.J.H., J.F.), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark (N.M., L.C.G., N.R.J., T.R.L., K.P., H.E.B., H.W.)
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET Centre (L.C.G., L.P.T., J.S., H.J.H., J.F.), Aarhus University Hospital, Aarhus, Denmark
| | - Nils Henrik Hansson
- Department of Cardiology (R.N., N.H.H., H.E., N.R.J., S.R., T.R.L., K.P., H.E.B., H.W.), Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sorensen
- Department of Nuclear Medicine & PET Centre (L.C.G., L.P.T., J.S., H.J.H., J.F.), Aarhus University Hospital, Aarhus, Denmark
- Department of Radiology and Nuclear Medicine, Uppsala University, Uppsala, Sweden (J.S.)
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET Centre (L.C.G., L.P.T., J.S., H.J.H., J.F.), Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET Centre (L.C.G., L.P.T., J.S., H.J.H., J.F.), Aarhus University Hospital, Aarhus, Denmark
| | - Hans Eiskjaer
- Department of Cardiology (R.N., N.H.H., H.E., N.R.J., S.R., T.R.L., K.P., H.E.B., H.W.), Aarhus University Hospital, Aarhus, Denmark
| | - Nichlas Riise Jespersen
- Department of Cardiology (R.N., N.H.H., H.E., N.R.J., S.R., T.R.L., K.P., H.E.B., H.W.), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark (N.M., L.C.G., N.R.J., T.R.L., K.P., H.E.B., H.W.)
| | - Søren Mellemkjaer
- Department of Cardiology (R.N., N.H.H., H.E., N.R.J., S.R., T.R.L., K.P., H.E.B., H.W.), Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Ravn Lassen
- Department of Cardiology (R.N., N.H.H., H.E., N.R.J., S.R., T.R.L., K.P., H.E.B., H.W.), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark (N.M., L.C.G., N.R.J., T.R.L., K.P., H.E.B., H.W.)
| | - Kasper Pryds
- Department of Cardiology (R.N., N.H.H., H.E., N.R.J., S.R., T.R.L., K.P., H.E.B., H.W.), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark (N.M., L.C.G., N.R.J., T.R.L., K.P., H.E.B., H.W.)
| | - Hans Erik Bøtker
- Department of Cardiology (R.N., N.H.H., H.E., N.R.J., S.R., T.R.L., K.P., H.E.B., H.W.), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark (N.M., L.C.G., N.R.J., T.R.L., K.P., H.E.B., H.W.)
| | - Henrik Wiggers
- Department of Cardiology (R.N., N.H.H., H.E., N.R.J., S.R., T.R.L., K.P., H.E.B., H.W.), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark (N.M., L.C.G., N.R.J., T.R.L., K.P., H.E.B., H.W.)
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9
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Larsen AH, Jessen N, Nørrelund H, Tolbod LP, Harms HJ, Feddersen S, Nielsen F, Brøsen K, Hansson NH, Frøkiær J, Poulsen SH, Sörensen J, Wiggers H. A randomised, double‐blind, placebo‐controlled trial of metformin on myocardial efficiency in insulin‐resistant chronic heart failure patients without diabetes. Eur J Heart Fail 2019; 22:1628-1637. [DOI: 10.1002/ejhf.1656] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/04/2019] [Accepted: 09/30/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
| | - Niels Jessen
- Department of Clinical Pharmacology Aarhus University Hospital Aarhus Denmark
- Department of Biomedicine Aarhus University Aarhus Denmark
- Steno Diabetes Centre Aarhus Aarhus University Hospital Aarhus Denmark
| | - Helene Nørrelund
- Department of Clinical Epidemiology, Institute of Clinical Medicine Aarhus University Hospital Aarhus Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET Centre Aarhus University Hospital Aarhus Denmark
| | | | - Søren Feddersen
- Department of Clinical Biochemistry and Pharmacology Odense University Hospital Odense Denmark
| | - Flemming Nielsen
- Department of Clinical Biochemistry and Pharmacology Odense University Hospital Odense Denmark
| | - Kim Brøsen
- Department of Clinical Biochemistry and Pharmacology Odense University Hospital Odense Denmark
| | | | - Jørgen Frøkiær
- Department of Nuclear Medicine and PET Centre Aarhus University Hospital Aarhus Denmark
| | | | - Jens Sörensen
- Department of Nuclear Medicine and PET Centre Aarhus University Hospital Aarhus Denmark
- Department of Medical Sciences, Uppsala Clinical Research Centre Uppsala University Uppsala Sweden
| | - Henrik Wiggers
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
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10
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Sörensen J, Harms HJ, Aalen JM, Baron T, Smiseth OA, Flachskampf FA. Myocardial Efficiency: A Fundamental Physiological Concept on the Verge of Clinical Impact. JACC Cardiovasc Imaging 2019; 13:1564-1576. [PMID: 31864979 DOI: 10.1016/j.jcmg.2019.08.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/26/2019] [Accepted: 08/21/2019] [Indexed: 02/08/2023]
Abstract
Myocardial external efficiency is the relation of mechanical energy generated by the left (or right) ventricle to the consumed chemical energy from aerobic metabolism. Efficiency can be calculated invasively, and, more importantly, noninvasively by using positron emission tomography, providing a single parameter by which to judge the adequacy of myocardial metabolism to generated mechanical output. This parameter has been found to be impaired in heart failure of myocardial or valvular etiology, and it changes in a characteristic manner with medical or interventional cardiac therapy. The authors discuss the concept, strengths, and limitations, known applications, and future perspectives of the use of myocardial efficiency.
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Affiliation(s)
- Jens Sörensen
- Department of Nuclear Medicine and PET, Surgical Sciences, Uppsala University, Sweden; Department of Nuclear Medicine and PET, Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine and PET, Clinical Institute, Aarhus University, Aarhus, Denmark
| | - John M Aalen
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Clinical Physiology, Akademiska University Hospital, Uppsala, Sweden
| | - Tomasz Baron
- Department of Medical Sciences, Uppsala University and Akademiska Hospital, Uppsala, Sweden; Department of Radiology, Uppsala University and Akademiska Hospital, Uppsala, Sweden; Department of Cardiology, Uppsala University and Akademiska Hospital, Uppsala, Sweden
| | - Otto Armin Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Radiology, Uppsala University and Akademiska Hospital, Uppsala, Sweden
| | - Frank A Flachskampf
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Clinical Physiology, Akademiska University Hospital, Uppsala, Sweden.
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11
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Nielsen RR, Sörensen J, Tolbod L, Alstrup AKO, Iversen P, Frederiksen CA, Wiggers H, Jorsal A, Frøkier J, Harms HJ. Quantitative estimation of extravascular lung water volume and preload by dynamic 15O-water positron emission tomography. Eur Heart J Cardiovasc Imaging 2019; 20:1120-1128. [PMID: 30887037 DOI: 10.1093/ehjci/jez038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 02/25/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Left ventricular filling pressure (preload) can be assessed by pulmonary capillary wedge pressure (PCWP) during pulmonary arterial catheterization (PAC). An emerging method [pulse indexed contour cardiac output (PICCO)] can estimate preload by global end-diastolic volume (GEDV) and congestion as extravascular lung water (EVLW) content. However, no reliable quantitative non-invasive methods are available. Hence, in a porcine model of pulmonary congestion, we evaluated EVLW and GEDV by positron emission tomography (PET). The method was applied in 35 heart failure (HF) patients and 9 healthy volunteers. METHODS AND RESULTS Eight pigs were studied. Pulmonary congestion was induced by a combination of beta-blockers, angiotensin-2 agonist and saline infusion. PAC, PICCO, computerized tomography, and 15O-H2O-PET were performed. EVLW increased from 521 ± 76 to 973 ± 325 mL (P < 0.001) and GEDV from 1068 ± 170 to 1254 ± 85 mL (P < 0.001). 15O-H2O-PET measures of EVLW increased from 566 ± 151 to 797 ± 231 mL (P < 0.001) and GEDV from 364 ± 60 to 524 ± 92 mL (P < 0.001). Both EVLW and GEDV measured with PICCO and 15O-H2O-PET correlated (r2 = 0.40, P < 0.001; r2 = 0.40, P < 0.001, respectively). EVLW correlated with Hounsfield units (HU; PICCO: r2 = 0.36, P < 0.001, PET: r2 = 0.46, P < 0.001) and GEDV with PCWP (PICCO: r2 = 0.20, P = 0.01, PET: r2 = 0.29, P = 0.002). In human subjects, measurements were indexed (I) for body surface area. Neither EVLWI nor HU differed between chronic stable HF patients and healthy volunteers (P = 0.11, P = 0.29) whereas GEDVI was increased in HF patients (336 ± 66 mL/m2 vs. 276 ± 44 mL/m2, P = 0.01). CONCLUSION The present study demonstrates that 15O-H2O-PET can assess pulmonary congestion and preload quantitatively. Hence, prognostic information from 15O-H2O-PET examinations should be evaluated in clinical trials.
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Affiliation(s)
- Roni Ranghøj Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus DK, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus DK, Denmark
| | - Jens Sörensen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus DK, Denmark.,Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus DK, Denmark.,PET Center, Uppsala University Hospital, Uppsala, Sweden
| | - Lars Tolbod
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus DK, Denmark
| | - Aage Kristian Olsen Alstrup
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus DK, Denmark
| | - Peter Iversen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus DK, Denmark
| | | | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus DK, Denmark
| | - Anders Jorsal
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus DK, Denmark
| | - Jørgen Frøkier
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus DK, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus DK, Denmark
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12
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Baron T, Holm Orndahl L, Kero T, Sorensen J, Bjerner T, Hedin EM, Harms HJ, Stahle E, Astudillo R, Flachskampf FA. P1779Quantitation of severe degenerative mitral regurgitation by echocardiography and CMR with acetate PET for external reference for left ventricular volumes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Quantitative echocardiographic assessment of severity of primary mitral regurgitation (MR) is challenging. CMR is recommended if MR severity cannot be clearly determined, since quantitation of regurgitation as well as of left ventricular (LV) volumes and function is crucial for the indication for surgery especially in asymptomatic patients.
Purpose
We aimed to compare volumetric measurements obtained from transthoracic echo (TTE) and cardiovascular magnetic resonance (CMR) using ECG-gated [(11)C]acetate PET as reference for assessment of LV volumes.
Methods
A total of 51 asymptomatic patients with severe primary mitral regurgitation underwent TTE, CMR and PET on the same day. Mitral regurgitant volumes (RVol) were measured by TTE using proximal convergence (PISA) method and by CMR, subtracting aortic forward flow volume from LV stroke volume. LV volumes were measured by TTE, CMR and PET.
Results
Despite a fair correlation between regurgitant volumes measured by TTE and CMR (r=0.53, p<0.001), PISA method heavily overestimated regurgitant volumes on TTE as compared to CMR (103±60ml vs. 78±35ml, p<0.001). TTE systematically underestimated LV volumes as compared to CMR (see table) despite a good correlation (r=0.81, 0.67 and 0.76 respective for LV EDV, ESV and SV, p<0.001 for all). There was no difference in LV EF between the methods. LV volumes obtained by CMR and PET showed a strong correlation (r=0.92, 0.79 and 0.89 respective for LV EDV, ESV and SV, p<0.001 for all) and agreement (see table).
Comparison of TTE, CMR and PET TTE CMR PET PET TTEvs.CMR PET CMRvs.PET F-test LV EDV, ml 145±34 241±57 234±51 <0.001 0.004 <0.001 LV ESV, ml 47±11 76±22 81±23 <0.001 0.067 <0.001L LV SV, ml 99±26 164±38 152±34 <0.001 <0.001 <0.001 LV EF, % 68±5 69±5 65±6 0.236 <0.001 <0.001
Conclusions
As compared to CMR, PISA method used by TTE substantially overestimates regurgitant volumes in patients with asymptomatic primary mitral regurgitation. Conversely, LV volumes in spite of good correlation are heavily underestimated by TTE in comparison with CMR. A strong correlation and agreement between LV volumes measured by CMR and PET confirms the accuracy of the former method which is considered as a golden standard for assessment of ventricular function and volumes. Thus, even so-called quantitative echo measures should be understoas essentially semi-quantitative indicators of severity.
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Affiliation(s)
- T Baron
- Uppsala University, Dept. of Medical Sciences, Cardiology and Clinical Physiology, Uppsala, Sweden
| | - L Holm Orndahl
- Uppsala University, Dept. of Medical Sciences, Cardiology and Clinical Physiology, Uppsala, Sweden
| | - T Kero
- Uppsala University, Dept. of Surgical Sciences, Radiology, Uppsala, Sweden
| | - J Sorensen
- Uppsala University, Dept. of Surgical Sciences, Radiology, Uppsala, Sweden
| | - T Bjerner
- Uppsala University, Dept. of Surgical Sciences, Radiology, Uppsala, Sweden
| | - E.-M Hedin
- Uppsala University, Dept. of Medical Sciences, Cardiology and Clinical Physiology, Uppsala, Sweden
| | - H J Harms
- Aarhus University Hospital, Dept. of Nuclear Medicine & PET Centre, Aarhus, Denmark
| | - E Stahle
- Uppsala University, Dept. of Surgical Sciences, Thoracic surgery, Uppsala, Sweden
| | - R Astudillo
- Uppsala University, Dept. of Surgical Sciences, Thoracic surgery, Uppsala, Sweden
| | - F A Flachskampf
- Uppsala University, Dept. of Medical Sciences, Cardiology and Clinical Physiology, Uppsala, Sweden
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13
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Rosengren S, Skibsted Clemmensen T, Tolbod L, Granstam SO, Eiskjaer H, Wikstrom G, Vedin O, Kero T, Lubberink M, Harms HJ, Flachskampf FA, Antoni G, Frost Andersen N, Hvitfeldt Poulsen S, Sorensen J. 37Diagnostic accuracy of [11C]PIB positron emission tomography for detection of cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez135.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Rosengren
- Uppsala University, Department of Medical Sciences, Haematology, Uppsala, Sweden
| | | | - L Tolbod
- Aarhus University Hospital, Department of Nuclear Medicine and PET, Aarhus, Denmark
| | - S O Granstam
- Uppsala University, Department of Medical Sciences, Clinical Physiology, Uppsala, Sweden
| | - H Eiskjaer
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - G Wikstrom
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - O Vedin
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - T Kero
- Uppsala University, Department of Surgical Sciences, Radiology, Uppsala, Sweden
| | - M Lubberink
- Uppsala University, Department of Surgical Sciences, Radiology, Uppsala, Sweden
| | - H J Harms
- Aarhus University Hospital, Department of Nuclear Medicine and PET, Aarhus, Denmark
| | - F A Flachskampf
- Uppsala University, Department of Medical Sciences, Clinical Physiology, Uppsala, Sweden
| | - G Antoni
- Uppsala University, Department of Medical Chemistry, Uppsala, Sweden
| | - N Frost Andersen
- Aarhus University Hospital, Department of Haematology, Aarhus, Denmark
| | | | - J Sorensen
- Uppsala University, Department of Surgical Sciences, Radiology, Uppsala, Sweden
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14
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Sorensen J, Harms HJ, Wikstrom G, Pilebro B, Vedin O, Granstam SO, Rosengren S. 240Symptomatic transthyretin cardiac amyloidosis is associated with chronic myocardial ischemia at rest and early death. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez145.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Sorensen
- Uppsala University, Surgical Sciences, Nuclear Medicine, Uppsala, Sweden
| | - H J Harms
- Aarhus University, Clinical Institute, Aarhus, Denmark
| | - G Wikstrom
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - B Pilebro
- Umea University Hospital, Cardiology, Umea, Sweden
| | - O Vedin
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - S O Granstam
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - S Rosengren
- Uppsala University, Medical sciences, Uppsala, Sweden
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15
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Nielsen R, Jorsal A, Iversen P, Tolbod LP, Bouchelouche K, Sørensen J, Harms HJ, Flyvbjerg A, Tarnow L, Kistorp C, Gustafsson I, Bøtker HE, Wiggers H. Effect of liraglutide on myocardial glucose uptake and blood flow in stable chronic heart failure patients: A double-blind, randomized, placebo-controlled LIVE sub-study. J Nucl Cardiol 2019; 26:585-597. [PMID: 28770459 DOI: 10.1007/s12350-017-1000-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The glucagon-like peptide-1 analog liraglutide increases heart rate and may be associated with more cardiac events in chronic heart failure (CHF) patients. We studied whether this could be ascribed to effects on myocardial glucose uptake (MGU), myocardial blood flow (MBF) and MBF reserve (MFR). METHODS AND RESULTS CHF patients with left ventricular ejection fraction ≤45% and without type 2 diabetes were randomized to liraglutide (N = 18) 1.8 mg once daily or placebo (N = 18) for 24 weeks in a double-blinded design. Changes in MGU during an oral glucose tolerance test (OGTT) and changes in MBF and MFR from baseline to follow-up were measured quantitatively by 18F-FDG and 15O-H2O positron emission tomography. Compared with placebo, liraglutide reduced weight (P = 0.03), HbA1c (P = 0.03) and the 2-hour glucose value during the OGTT (P = 0.004). Despite this, changes in MGU (P = 0.98), MBF (P = 0.76) and MFR (P = 0.89) from baseline to follow-up did not differ between groups. Furthermore, there was no association between the level of insulin resistance at baseline and changes in MGU in patients treated with liraglutide. CONCLUSION Liraglutide did not affect MGU, MBF, or MFR in non-diabetic CHF patients. Any potential increase in cardiac events in these patients seems not to involve changes in MGU, MBF, or MFR. TRIAL REGISTRATION Trial registry: http://www.ClinicalTrials.org . Identifier: NCT01472640. Url: https://clinicaltrials.gov/ct2/show/NCT01472640?term=NCT01472640&rank=1.
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Affiliation(s)
- Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Anders Jorsal
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Peter Iversen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sørensen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Caroline Kistorp
- Department of Endocrinology and Internal Medicine, Herlev University Hospital, Copenhagen, Denmark
| | - Ida Gustafsson
- Department of Cardiology, Hvidovre University Hospital, Copenhagen, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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16
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Hansson NH, Harms HJ, Kim WY, Nielsen R, Tolbod LP, Frøkiær J, Bouchelouche K, Poulsen SH, Wiggers H, Parner ET, Sörensen J. Test-retest repeatability of myocardial oxidative metabolism and efficiency using standalone dynamic 11C-acetate PET and multimodality approaches in healthy controls. J Nucl Cardiol 2018; 25:1929-1936. [PMID: 29855984 DOI: 10.1007/s12350-018-1302-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/25/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myocardial efficiency measured by 11C-acetate positron emission tomography (PET) has successfully been used in clinical research to quantify mechanoenergetic coupling. The objective of this study was to establish the repeatability of myocardial external efficiency (MEE) and work metabolic index (WMI) by non-invasive concepts. METHODS AND RESULTS Ten healthy volunteers (63 ± 4 years) were examined twice, one week apart, using 11C-acetate PET, cardiovascular magnetic resonance (CMR), and echocardiography. Myocardial oxygen consumption from PET was combined with stroke work data from CMR, echocardiography, or PET to obtain MEE and WMI for each modality. Repeatability was estimated as the coefficient of variation (CV) between test and retest. MEECMR, MEEEcho, and MEEPET values were 21.9 ± 2.7%, 16.4 ± 3.7%, and 23.8 ± 4.9%, respectively, P < .001. WMICMR, WMIEcho, and WMIPET values were 4.42 ± 0.90, 4.07 ± 0.63, and 4.58 ± 1.13 mmHg × mL/m2 × 106, respectively, P = .45. Repeatability for MEECMR was superior compared with MEEEcho but did not differ significantly compared with MEEPET (6.3% vs 12.9% and 9.4%, P = .04 and .25). CV values for WMICMR, WMIEcho, and WMIPET were 10.0%, 14.8%, and 12.0%, respectively, (P = .53). CONCLUSIONS Non-invasive measurements of MEE using 11C-acetate PET are highly repeatable. A PET-only approach did not differ significantly from CMR/PET and might facilitate further clinical research due to lower costs and broader applicability.
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Affiliation(s)
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars P Tolbod
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Thorlund Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jens Sörensen
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
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17
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Nielsen R, Jorsal A, Iversen P, Tolbod L, Bouchelouche K, Sørensen J, Harms HJ, Flyvbjerg A, Bøtker HE, Wiggers H. Heart failure patients with prediabetes and newly diagnosed diabetes display abnormalities in myocardial metabolism. J Nucl Cardiol 2018; 25:169-176. [PMID: 27473218 DOI: 10.1007/s12350-016-0622-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/07/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND In type 2 diabetes, a decrease in myocardial glucose uptake (MGU) may lower glucose oxidation and contribute to progression of chronic heart failure (CHF). However, it is unsettled whether CHF patients with prediabetes have abnormal MGU and myocardial blood flow (MBF) during normal physiological conditions. METHODS AND RESULTS We studied 35 patients with CHF and reduced left ventricular ejections fraction (34 ± 9%) without overt T2D (mean HbA1c: 40 ± 4 mmol/mol) using echocardiography and quantitative measurements of MGU by 18F-FDG-PET and perfusion by 15O-H2O-PET. An oral glucose tolerance test (OGTT) was performed during the FDG-PET, which identified 17 patients with abnormal and 18 patients with normal glucometabolic response. Global MGU was higher in patients with normal OGTT response (0.31 ± 0.09 µmol/g/min) compared with patients with abnormal OGTT response (0.25 ± 0.09 µmol/g/min) (P = 0.05). MBF (P = 0.22) and myocardial flow reserve (MFR) (P = 0.83) were similar in the study groups. The reduced MGU in prediabetic patients was attributable to reduced MGU in viable myocardium with normal MFR (P < 0.001). CONCLUSION CHF patients with prediabetes have reduced MGU in segments with preserved MFR as compared to CHF patients with normal glucose tolerance. Whether reversal of these myocardial abnormalities can improve outcome needs to be investigated in large-scale studies.
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Affiliation(s)
- Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Anders Jorsal
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Peter Iversen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Tolbod
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sørensen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Allan Flyvbjerg
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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18
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Nordström J, Kero T, Harms HJ, Widström C, Flachskampf FA, Sörensen J, Lubberink M. Calculation of left ventricular volumes and ejection fraction from dynamic cardiac-gated 15O-water PET/CT: 5D-PET. EJNMMI Phys 2017; 4:26. [PMID: 29138942 PMCID: PMC5686036 DOI: 10.1186/s40658-017-0195-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 11/06/2017] [Indexed: 12/02/2022] Open
Abstract
Background Quantitative measurement of myocardial blood flow (MBF) is of increasing interest in the clinical assessment of patients with suspected coronary artery disease (CAD). 15O-water positron emission tomography (PET) is considered the gold standard for non-invasive MBF measurements. However, calculation of left ventricular (LV) volumes and ejection fraction (EF) is not possible from standard 15O-water uptake images. The purpose of the present work was to investigate the possibility of calculating LV volumes and LVEF from cardiac-gated parametric blood volume (VB) 15O-water images and from first pass (FP) images. Sixteen patients with mitral or aortic regurgitation underwent an eight-gate dynamic cardiac-gated 15O-water PET/CT scan and cardiac MRI. VB and FP images were generated for each gate. Calculations of end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV) and LVEF were performed with automatic segmentation of VB and FP images, using commercially available software. LV volumes and LVEF were calculated with surface-, count-, and volume-based methods, and the results were compared with gold standard MRI. Results Using VB images, high correlations between PET and MRI ESV (r = 0.89, p < 0.001), EDV (r = 0.85, p < 0.001), SV (r = 0.74, p = 0.006) and LVEF (r = 0.72, p = 0.008) were found for the volume-based method. Correlations for FP images were slightly, but not significantly, lower than those for VB images when compared to MRI. Surface- and count-based methods showed no significant difference compared with the volume-based correlations with MRI. The volume-based method showed the best agreement with MRI with no significant difference on average for EDV and LVEF but with an overestimation of values for ESV (14%, p = 0.005) and SV (18%, p = 0.004) when using VB images. Using FP images, none of the parameters showed a significant difference from MRI. Inter-operator repeatability was excellent for all parameters (ICC > 0.86, p < 0.001). Conclusion Calculation of LV volumes and LVEF from dynamic 15O-water PET is feasible and shows good correlation with MRI. However, the analysis method is laborious, and future work is needed for more automation to make the method more easily applicable in a clinical setting.
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Affiliation(s)
- Jonny Nordström
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden. .,Centre for Research and Development, Uppsala University, Gävle, Gävleborg County, Sweden.
| | - Tanja Kero
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.,Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Charles Widström
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.,Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - Frank A Flachskampf
- Cardiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.,Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Mark Lubberink
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.,Medical Physics, Uppsala University Hospital, Uppsala, Sweden
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19
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Hansson NH, Sörensen J, Harms HJ, Kim WY, Nielsen R, Tolbod LP, Frøkiær J, Bouchelouche K, Dodt KK, Sihm I, Poulsen SH, Wiggers H. Metoprolol Reduces Hemodynamic and Metabolic Overload in Asymptomatic Aortic Valve Stenosis Patients. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006557. [DOI: 10.1161/circimaging.117.006557] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/07/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Nils Henrik Hansson
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Jens Sörensen
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Hendrik Johannes Harms
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Won Yong Kim
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Roni Nielsen
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Lars Poulsen Tolbod
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Jørgen Frøkiær
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Kirsten Bouchelouche
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Karen Kaae Dodt
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Inger Sihm
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Steen Hvitfeldt Poulsen
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
| | - Henrik Wiggers
- From the Department of Cardiology (N.H.H., W.Y.K., R.N., S.H.P., H.W.) and Department of Nuclear Medicine and PET-Center (J.S., H.J.H., L.P.T., J.F., K.B.), Aarhus University Hospital, Denmark; Department of Cardiology, Horsens Regional Hospital, Denmark (K.K.D.); and Aarhus Hjerteklinik, Denmark (I.S.)
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20
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Gormsen LC, Svart M, Thomsen HH, Søndergaard E, Vendelbo MH, Christensen N, Tolbod LP, Harms HJ, Nielsen R, Wiggers H, Jessen N, Hansen J, Bøtker HE, Møller N. Ketone Body Infusion With 3-Hydroxybutyrate Reduces Myocardial Glucose Uptake and Increases Blood Flow in Humans: A Positron Emission Tomography Study. J Am Heart Assoc 2017; 6:JAHA.116.005066. [PMID: 28242634 PMCID: PMC5524028 DOI: 10.1161/jaha.116.005066] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND High levels of ketone bodies are associated with improved survival as observed with regular exercise, caloric restriction, and-most recently-treatment with sodium-glucose linked transporter 2 inhibitor antidiabetic drugs. In heart failure, indices of ketone body metabolism are upregulated, which may improve energy efficiency and increase blood flow in skeletal muscle and the kidneys. Nevertheless, it is uncertain how ketone bodies affect myocardial glucose uptake and blood flow in humans. Our study was therefore designed to test whether ketone body administration in humans reduces myocardial glucose uptake (MGU) and increases myocardial blood flow. METHODS AND RESULTS Eight healthy subjects, median aged 60 were randomly studied twice: (1) During 390 minutes infusion of Na-3-hydroxybutyrate (KETONE) or (2) during 390 minutes infusion of saline (SALINE), together with a concomitant low-dose hyperinsulinemic-euglycemic clamp to inhibit endogenous ketogenesis. Myocardial blood flow was measured by 15O-H2O positron emission tomography/computed tomography, myocardial fatty acid metabolism by 11C-palmitate positron emission tomography/computed tomography and MGU by 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Similar euglycemia, hyperinsulinemia, and suppressed free fatty acids levels were recorded on both study days; Na-3-hydroxybutyrate infusion increased circulating Na-3-hydroxybutyrate levels from zero to 3.8±0.5 mmol/L. MGU was halved by hyperketonemia (MGU [nmol/g per minute]: 304±97 [SALINE] versus 156±62 [KETONE], P<0.01), whereas no effects were observed on palmitate uptake oxidation or esterification. Hyperketonemia increased heart rate by ≈25% and myocardial blood flow by 75%. CONCLUSIONS Ketone bodies displace MGU and increase myocardial blood flow in healthy humans; these novel observations suggest that ketone bodies are important cardiac fuels and vasodilators, which may have therapeutic potentials.
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Affiliation(s)
- Lars C Gormsen
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Svart
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Esben Søndergaard
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Mikkel H Vendelbo
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Nana Christensen
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Jessen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Hansen
- Department of Forensic Medicine, Aarhus University, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Møller
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
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21
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Hansson NHS, Sörensen J, Harms HJ, Kim WY, Nielsen R, Tolbod LP, Frøkiær J, Bouchelouche K, Dodt KK, Sihm I, Poulsen SH, Wiggers H. Myocardial Oxygen Consumption and Efficiency in Aortic Valve Stenosis Patients With and Without Heart Failure. J Am Heart Assoc 2017; 6:JAHA.116.004810. [PMID: 28167498 PMCID: PMC5523773 DOI: 10.1161/jaha.116.004810] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Myocardial oxygen consumption (MVO2) and its coupling to contractile work are fundamentals of cardiac function and may be involved causally in the transition from compensated left ventricular hypertrophy to failure. Nevertheless, these processes have not been studied previously in patients with aortic valve stenosis (AS). Methods and Results Participants underwent 11C‐acetate positron emission tomography, cardiovascular magnetic resonance, and echocardiography to measure MVO2 and myocardial external efficiency (MEE) defined as the ratio of left ventricular stroke work and the energy equivalent of MVO2. We studied 10 healthy controls (group A), 37 asymptomatic AS patients with left ventricular ejection fraction ≥50% (group B), 12 symptomatic AS patients with left ventricular ejection fraction ≥50% (group C), and 9 symptomatic AS patients with left ventricular ejection fraction <50% (group D). MVO2 did not differ among groups A, B, C, and D (0.105±0.02, 0.117±0.024, 0.129±0.032, and 0.104±0.026 mL/min per gram, respectively; P=0.07), whereas MEE was reduced in group D (21.0±1.6%, 22.3±3.3%, 22.1±4.2%, and 17.3±4.7%, respectively; P<0.05). Similarly, patients with global longitudinal strain greater than −12% and paradoxical low‐flow, low‐gradient AS had impaired MEE (P<0.05 versus controls). The ability to discriminate between symptomatic and asymptomatic patients was superior for global longitudinal strain compared with MVO2 and MEE (area under the curve 0.98, 0.48, and 0.61, respectively; P<0.05). Conclusions AS patients display a persistent ability to maintain normal MVO2 and MEE (ie, the ability to convert energy into stroke work); however, patients with left ventricular ejection fraction <50%; global longitudinal strain greater than −12%; or paradoxical low‐flow, low‐gradient AS demonstrate reduced MEE. These findings suggest that mitochondrial uncoupling contributes to the dismal prognosis in patients with reduced contractile function or paradoxical low‐flow, low‐gradient AS.
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Affiliation(s)
| | - Jens Sörensen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars P Tolbod
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Karen Kaae Dodt
- Department of Cardiology, Horsens Regional Hospital, Horsens, Denmark
| | | | | | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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22
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Hansson NH, Tolbod L, Harms HJ, Wiggers H, Kim WY, Hansen E, Zaremba T, Frøkiær J, Jakobsen S, Sørensen J. Erratum to: Evaluation of ECG-gated [ 11C]acetate PET for measuring left ventricular volumes, mass, and myocardial external efficiency. J Nucl Cardiol 2016; 23:1232. [PMID: 27170337 DOI: 10.1007/s12350-016-0537-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lars Tolbod
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
- MR Research Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Esben Hansen
- MR Research Centre, Aarhus University Hospital, Aarhus C, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Tomas Zaremba
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Steen Jakobsen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Jens Sørensen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
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23
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Hansson NH, Tolbod L, Harms HJ, Wiggers H, Kim WY, Hansen E, Zaremba T, Frøkiær J, Jakobsen S, Sørensen J. Evaluation of ECG-gated [(11)C]acetate PET for measuring left ventricular volumes, mass, and myocardial external efficiency. J Nucl Cardiol 2016; 23:670-9. [PMID: 27094041 DOI: 10.1007/s12350-015-0331-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/27/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Noninvasive estimation of myocardial external efficiency (MEE) requires measurements of left ventricular (LV) oxygen consumption with [(11)C]acetate PET in addition to LV stroke volume and mass with cardiovascular magnetic resonance (CMR). Measuring LV geometry directly from ECG-gated [(11)C]acetate PET might enable MEE evaluation from a single PET scan. Therefore, we sought to establish the accuracy of measuring LV volumes, mass, and MEE directly from ECG-gated [(11)C]acetate PET. METHODS Thirty-five subjects with aortic valve stenosis underwent ECG-gated [(11)C]acetate PET and CMR. List mode PET data were rebinned into 16-bin ECG-gated uptake images before measuring LV volumes and mass using commercial software and compared to CMR. Dynamic datasets were used for calculation of mean LV oxygen consumption and MEE. RESULTS LV mass, volumes, and ejection fraction measured by CMR and PET correlated strongly (r = 0.86-0.92, P < .001 for all), but were underestimated by PET (P < .001 for all except ESV P = .79). PET-based MEE, corrected for bias, correlated fairly with PET/CMR-based MEE (r = 0.60, P < .001, bias -3 ± 21%, P = .56). PET-based MEE bias was strongly associated with LV wall thickness. CONCLUSIONS Although analysis-related improvements in accuracy are recommended, LV geometry estimated from ECG-gated [(11)C]acetate PET correlate excellently with CMR and can indeed be used to evaluate MEE.
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Affiliation(s)
| | - Lars Tolbod
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
- MR Research Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Esben Hansen
- MR Research Centre, Aarhus University Hospital, Aarhus C, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Tomas Zaremba
- Department of Cardiology, Aarhus University Hospital, Aarhus C, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Steen Jakobsen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
| | - Jens Sørensen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus C, Denmark
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24
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Harms HJ, Stubkjær Hansson NH, Tolbod LP, Kim WY, Jakobsen S, Bouchelouche K, Wiggers H, Frøkiaer J, Sörensen J. Automatic Extraction of Myocardial Mass and Volume Using Parametric Images from Dynamic Nongated PET. J Nucl Med 2016; 57:1382-7. [PMID: 27127219 DOI: 10.2967/jnumed.115.170613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/26/2016] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Dynamic cardiac PET is used to quantify molecular processes in vivo. However, measurements of left ventricular (LV) mass and volume require electrocardiogram-gated PET data. The aim of this study was to explore the feasibility of measuring LV geometry using nongated dynamic cardiac PET. METHODS Thirty-five patients with aortic-valve stenosis and 10 healthy controls underwent a 27-min (11)C-acetate PET/CT scan and cardiac MRI (CMR). The controls were scanned twice to assess repeatability. Parametric images of uptake rate K1 and the blood pool were generated from nongated dynamic data. Using software-based structure recognition, the LV wall was automatically segmented from K1 images to derive functional assessments of LV mass (mLV) and wall thickness. End-systolic and end-diastolic volumes were calculated using blood pool images and applied to obtain stroke volume and LV ejection fraction (LVEF). PET measurements were compared with CMR. RESULTS High, linear correlations were found for LV mass (r = 0.95), end-systolic volume (r = 0.93), and end-diastolic volume (r = 0.90), and slightly lower correlations were found for stroke volume (r = 0.74), LVEF (r = 0.81), and thickness (r = 0.78). Bland-Altman analyses showed significant differences for mLV and thickness only and an overestimation for LVEF at lower values. Intra- and interobserver correlations were greater than 0.95 for all PET measurements. PET repeatability accuracy in the controls was comparable to CMR. CONCLUSION LV mass and volume are accurately and automatically generated from dynamic (11)C-acetate PET without electrocardiogram gating. This method can be incorporated in a standard routine without any additional workload and can, in theory, be extended to other PET tracers.
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Affiliation(s)
- Hendrik Johannes Harms
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; and
| | - Steen Jakobsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; and
| | - Jørgen Frøkiaer
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sörensen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark Department of Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
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Harms HJ, Tolbod LP, Hansson NHS, Kero T, Orndahl LH, Kim WY, Bjerner T, Bouchelouche K, Wiggers H, Frøkiær J, Sörensen J. Automatic extraction of forward stroke volume using dynamic PET/CT: a dual-tracer and dual-scanner validation in patients with heart valve disease. EJNMMI Phys 2015; 2:25. [PMID: 26501826 PMCID: PMC4883637 DOI: 10.1186/s40658-015-0133-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/15/2015] [Indexed: 02/01/2023] Open
Abstract
Background The aim of this study was to develop and validate an automated method for extracting forward stroke volume (FSV) using indicator dilution theory directly from dynamic positron emission tomography (PET) studies for two different tracers and scanners. Methods 35 subjects underwent a dynamic 11C-acetate PET scan on a Siemens Biograph TruePoint-64 PET/CT (scanner I). In addition, 10 subjects underwent both dynamic 15O-water PET and 11C-acetate PET scans on a GE Discovery-ST PET/CT (scanner II). The left ventricular (LV)-aortic time-activity curve (TAC) was extracted automatically from PET data using cluster analysis. The first-pass peak was isolated by automatic extrapolation of the downslope of the TAC. FSV was calculated as the injected dose divided by the product of heart rate and the area under the curve of the first-pass peak. Gold standard FSV was measured using phase-contrast cardiovascular magnetic resonance (CMR). Results FSVPET correlated highly with FSVCMR (r = 0.87, slope = 0.90 for scanner I, r = 0.87, slope = 1.65, and r = 0.85, slope = 1.69 for scanner II for 15O-water and 11C-acetate, respectively) although a systematic bias was observed for both scanners (p < 0.001 for all). FSV based on 11C-acetate and 15O-water correlated highly (r = 0.99, slope = 1.03) with no significant difference between FSV estimates (p = 0.14). Conclusions FSV can be obtained automatically using dynamic PET/CT and cluster analysis. Results are almost identical for 11C-acetate and 15O-water. A scanner-dependent bias was observed, and a scanner calibration factor is required for multi-scanner studies. Generalization of the method to other tracers and scanners requires further validation.
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Affiliation(s)
- Hendrik Johannes Harms
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | | | - Tanja Kero
- Departments of Nuclear Medicine & PET, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
| | - Lovisa Holm Orndahl
- Department of Cardiology, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Tomas Bjerner
- Department of Radiology, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Jens Sörensen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,Departments of Nuclear Medicine & PET, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
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Güçlü A, Germans T, Witjas-Paalberends ER, Stienen GJM, Brouwer WP, Harms HJ, Marcus JT, Vonk ABA, Stooker W, Yilmaz A, Klein P, Ten Berg JM, Kluin J, Asselbergs FW, Lammertsma AA, Knaapen P, van Rossum AC, van der Velden J. ENerGetIcs in hypertrophic cardiomyopathy: traNslation between MRI, PET and cardiac myofilament function (ENGINE study). Neth Heart J 2013; 21:567-71. [PMID: 24114686 PMCID: PMC3833912 DOI: 10.1007/s12471-013-0478-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Hypertrophic cardiomyopathy (HCM) is an autosomal dominant heart disease mostly due to mutations in genes encoding sarcomeric proteins. HCM is characterised by asymmetric hypertrophy of the left ventricle (LV) in the absence of another cardiac or systemic disease. At present it lacks specific treatment to prevent or reverse cardiac dysfunction and hypertrophy in mutation carriers and HCM patients. Previous studies have indicated that sarcomere mutations increase energetic costs of cardiac contraction and cause myocardial dysfunction and hypertrophy. By using a translational approach, we aim to determine to what extent disturbances of myocardial energy metabolism underlie disease progression in HCM. Methods Hypertrophic obstructive cardiomyopathy (HOCM) patients and aortic valve stenosis (AVS) patients will undergo a positron emission tomography (PET) with acetate and cardiovascular magnetic resonance imaging (CMR) with tissue tagging before and 4 months after myectomy surgery or aortic valve replacement + septal biopsy. Myectomy tissue or septal biopsy will be used to determine efficiency of sarcomere contraction in-vitro, and results will be compared with in-vivo cardiac performance. Healthy subjects and non-hypertrophic HCM mutation carriers will serve as a control group. Endpoints Our study will reveal whether perturbations in cardiac energetics deteriorate during disease progression in HCM and whether these changes are attributed to cardiac remodelling or the presence of a sarcomere mutation per se. In-vitro studies in hypertrophied cardiac muscle from HOCM and AVS patients will establish whether sarcomere mutations increase ATP consumption of sarcomeres in human myocardium. Our follow-up imaging study in HOCM and AVS patients will reveal whether impaired cardiac energetics are restored by cardiac surgery.
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Affiliation(s)
- A Güçlü
- Department of Cardiology, Institute for Cardiovascular Research (ICaR-VU, VU University Medical Center, ZH 5F-13, PO Box 7057, 1007MB, Amsterdam, the Netherlands,
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Crowell RE, Gilliland FD, Temes RT, Harms HJ, Neft RE, Heaphy E, Auckley DH, Crooks LA, Jordan SW, Samet JM, Lechner JF, Belinsky SA. Detection of trisomy 7 in nonmalignant bronchial epithelium from lung cancer patients and individuals at risk for lung cancer. Cancer Epidemiol Biomarkers Prev 1996; 5:631-7. [PMID: 8824366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Early identification and subsequent intervention are needed to decrease the high mortality rate associated with lung cancer. The examination of bronchial epithelium for genetic changes could be a valuable approach to identify individuals at greatest risk. The purpose of this investigation was to assay cells recovered from nonmalignant bronchial epithelium by fluorescence in situ hybridization for trisomy of chromosome 7, an alteration common in non-small cell lung cancer. Bronchial epithelium was collected during bronchoscopy from 16 cigarette smokers undergoing clinical evaluation for possible lung cancer and from seven individuals with a prior history of underground uranium mining. Normal bronchial epithelium was obtained from individuals without a prior history of smoking (never smokers). Bronchial cells were collected from a segmental bronchus in up to four different lung lobes for cytology and tissue culture. Twelve of 16 smokers were diagnosed with lung cancer. Cytological changes found in bronchial epithelium included squamous metaplasia, hyperplasia, and atypical glandular cells. These changes were present in 33, 12, and 47% of sites from lung cancer patients, smokers, and former uranium miners, respectively. Less than 10% of cells recovered from the diagnostic brush had cytological changes, and in several cases, these changes were present within different lobes from the same patient. Background frequencies for trisomy 7 were 1.4 +/- 0.3% in bronchial epithelial cells from never smokers. Eighteen of 42 bronchial sites from lung cancer patients showed significantly elevated frequencies of trisomy 7 compared to never smoker controls. Six of the sites positive for trisomy 7 also contained cytological abnormalities. Trisomy 7 was found in six of seven patients diagnosed with squamous cell carcinoma, one of one patient with adenosquamous cell carcinoma, but in only one of four patients with adenocarcinoma. A significant increase in trisomy 7 frequency was detected in cytologically normal bronchial epithelium collected from four sites in one cancer-free smoker, whereas epithelium from the other smokers did not contain this chromosome abnormality. Finally, trisomy 7 was observed in almost half of the former uranium miners; three of seven sites positive for trisomy 7 also exhibited hyperplasia. Two of the former uranium miners who were positive for trisomy 7 developed squamous cell carcinoma 2 years after collection of bronchial cells. To determine whether the increased frequency of trisomy 7 reflects generalized aneuploidy or specific chromosomal duplication, a subgroup of samples was evaluated for trisomy of chromosome 2; the frequency was not elevated in any of the cases as compared with controls. The studies described in this report are the first to detect and quantify the presence of trisomy 7 in subjects at risk for lung cancer. These results also demonstrate the ability to detect genetic changes in cytologically normal cells, suggesting that molecular analyses may enhance the power for detecting premalignant changes in bronchial epithelium in high-risk individuals.
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Affiliation(s)
- R E Crowell
- Department of Medicine, Albuquerque Veterans Administration Medical Center, University of New Mexico Health Sciences Center 87131, USA
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