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Hervier E, Glessgen C, Nkoulou R, François Deux J, Vallee JP, Adamopoulos D. Hybrid PET/MR in Cardiac Imaging. Magn Reson Imaging Clin N Am 2023; 31:613-624. [PMID: 37741645 DOI: 10.1016/j.mric.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/25/2023]
Abstract
In the last few years, technological advances in MR imaging, PET detectors, and attenuation correction algorithms have allowed the creation of truly integrated PET/MR imaging systems, for both clinical and research applications. These machines allow a comprehensive investigation of cardiovascular diseases, by offering a wide variety of detailed anatomical and functional data in combination. Despite significant pathophysiologic mechanisms being clarified by this new data, its clinical relevance and prognostic significance have not been demonstrated yet.
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Affiliation(s)
- Elsa Hervier
- Diagnostics Department, Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland
| | - Carl Glessgen
- Diagnostics Department, Radiology, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland
| | - René Nkoulou
- Diagnostics Department, Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland
| | - Jean François Deux
- Diagnostics Department, Radiology, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland
| | - Jean-Paul Vallee
- Diagnostics Department, Radiology, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland
| | - Dionysios Adamopoulos
- Department of Medical Specialties, Cardiology, Geneva University Hospital, Gabrielle-Perret-Gentil 4 street, 1205, Geneva, Switzerland.
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2
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Schoepf IC, Thorball CW, Kovari H, Ledergerber B, Buechel RR, Calmy A, Weber R, Kaufmann PA, Nkoulou R, Schwenke JM, Braun DL, Fellay J, Tarr PE. Polygenic Risk Scores for Prediction of Subclinical Coronary Artery Disease in Persons With Human Immunodeficiency Virus (HIV): The Swiss HIV Cohort Study. Clin Infect Dis 2023; 76:48-56. [PMID: 36097729 DOI: 10.1093/cid/ciac758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/07/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In people with human immunodeficiency virus (HIV) (PWH), individual polygenic risk scores (PRSs) are associated with coronary artery disease (CAD) events. Whether PRSs are associated with subclinical CAD is unknown. METHODS In Swiss HIV Cohort Study participants of European descent, we defined subclinical CAD as presence of soft, mixed, or high-risk plaque (SMHRP) on coronary computed tomography (CT) angiography, or as participants in the top tertile of the study population's coronary artery calcium (CAC) score, using noncontrast CT. We obtained univariable and multivariable odds ratios (ORs) for subclinical CAD endpoints based on nongenetic risk factors, and validated genome-wide PRSs built from single nucleotide polymorphisms associated with CAD, carotid intima-media thickness (IMT), or longevity in the general population. RESULTS We included 345 genotyped participants (median age, 53 years; 89% male; 96% suppressed HIV RNA); 172 and 127 participants had SMHRP and CAC, respectively. CAD-associated PRS and IMT-associated PRS were associated with SMHRP and CAC (all P < .01), but longevity PRS was not. Participants with unfavorable CAD-PRS (top quintile) had an adjusted SMHRP OR = 2.58 (95% confidence interval [CI], 1.18-5.67), and a CAC OR = 3.95 (95% CI, 1.45-10.77) vs. bottom quintile. Unfavorable nongenetic risk (top vs. bottom quintile) was associated with adjusted SMHRP OR = 24.01 (95% CI, 9.75-59.11), and a CAC-OR = 65.07 (95% CI, 18.48-229.15). Area under the receiver operating characteristic curve increased when we added CAD-PRS to nongenetic risk factors (SMHRP: 0.75 and 0.78, respectively; CAC: 0.80 and 0.83, respectively). CONCLUSIONS In Swiss PWH, subclinical CAD is independently associated with an individual CAD-associated PRS. Combining nongenetic and genetic cardiovascular risk factors provided the most powerful subclinical CAD prediction.
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Affiliation(s)
- Isabella C Schoepf
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.,Hepatology, Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.,University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Christian W Thorball
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Disease, Geneva University Hospital, Geneva, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - René Nkoulou
- Division of Cardiology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Johannes M Schwenke
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jacques Fellay
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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3
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Condoluci A, Théaudin M, Schwotzer R, Pazhenkottil AP, Arosio P, Averaimo M, Bacher U, Bode P, Cavalli A, Dirnhofer S, Djerbi N, Dobner S, Fehr T, Garofalo M, Gaspert A, Gerull S, Heimgartner R, Hübers A, Jung HH, Kessler C, Knöpfel R, Laptseva N, Magini G, Manka R, Mazzucchelli L, Meyer M, Mihaylova V, Monney P, Mylonas A, Nkoulou R, Pabst T, Pfister O, Rüfer A, Schmidt A, Seeger H, Stämpfli SF, Stirnimann G, Suter T, Treglia G, Tzankov A, Vetter F, Zweier M, Flammer AJ, Gerber B. Management of transthyretin amyloidosis. Swiss Med Wkly 2021; 151:w30053. [PMID: 34694105 DOI: 10.4414/smw.2021.w30053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Transthyretin amyloidosis (ATTR amyloidosis) is a disease caused by deposition of transthyretin fibrils in organs and tissues, which causes their dysfunction. The clinical heterogeneity of ATTR amyloidosis and the variable presentation of symptoms at early disease stages, historically meant treatment delays. Diagnostic tools and therapy options of ATTR amyloidosis have markedly improved in recent years. The first Swiss Amyloidosis Network (SAN) meeting (Zurich, Switzerland, January 2020) aimed to define a consensus statement regarding the diagnostic work-up and treatment for systemic amyloidosis, tailored to the Swiss healthcare system. A consortium of 45 clinicians and researchers from all Swiss regions and universities was selected by the SAN committee to represent all sub-specialty groups involved in care of patients with amyloidosis. A steering committee conducted the literature search and analysis, wrote the critical synthesis and elaborated a list of statements that were evaluated by all the participants. These recommendations will improve outcomes and quality of life for patients with ATTR amyloidosis. A global review of these guidelines is planned every 3 years with a formal meeting of all the involved experts.
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Affiliation(s)
- Adalgisa Condoluci
- Division of Haematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Marie Théaudin
- Department of Neurology, Neuromuscular Unit, University Hospital and University of Lausanne, Switzerland
| | - Rahel Schwotzer
- Department of Medical Oncology and Haematology, University Hospital of Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Cardiology, University Heart Centre, University Hospital and University Zurich, Switzerland.,Cardiac Imaging, Department of Nuclear Medicine, University Hospital and University of Zurich, Switzerland
| | - Paolo Arosio
- Department of Chemistry and Applied Biosciences, ETHZ, Zurich, Switzerland
| | | | - Ulrike Bacher
- Department of Haematology, Inselspital, University Hospital and University of Bern, Switzerland
| | - Peter Bode
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Switzerland
| | - Andrea Cavalli
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Department of Medical Genetics and Pathology, University Hospital and University of Basel, Switzerland
| | - Nadia Djerbi
- Department of Medical Oncology and Haematology, University Hospital of Zurich, Switzerland
| | - Stephan Dobner
- Department of Cardiology, Inselspital, University Hospital and University of Bern, Switzerland
| | - Thomas Fehr
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Maura Garofalo
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Ariana Gaspert
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Switzerland
| | - Sabine Gerull
- Department of Hematology, Cantonal Hospital Aarau, Switzerland
| | - Raphael Heimgartner
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Annemarie Hübers
- Department of Neurology, University Hospital and University of Geneva, Switzerland
| | - Hans H Jung
- Department of Neurology, University Hospital and University Zurich, Switzerland
| | - Chiara Kessler
- Division of Haematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Raphael Knöpfel
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Natallia Laptseva
- Department of Cardiology, University Heart Centre, University Hospital and University Zurich, Switzerland
| | - Giulia Magini
- Service de Transplantation, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Centre, University Hospital and University Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich,Switzerland
| | | | - Martin Meyer
- Department of Cardiology, University Heart Centre, University Hospital and University Zurich, Switzerland
| | - Violeta Mihaylova
- Department of Neurology, University Hospital and University Zurich, Switzerland
| | - Pierre Monney
- Department of Cardiology, University Hospital and University of Lausanne, Switzerland
| | - Alessio Mylonas
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - René Nkoulou
- Department of Cardiology, University Hospital and University of Geneva, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Switzerland
| | - Otmar Pfister
- Department of Cardiology, University Hospital and University of Basel, Switzerland
| | - Axel Rüfer
- Department of Haematology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Adrian Schmidt
- Department of Internal Medicine, Clinic for Medical Oncology and Haematology, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Harald Seeger
- Department of Nephrology, University Hospital and University Zurich, Switzerland
| | - Simon F Stämpfli
- Department of Cardiology, Heart Centre Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Guido Stirnimann
- University Clinic for Visceral Surgery and Medicine, University Hospital Inselspital and University of Bern, Switzerland
| | - Thomas Suter
- Department of Cardiology, Inselspital, University Hospital and University of Bern, Switzerland
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, University Hospital and University of Lausanne, Switzerland.,Faculty of Biomedical sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Alexandar Tzankov
- Department of Medical Genetics and Pathology, University Hospital and University of Basel, Switzerland
| | - Friederike Vetter
- Department of Medical Oncology and Haematology, University Hospital of Zurich, Switzerland
| | - Markus Zweier
- Institute of Medical Genetics, University of Zurich, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Heart Centre, University Hospital and University Zurich, Switzerland
| | - Bernhard Gerber
- Division of Haematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,University of Zurich, Switzerland
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4
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Iglesias JF, Nkoulou R, Noble S, Degrauwe S. Combined Cardiac PET-CT and Transcatheter Closure for Left Internal Mammary Artery Side Branch Steal Syndrome. JACC Case Rep 2021; 3:297-299. [PMID: 34317522 PMCID: PMC8310985 DOI: 10.1016/j.jaccas.2020.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/18/2022]
Abstract
We report on a patient with left internal mammary artery (LIMA) side branch steal syndrome and refractory angina who underwent successful transcatheter LIMA side branch closure after cardiac positron emission tomography−computed tomography assessment. The procedure resulted in improved myocardial ischemia, hyperemic blood flow, coronary flow reserve, and anginal symptoms. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Juan F Iglesias
- Cardiology Department, Geneva University Hospitals, Geneva, Switzerland
| | - René Nkoulou
- Cardiology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Noble
- Cardiology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Degrauwe
- Cardiology Department, Geneva University Hospitals, Geneva, Switzerland
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5
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Sanaat A, Shiri I, Arabi H, Mainta I, Nkoulou R, Zaidi H. Deep learning-assisted ultra-fast/low-dose whole-body PET/CT imaging. Eur J Nucl Med Mol Imaging 2021; 48:2405-2415. [PMID: 33495927 PMCID: PMC8241799 DOI: 10.1007/s00259-020-05167-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Tendency is to moderate the injected activity and/or reduce acquisition time in PET examinations to minimize potential radiation hazards and increase patient comfort. This work aims to assess the performance of regular full-dose (FD) synthesis from fast/low-dose (LD) whole-body (WB) PET images using deep learning techniques. METHODS Instead of using synthetic LD scans, two separate clinical WB 18F-Fluorodeoxyglucose (18F-FDG) PET/CT studies of 100 patients were acquired: one regular FD (~ 27 min) and one fast or LD (~ 3 min) consisting of 1/8th of the standard acquisition time. A modified cycle-consistent generative adversarial network (CycleGAN) and residual neural network (ResNET) models, denoted as CGAN and RNET, respectively, were implemented to predict FD PET images. The quality of the predicted PET images was assessed by two nuclear medicine physicians. Moreover, the diagnostic quality of the predicted PET images was evaluated using a pass/fail scheme for lesion detectability task. Quantitative analysis using established metrics including standardized uptake value (SUV) bias was performed for the liver, left/right lung, brain, and 400 malignant lesions from the test and evaluation datasets. RESULTS CGAN scored 4.92 and 3.88 (out of 5) (adequate to good) for brain and neck + trunk, respectively. The average SUV bias calculated over normal tissues was 3.39 ± 0.71% and - 3.83 ± 1.25% for CGAN and RNET, respectively. Bland-Altman analysis reported the lowest SUV bias (0.01%) and 95% confidence interval of - 0.36, + 0.47 for CGAN compared with the reference FD images for malignant lesions. CONCLUSION CycleGAN is able to synthesize clinical FD WB PET images from LD images with 1/8th of standard injected activity or acquisition time. The predicted FD images present almost similar performance in terms of lesion detectability, qualitative scores, and quantification bias and variance.
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Affiliation(s)
- Amirhossein Sanaat
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva, Switzerland
| | - Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva, Switzerland
| | - Hossein Arabi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva, Switzerland
| | - Ismini Mainta
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva, Switzerland
| | - René Nkoulou
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva, Switzerland
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva, Switzerland
- Geneva University Neurocenter, Geneva University, 1205 Geneva, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Nuclear Medicine, University of Southern Denmark, DK-500 Odense, Denmark
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6
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Kovari H, Calmy A, Doco-Lecompte T, Nkoulou R, Marzel A, Weber R, Kaufmann PA, Buechel RR, Ledergerber B, Tarr PE. Antiretroviral Drugs Associated With Subclinical Coronary Artery Disease in the Swiss Human Immunodeficiency Virus Cohort Study. Clin Infect Dis 2021; 70:884-889. [PMID: 30958888 DOI: 10.1093/cid/ciz283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/16/2018] [Accepted: 04/04/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) events have been associated with certain antiretroviral therapy (ART) agents. In contrast, the influence of ART on subclinical atherosclerosis is not clear. The study objective was to assess the association between individual ART agents and the prevalence and extent of subclinical CAD. METHODS Coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA) were performed in ≥45-year-old Swiss Human Immunodeficiency Virus Cohort Study participants. The following subclinical CAD endpoints were analyzed separately: CAC score >0, any plaque, calcified plaque, noncalcified/mixed plaque, segment involvement score (SIS), and segment severity score (SSS). Logistic regression models calculated by inverse probability of treatment weights (IPTW) were used to explore associations between subclinical CAD and cumulative exposure to the 10 most frequently used drugs. RESULTS There were 403 patients who underwent CCTA. A CAC score >0 was recorded in 188 (47%), any plaque in 214 (53%), calcified plaque in 151 (38%), and noncalcified/mixed plaque in 150 (37%) participants. A CAC score >0 was negatively associated with efavirenz (IPTW adjusted odds ratio per 5 years 0.73, 95% confidence interval [CI] 0.56-0.96), tenofovir disoproxil fumarate (0.68, 95% CI 0.49-0.95), and lopinavir (0.64, 95% CI 0.43-0.96). Any plaque was negatively associated with tenofovir disoproxil fumarate (0.71, 95% CI 0.51-0.99). Calcified plaque was negatively associated with efavirenz (0.7, 95% CI 0.57-0.97). Noncalcified/mixed plaque was positively associated with abacavir (1.46, 95% CI 1.08-1.98) and negatively associated with emtricitabine (0.67, 95% CI 0.46-0.99). For SSS and SIS, we found no association with any drug. CONCLUSIONS An increased risk of noncalcified/mixed plaque was only found in patients exposed to abacavir. Emtricitabine was negatively associated with noncalcified/mixed plaque, while tenofovir disoproxil fumarate and efavirenz were negatively associated with any plaque and calcified plaque, respectively.
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Affiliation(s)
- Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University of Geneva, Switzerland
| | | | - René Nkoulou
- Division of Cardiology, University Hospital Geneva, University of Geneva, Switzerland
| | - Alex Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Philip E Tarr
- Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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7
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Schwotzer R, Flammer AJ, Gerull S, Pabst T, Arosio P, Averaimo M, Bacher VU, Bode P, Cavalli A, Concoluci A, Dirnhofer S, Djerbi N, Dobner SW, Fehr T, Garofalo M, Gaspert A, Heimgartner R, Hübers A, Jung HH, Kessler C, Knöpfel R, Laptseva N, Manka R, Mazzucchelli L, Meyer M, Mihaylova V, Monney P, Mylonas A, Nkoulou R, Pazhenkottil A, Pfister O, Rüfer A, Schmidt A, Seeger H, Stämpfli SF, Stirnimann G, Suter T, Théaudin M, Treglia G, Tzankov A, Vetter F, Zweier M, Gerber B. Expert recommendation from the Swiss Amyloidosis Network (SAN) for systemic AL-amyloidosis. Swiss Med Wkly 2020; 150:w20364. [PMID: 33277911 DOI: 10.4414/smw.2020.20364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Systemic amyloidosis is a heterogeneous group of diseases associated with protein misfolding into insoluble beta-sheet rich structures that deposit extracellularly in different organs, eventually compromising their function. There are more than 30 different proteins, known to be amyloidogenic with “light chain” (AL)-amyloidosis being the most common type, followed by transthyretin (ATTR)-, and amyloid protein A (AA)-amyloidosis. Systemic amyloidosis is a rare disease with an incidence of around 10 patients in 1 million inhabitants. Recently several new therapeutic options have been developed for subgroups of amyloidosis patients, and the introduction of novel therapies for plasma cell myeloma has led to an increase in the therapeutic armamentarium for plasma cell disorders, including AL amyloidosis. Among them, proteasome inhibitors, immunomodulatory agents (-imids), and monoclonal antibodies have been successfully introduced into clinical practice. Still, high-quality data from randomised controlled trials regarding the benefit of these cost-intensive drugs in AL amyloidosis are widely lacking, and due to the rarity of the disease many physicians will not gain routine experience in the management of these frail patients. The diagnosis of AL amyloidosis relies on a close collaboration between clinicians, pathologists, imaging experts, and sometimes geneticists. Diagnosis and treatment options in this complex disorder should be discussed in dedicated multidisciplinary boards. In January 2020, the first meeting of the Swiss Amyloidosis Network took place in Zurich, Switzerland. One aim of this meeting was to establish a consensus guideline regarding the diagnostic work-up and the treatment recommendations for systemic amyloidosis tailored to the Swiss health care system. Forty-five participants from different fields in medicine discussed many aspects of amyloidosis. These are the Swiss Amyloidosis Network recommendations which focus on diagnostic work-up and treatment of AL-amyloidosis.
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Affiliation(s)
- Rahel Schwotzer
- Department of Medical Oncology and Haematology, University Hospital Zurich, Switzerland
| | | | - Sabine Gerull
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Thomas Pabst
- Department of Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Paolo Arosio
- Departement of Chemistry and Applied Biosciences. 'ETHZ', Zurich, Switzerland
| | | | - Vera Ulrike Bacher
- Department of Hematology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Peter Bode
- Departement of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Cavalli
- Institute of Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland / Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Adalgisa Concoluci
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Stefan Dirnhofer
- Departement of Medical Genetics and Pathology, University Hospital and University of Basel, Basel, Switzerland
| | - Nadia Djerbi
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Stefan W Dobner
- Departement of Cardiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Thomas Fehr
- Departement of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Maura Garofalo
- Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland
| | - Ariana Gaspert
- Departement of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Raphael Heimgartner
- Departement of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Annemarie Hübers
- Departement of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - Hans H Jung
- Departement of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Chiara Kessler
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Raphael Knöpfel
- Departement of Internal Medicine, Hospital Thusis, Thusis, Switzerland
| | - Natallia Laptseva
- Departement of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Hospital, Zurich, Switzerland / Departement of Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Martin Meyer
- Department of Cardiology, University Hospital, Zurich, Switzerland
| | - Violeta Mihaylova
- Department of Neurology, University Hospital and University Zurich, Zurich, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessio Mylonas
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - René Nkoulou
- Department of Cardiology, University Hospital and University of Geneva, Geneva, Switzerland
| | - Aju Pazhenkottil
- Department of Cardiology, University Hospital, Zurich, Switzerland
| | - Otmar Pfister
- Department of Cardiology, University Hospital and University of Basel, Basel, Switzerland
| | - Axel Rüfer
- Department of Hematology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Adrian Schmidt
- Department of Internal Medicine, Clinic for Medical Oncology and Hematology, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Harald Seeger
- Department of Nephrology, University Hospital and University Zurich, Zurich, Switzerland
| | - Simon F Stämpfli
- Department of Cardiology, Heart Centre Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Guido Stirnimann
- University Clinic for Visceral Surgery and Medicine, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Thomas Suter
- Department of Cardiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marie Théaudin
- Department of Neurology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland / Department of Nuclear Medicine and Molecular Imaging, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandar Tzankov
- Department of Medical Genetics and Pathology, University Hospital and University of Basel, Basel, Switzerland
| | - Friederike Vetter
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Markus Zweier
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - Bernhard Gerber
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Tarr PE, Ledergerber B, Calmy A, Doco-Lecompte T, Schoepf IC, Marzel A, Weber R, Kaufmann PA, Nkoulou R, Buechel RR, Kovari H. Longitudinal Progression of Subclinical Coronary Atherosclerosis in Swiss HIV-Positive Compared With HIV-Negative Persons Undergoing Coronary Calcium Score Scan and CT Angiography. Open Forum Infect Dis 2020; 7:ofaa438. [PMID: 33134415 PMCID: PMC7585327 DOI: 10.1093/ofid/ofaa438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/11/2020] [Indexed: 01/11/2023] Open
Abstract
Background People with HIV (HIV+) may have increased cardiovascular event rates compared with HIV-negative (HIV-) persons. Cross-sectional data from the United States and Switzerland, based on coronary artery calcium scan (CAC) and coronary computed tomography angiography (CCTA), suggest, respectively, increased and similar prevalence of subclinical atherosclerosis in HIV+ vs HIV- persons. Methods We repeated CAC/CCTA in 340 HIV+ and 90 HIV- study participants >2 years after baseline CAC/CCTA. We assessed the association of HIV infection, Framingham risk score (FRS), and HIV-related factors with the progression of subclinical atherosclerosis. Results HIV+ were younger than HIV- participants (median age, 52 vs 56 years; P < .01) but had similar median 10-year FRS (8.9% vs 9.0%; P = .82); 94% had suppressed HIV viral load. In univariable and multivariable analyses, FRS was associated with the incidence rate ratio (IRR) of new subclinical atherosclerosis at the follow-up CAC/CCTA, but HIV infection was not: any plaque (adjusted IRR for HIV+ vs HIV- participants, 1.21; 95% CI, 0.62–2.35), calcified plaque (adjusted IRR for HIV+ vs HIV- participants, 1.06; 95% CI, 0.56–2), noncalcified/mixed plaque (adjusted IRR for HIV+ vs HIV- participants, 1.24; 95% CI, 0.69–2.21), and high-risk plaque (adjusted IRR for HIV+ vs HIV- participants, 1.46; 95% CI, 0.66–3.20). Progression of CAC score between baseline and follow-up CAC/CCTA was similar in HIV+ (median annualized change [interquartile range {IQR}], 0.41 [0–10.19]) and HIV- participants (median annualized change [IQR], 2.38 [0–16.29]; P = .11), as was progression of coronary segment severity score (HIV+: median annualized change [IQR], 0 [0–0.47]; HIV-: median annualized change [IQR], 0 [0–0.52]; P = .10) and coronary segment involvement score (HIV+: median annualized change [IQR], 0 [0–0.45]; HIV-: median annualized change [IQR], 0 [0–0.41]; P = .25). Conclusions In this longitudinal CAC/CCTA study from Switzerland, Framingham risk score was associated with progression of subclinical atherosclerosis, but HIV infection was not.
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Affiliation(s)
- Philip E Tarr
- University Department of Medicine and Division of Infectious Diseases, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Thanh Doco-Lecompte
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Isabella C Schoepf
- University Department of Medicine and Division of Infectious Diseases, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Alex Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - René Nkoulou
- Division of Cardiology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Tarr PE, Ledergerber B, Calmy A, Doco-Lecompte T, Marzel A, Weber R, Kaufmann PA, Nkoulou R, Buechel RR, Kovari H. Subclinical coronary artery disease in Swiss HIV-positive and HIV-negative persons. Eur Heart J 2019; 39:2147-2154. [PMID: 29590332 DOI: 10.1093/eurheartj/ehy163] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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] [Received: 09/11/2017] [Accepted: 03/06/2018] [Indexed: 12/31/2022] Open
Abstract
Aims HIV-positive persons have increased cardiovascular event rates but data on the prevalence of subclinical atherosclerosis compared with HIV-negative persons are not uniform. We assessed subclinical atherosclerosis utilizing coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA) in 428 HIV-positive participants of the Swiss HIV Cohort Study and 276 HIV-negative controls concurrently referred for clinically indicated CCTA. Methods and results We assessed the association of HIV infection, cardiovascular risk profile, and HIV-related factors with subclinical atherosclerosis in univariable and multivariable analyses. HIV-positive participants (median duration of HIV infection, 15 years) were younger than HIV-negative participants (median age 52 vs. 56 years; P < 0.01) but had similar median 10-year Framingham risk scores (9.0% vs. 9.7%; P = 0.40). The prevalence of CAC score >0 (53% vs. 56.2%; P = 0.42) and median CAC scores (47 vs. 47; P = 0.80) were similar, as was the prevalence of any, non-calcified/mixed, and high-risk plaque. In multivariable adjusted analysis, HIV-positive participants had a lower prevalence of calcified plaque than HIV-negative participants [36.9% vs. 48.6%, P < 0.01; adjusted odds ratio (aOR) 0.57; 95% confidence interval (CI) 0.40-0.82; P < 0.01], lower coronary segment severity score (aOR 0.72; 95% CI 0.53-0.99; P = 0.04), and lower segment involvement score (aOR 0.71, 95% CI 0.52-0.97; P = 0.03). Advanced immunosuppression was associated with non-calcified/mixed plaque (aOR 1.97; 95% CI 1.09-3.56; P = 0.02). Conclusion HIV-positive persons in Switzerland had a similar degree of non-calcified/mixed plaque and high-risk plaque, and may have less calcified coronary plaque, and lower coronary atherosclerosis involvement and severity scores than HIV-negative persons with similar Framingham risk scores.
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Affiliation(s)
- Philip E Tarr
- University Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Thanh Doco-Lecompte
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Alex Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - René Nkoulou
- Division of Cardiology, University Hospital Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
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Nkoulou R, Zaidi H. Does simplified quantitative analysis of 18F-FDG PET in cardiac inflammatory disease work? J Nucl Cardiol 2019; 26:919-921. [PMID: 29344921 DOI: 10.1007/s12350-017-1179-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
- R Nkoulou
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland.
- Division of Cardiology, Geneva University Hospital, Geneva, Switzerland.
| | - H Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, Groningen, Netherlands
- Geneva University Neurocenter, University of Geneva, Geneva, Switzerland
- Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark
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Namdar M, Rager O, Priamo J, Frei A, Noble S, Amzalag G, Ratib O, Nkoulou R. Prognostic value of revascularising viable myocardium in elderly patients with stable coronary artery disease and left ventricular dysfunction: a PET/CT study. Int J Cardiovasc Imaging 2018; 34:1673-1678. [DOI: 10.1007/s10554-018-1380-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/24/2018] [Indexed: 11/24/2022]
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Vincenti G, Quercioli A, Zaidi H, Nkoulou R, Dewarrat S, Rager O, Ambrosio G, Seimbille Y, Mach F, Ratib O, Schindler TH. Combined evaluation of myocardial perfusion and coronary morphology in the identification of subclinical CAD. Nuklearmedizin 2018; 49:173-82. [DOI: 10.3413/nukmed-0312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 07/03/2010] [Indexed: 11/20/2022]
Abstract
Summary
Purpose: To evaluate the mean effective radiation dose of 13N-ammonia PET/CT and ECGpulsing CT angiography (CTA) in the evaluation of myocardial perfusion, myocardial blood flow (MBF) and coronary morphology for the identification of subclinical CAD. Patients, material, methods: Following rest-stress 13N-ammonia PET/CT perfusion imaging and MBF quantification, ECG-pulsing CTA at a pulse window of 70% of the R-R cycle was performed in ten healthy controls and in sixteen individuals with cardiovascular risk factors. Individual radiation dose exposure for ECG-pulsing CTA was estimated from the dose-length product. Results: PET demonstrated normal perfusion in all study individuals, while hyperemic MBFs during dipyridamole stimulation and the myocardial flow reserve (MFR) in cardiovascular risk individuals were significantly lower than in healthy controls (1.34 ± 0.26 vs. 2.28 ± 0.47 ml/g/min and 1.48 ± 0.39 vs. 3.24 ± 0.81, both p . 0.0001). Further, ECG-pulsing CTA identified mild calcified and non-calcified coronary plaque burden in 7 (43%) individuals of the cardiovascular risk group. Rest-stress 13N-ammonia PET/CT perfusion study yielded a mean effective radiation dose of 3.07 ± 0.06 mSv (2.07 ± 0.06 mSv from the rest-stress 13N-ammonia injections and 1.0 mSv from the 2 CT transmission scans), while ECG-pulsing CTA was associated with 5.57 ± 2.00 mSv. The mean effective radiation dose of the combined 13N-ammonia PET/CT and ECG-pulsing CTA exams in the evaluation of myocardial perfusion and coronary morphology was 8.0 ± 1.5 mSv. Conclusion: 13N-ammonia PET/CT and ECG-pulsing CTA affords cardiac hybrid imaging studies in the evaluation of subclinical CAD with a relatively low mean effective radiation exposure of 8.0 ± 1.5mSv.
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Pazhenkottil A, Nkoulou R, Wolfrum M, Kuest S, Ghadri J, Fiechter M, Buechel R, Herzog B, Gaemperli O, Kaufmann P. REAL-TIME ASSESSMENT OF DOBUTAMINE-STRESS-INDUCED WALL MOTION ABNORMALITIES BY GATED SPECT MYOCARDIAL PERFUSION IMAGING WITH CADMIUM-ZINC-TELLURIDE DETECTORS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60925-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carballo D, Nkoulou R, Vincenti G, Quercioli A, Heinzer S, Didier D, Stuber M, Schindler T, Ratib O, Vallee J. Value of a hybrid PET/MRI in the assessment of cardiac viability. J Cardiovasc Magn Reson 2012. [PMCID: PMC3305496 DOI: 10.1186/1532-429x-14-s1-p80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Cherian S, Nkoulou R, Kalangos A, Cikirikcioglu M. Positron emission tomography-computed tomography scan helps decision making in cardiac surgery. Eur J Cardiothorac Surg 2012; 43:650. [PMID: 23111562 DOI: 10.1093/ejcts/ezs526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/15/2022] Open
Affiliation(s)
- Sanjay Cherian
- Division of Cardiovascular Surgery, Medical Faculty, University Hospital of Geneva, Geneva, Switzerland
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Husmann L, Herzog BA, Pazhenkottil AP, Buechel RR, Nkoulou R, Ghadri JR, Valenta I, Burger IA, Gaemperli O, Wyss CA, Kaufmann PA. Lowering heart rate with an optimised breathing protocol for prospectively ECG-triggered CT coronary angiography. Br J Radiol 2011; 84:790-5. [PMID: 21849364 DOI: 10.1259/bjr/29696915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim was to prospectively characterise the effect of the level of breath-hold on heart rate in CT coronary angiography (CTCA) with prospective electrocardiogram (ECG) triggering and its impact on coronary artery attenuation. METHODS 260 patients (86 women; mean age 59 ± 11 years) underwent 64-slice CTCA using prospective ECG triggering. Prior to CTCA, heart rates were recorded during 15 s of breath-hold at three different levels of inspiration (normal, intermediate and deep). The inspiration level with the lowest heart rate was chosen for actual CTCA scanning. Coronary artery attenuation was measured, and the presence of backflow of contrast material into the inferior vena cava (as an indicator of increased intrathoracic pressure) was recorded. RESULTS The mean heart rate at breath-hold was significantly different for the three inspiration levels (normal, 60 ± 8 bpm; intermediate, 59 ± 8 bpm; deep, 57 ± 7 bpm; p<0.001). The maximum heart rate reduction in each patient at breath-hold averaged 5.3 ± 5.1 bpm, and was observed at a normal inspiration depth in 23 (9%) patients, at an intermediate inspiration depth in 102 (39%) patients and at deep inspiration in 135 (52%) patients. Overall, there was no association between the level of breath-hold and coronary vessel attenuation (p-value was not significant). However, the backflow of contrast material into the inferior vena cava (n = 26) was found predominantly at deep inspiration levels (p<0.001), and, when it occurred, it was associated with reduced coronary attenuation compared with patients with no backflow (p<0.05). CONCLUSION The breath-hold level to best reduce heart rate for CTCA should be individually assessed prior to scanning because a mean heart rate reduction of 5 bpm can be achieved.
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Affiliation(s)
- L Husmann
- Department of Radiology, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
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Buechel RR, Herzog BA, Husmann L, Burger IA, Pazhenkottil AP, Treyer V, Valenta I, von Schulthess P, Nkoulou R, Wyss CA, Kaufmann PA. Erratum to: Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: first clinical validation. Eur J Nucl Med Mol Imaging 2011. [DOI: 10.1007/s00259-011-1805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Buechel RR, Pazhenkottil AP, Herzog BA, Brueckner M, Nkoulou R, Ghadri JR, Kuest SM, Wyss CA, Husmann L, Kaufmann PA. Prognostic performance of low-dose coronary CT angiography with prospective ECG triggering. Heart 2011; 97:1385-90. [DOI: 10.1136/hrt.2010.217638] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Valenta I, Quercioli A, Vincenti G, Nkoulou R, Dewarrat S, Rager O, Zaidi H, Seimbille Y, Mach F, Ratib O, Schindler TH. Structural epicardial disease and microvascular function are determinants of an abnormal longitudinal myocardial blood flow difference in cardiovascular risk individuals as determined with PET/CT. J Nucl Cardiol 2010; 17:1023-33. [PMID: 20658271 DOI: 10.1007/s12350-010-9272-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to determine whether epicardial structural disease may affect the manifestation of a longitudinal decrease in myocardial blood flow (MBF) or MBF difference during hyperemia in cardiovascular risk individuals, and its dependency on the flow increase. METHODS AND RESULTS In 54 cardiovascular risk individuals (at risk) and in 26 healthy controls, MBF was measured with (13)N-ammonia and PET/CT in mL/g/min at rest and during dipyridamole stimulation. Computed tomography coronary angiography (CTA) was performed using a 64-slice CT of a PET/CT system. Absolute MBFs during dipyridamole stimulation were mildly lower in the mid-distal than in the mid-LV myocardium in controls (2.20 ± .51 vs 2.29 ± .51, P < .0001), while it was more pronounced in at risk with normal and abnormal CTA (1.56 ± .42 vs 1.91 ± .46 and 1.18 ± .34 vs 1.51 ± .40 mL/g/min, respectively, P < .0001), resulting in a longitudinal MBF difference that was highest in at risk with normal CTA, intermediate in at risk abnormal CTA, and lowest in controls (.35 ± .16 and .22 ± .09 vs .09 ± .04 mL/g/min, respectively, P < .0001). On multivariate analysis, log-CCS and mid-LV hyperemic MBF increase, indicative of microvascular function, were independent predictors of the observed longitudinal MBF difference (P ≤ .004 by ANOVA). CONCLUSIONS Epicardial structural disease and microvascular function are important determinants of an abnormal longitudinal MBF difference as determined with PET/CT.
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Affiliation(s)
- Ines Valenta
- Department of Internal Medicine, Cardiovascular Center, Nuclear Cardiology, University Hospital of Geneva, Geneva, Switzerland
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Quercioli A, Vincenti MG, Nkoulou R, Dewarrat S, Seimbille Y, Ratib O, Mach F, Schindler TH. CORONARY CIRCULATORY DYSFUNCTION IS ASSOCIATED WITH DIASTOLIC DYSFUNCTION IN INDIVIDUALS AT CARDIOVASCULAR RISK. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vuilleumier N, Rossier MF, Pagano S, Python M, Charbonney E, Nkoulou R, James R, Reber G, Mach F, Roux-Lombard P. Anti-apolipoprotein A-1 autoantibodies as an independent cardiovascular prognostic marker affecting basal heart rate in myocardial infarction. Ann Rheum Dis 2010. [DOI: 10.1136/ard.2010.129577u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vuilleumier N, Rossier MF, Pagano S, Python M, Charbonney E, Nkoulou R, James R, Reber G, Mach F, Roux-Lombard P. Anti-apolipoprotein A-1 IgG as an independent cardiovascular prognostic marker affecting basal heart rate in myocardial infarction. Eur Heart J 2010; 31:815-23. [PMID: 20176799 DOI: 10.1093/eurheartj/ehq055] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [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: 12/12/2022] Open
Abstract
AIMS To assess the prognostic value of anti-apolipoprotein A-1 (anti-apoA-1) IgG after myocardial infarction (MI) and its association with major cardiovascular events (MACEs) at 12 months and to determine their association with resting heart rate (RHR), a well-established prognostic feature after MI. Anti-apoA-1 IgG have been reported in MI without autoimmune disease, but their clinical significance remains undetermined. METHODS AND RESULTS A total of 221 consecutive patients with MI were prospectively included, and all completed a 12-month follow-up. Major cardiovascular events consisted in death, MI, stroke, or hospitalization either for an acute coronary syndrome or heart failure. Resting heart rate was obtained on Holter the day before discharge under the same medical treatment. Neonate rat ventricular cardiomyocytes (NRVC) were used in vitro to assess the direct anti-apoA-1 IgG effect on RHR. During follow-up, 13% of patients presented a MACE. Anti-apoA-1 IgG positivity was 9% and was associated with a higher RHR (P = 0.0005) and higher MACE rate (adjusted OR, 4.3; 95% CI, 1.46-12.6; P = 0.007). Survival models confirmed the significant nature of this association. Patients with MACE had higher median anti-apoA-1 IgG values at admission than patients without (P = 0.007). On NRVC, plasma from MI patients and monoclonal anti-apoA-1 IgG induced an aldosterone and dose-dependent positive chronotropic effect, abrogated by apoA-1 and therapeutic immunoglobulin (IVIG) pre-incubation. CONCLUSIONS In MI patients, anti-apoA-1 IgG is independently associated with MACE at 1-year, interfering with a currently unknown aldosterone-dependent RHR determinant. Knowing whether anti-apoA-1 IgG assessment could be of interest to identify an MI patient subset susceptible to benefit from apoA-1/IVIG therapy remains to be demonstrated.
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Affiliation(s)
- Nicolas Vuilleumier
- Service of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva 14, Switzerland.
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Pazhenkottil AP, Husmann L, Buechel RR, Herzog BA, Nkoulou R, Burger IA, Vetterli A, Valenta I, Ghadri JR, von Schulthess P, Kaufmann PA. Validation of a new contrast material protocol adapted to body surface area for optimized low-dose CT coronary angiography with prospective ECG-triggering. Int J Cardiovasc Imaging 2010; 26:591-7. [PMID: 20131006 DOI: 10.1007/s10554-010-9594-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [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] [Received: 09/30/2009] [Accepted: 01/18/2010] [Indexed: 01/24/2023]
Abstract
In patients with large total blood volume contrast material (CM) dilution decreases coronary attenuation in CT coronary angiography (CTCA). As increased blood volume is well paralleled by body surface area (BSA) we assessed a BSA-adapted CM protocol to compensate for dilution effects. Low-dose CTCA with prospective ECG-triggering was performed in 80 patients with a BSA-adapted CM bolus ranging 40-105 ml and injection rate ranging 3.5-5.0 ml/s for a BSA of <1.70 to >or=2.5 m(2). Eighty control patients matched for BSA who had previously undergone routine CTCA with a fixed CM protocol of 80 ml at 5 ml/s served as reference group. The average vessel attenuation from the proximal right (RCA) and the left main coronary artery (LMA) was assessed. Correlation of BSA with vessel attenuation was assessed in both groups. BSA-matching of all patients was successful (BSA-adapted group 1.98 +/- 0.15 m(2), range 1.66-2.39 m(2) versus reference group 1.98 +/- 0.17 m(2), range 1.59-2.38 m(2); P = 0.74). Mean CM bolus was significantly smaller in the BSA-adapted versus the reference group (70.9 +/- 14.1 vs. 80.0 +/- 0 ml, P < 0.001). There was no correlation in the BSA-adapted group (r = -0.07, P = 0.53, SEE = 0.15), while coronary attenuation was inversely related to BSA in the reference group (r = -0.59, P < 0.001, SEE = 0.14). We have successfully validated a BSA-adapted contrast material protocol which results in a comparable coronary contrast enhancement independent of individual BSA. This was achieved despite a significant reduction in the overall contrast material amount.
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Affiliation(s)
- Aju P Pazhenkottil
- Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
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Buechel RR, Herzog BA, Husmann L, Burger IA, Pazhenkottil AP, Treyer V, Valenta I, von Schulthess P, Nkoulou R, Wyss CA, Kaufmann PA. Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: first clinical validation. Eur J Nucl Med Mol Imaging 2010; 37:773-8. [PMID: 20107783 DOI: 10.1007/s00259-009-1375-7] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 11/03/2009] [Indexed: 01/29/2023]
Abstract
PURPOSE To assess the diagnostic performance of a novel ultrafast cardiac gamma camera with cadmium-zinc-telluride (CZT) solid-state semiconductor detectors for nuclear myocardial perfusion imaging (MPI). METHODS The study group comprised 75 consecutive patients (55 men, BMI range 19-45 kg/m(2)) who underwent a 1-day (99m)Tc-tetrofosmin adenosine-stress/rest imaging protocol. Scanning was performed first on a conventional dual-detector SPECT gamma camera (Ventri, GE Healthcare) with a 15-min acquisition time each for stress and rest. All scans were immediately repeated on an ultrafast CZT camera (Discovery 530 NMc, GE Healthcare) with a 3-min scan time for stress and a 2-min scan time for rest. Clinical agreement (normal, ischaemia, scar) between CZT and SPECT was assessed for each patient and for each coronary territory using SPECT MPI as the reference standard. Segmental myocardial tracer uptake values (percent of maximum) using a 20-segment model and left ventricular ejection fraction (EF) values obtained using CZT were compared with those obtained using conventional SPECT by intraclass correlation and by calculating Bland-Altman limits of agreement. RESULTS There was excellent clinical agreement between CZT and conventional SPECT on a per-patient basis (96.0%) and on a per-vessel territory basis (96.4%) as shown by a highly significant correlation between segmental tracer uptake values (r=0.901, p<0.001). Similarly, EF values for both scanners were highly correlated (r=0.976, p<0.001) with narrow Bland-Altman limits of agreement (-5.5-10.6%). CONCLUSION The novel CZT camera allows a more than fivefold reduction in scan time and provides clinical information equivalent to conventional standard SPECT MPI.
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Affiliation(s)
- Ronny R Buechel
- Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
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Vincenti G, Nkoulou R, Steiner C, Imperiano H, Ambrosio G, Mach F, Ratib O, Vallee JP, Schindler TH. Noninvasive stress testing of myocardial perfusion defects: head-to-head comparison of thallium-201 SPECT to MRI perfusion. J Nucl Cardiol 2009; 16:549-61. [PMID: 19488826 DOI: 10.1007/s12350-009-9097-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 04/30/2009] [Accepted: 05/01/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND To evaluate the diagnostic value of magnetic resonance imaging (MRI) of myocardial perfusion in the assessment of flow-limiting epicardial stenosis in a head-to-head comparison with abnormal thallium-201 ((201)TI) single photon emission tomography (SPECT) studies in patients with predominantly known coronary artery disease (CAD). METHODS AND RESULTS Twenty-one patients (mean age 65 +/- 10 years) with reversible myocardial perfusion defects on (201)TI-SPECT images during dipyridamole-stimulated hyperemia were recruited for study purpose. Within 5 days of the (201)TI-SPECT study, myocardial perfusion was studied again with MRI during dipyridamole stimulation and at rest. Overall, (201)TI-SPECT identified 30 reversible regional perfusion defects. The sensitivity to detect hypoperfused segments was 70% (21/30) with the GRE-MRI perfusion analysis with (201)TI-SPECT as reference. When patients were subgrouped according to the extent of regional reversible perfusion defects on (201)TI-SPECT, mild- (SDS: 2-4), moderate- (SDS: 5-8), and severe- (SDS > 8) perfusion defects were also identified by GRE-MRI perfusion analysis in 75% (6/8), in 56% (9/16) and 100% (6/6), respectively. CONCLUSIONS GRE-MRI first-pass stress perfusion imaging may not identify up to 30% of mild-to-moderate perfusion defects in a group of preselected patients with predominantly known CAD and abnormal (201)TI-SPECT studies.
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Affiliation(s)
- Gabriella Vincenti
- Department of Internal Medicine, Cardiovascular Center, Nuclear Cardiology, University Hospital of Geneva, Geneva, Switzerland
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Grosgurin O, Rutschmann O, Plojoux J, Keller P, Niquille M, Nkoulou R, Sarasin F. 153: Out-of-Hospital Emergency Physician Activation of Interventional Cardiology Team Reduces Door-to-Balloon Time in ST-Elevation Myocardial Infarction. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Nkoulou R, Beauchet O, Perrenoud JJ. [Paced right bundle branch block: what to do?]. Rev Med Suisse 2007; 3:2552-2554. [PMID: 18072605] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Left bundle branch block (LBBB) is the assumed presentation of right ventricular pacing. Paced right bundle branch block (RBBB) raises the suspicion of lead malposition. In a well placed right ventricular lead an atypical conduction pattern must be evoked. It is important to differentiate malposition from well placed ventricular lead because malposition is associated with embolic complications and may require therapeutic interventions including anticoagulation or radical lead replacement. We report the case of two patients with a paced RBBB pattern despite a well-placed right ventricular lead, as confirmed by chest X-ray and echocardiography. We discuss the etiologies and attitude to adopt when electrocardiogram (ECG) shows a paced RBBB.
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Affiliation(s)
- R Nkoulou
- Service de cardiologie, HUG, 1211 Genève.
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Bréant C, Borst F, Nkoulou R, Irion O, Geissbuhler A. Closing the loop: bringing decision support clinical data at the clinician desktop. Stud Health Technol Inform 2007; 129:890-4. [PMID: 17911844] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
We describe the development of an inquiry office to bridge the gap between clinician needs for decision support systems and readily available large quantities of integrated clinical data. With this link, an information feedback mechanism is implemented that closes the loop of information flow by bringing decision support information from the data warehouse at the clinician desktop. As a result, and as a new DRG cost reimbursement system has been introduced, we have provided the heads of over 30 medical services with an intranet web-based application to access patient encoding of diagnoses, procedures, and DRGs of their respective service. The inquiry office has also developed a query service to process specific requests. It has implemented the automatic screening of patient clinical data of past and current hospitalizations in order to select cases for multiple studies, research, and teaching projects. The purpose of this clinical data warehouse and its information feedback process is to offer a coherent, comprehensive, and reliable return of information to improve decision making, to enable research projects, and to facilitate statistical outputs.
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Affiliation(s)
- Claudine Bréant
- Service of Medical Informatics, University Hospitals of Geneva, Geneva, Switzerland.
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Graf C, Nkoulou R, Trombert V, Perrenoud JJ. SAFETY OF TIROFIBAN THERAPY IN VERY OLD PATIENTS WITH ACUTE CORONARY SYNDROME OR NON-Q-WAVE MYOCARDIAL INFARCTION. J Am Geriatr Soc 2005; 53:172-3. [PMID: 15667404 DOI: 10.1111/j.1532-5415.2005.53031_7.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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