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Kaur S, Parikh P, Khatri J, Jaber W. Coronary vasculopathy due to moyamoya disease. J Nucl Cardiol 2023; 30:2229-2232. [PMID: 36443588 DOI: 10.1007/s12350-022-03148-5] [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] [Received: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/30/2022]
Abstract
Moyamoya disease is a rare disorder associated with progressive intracranial arterial stenosis with fragile, small collateralization that gives an angiographic appearance of a puff of smoker or, in Japanese, "moya-moya". We report a case of coronary artery ostial occlusive disease as an extracranial manifestation of Moyamoya. In the case, we demonstrate that thigh risk features of cardiac positron emission tomography (PET) that ultimately lead to the diagnosis of coronary artery occlusion.
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Affiliation(s)
- Simrat Kaur
- Depart of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | | | | | - Wael Jaber
- Depart of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
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Kitkungvan D, Johnson NP, Bui L, Patel MB, Roby AE, Haynie M, Kirkeeide R, Hood S, Gould KL. Does financial hardship associate with abnormal quantitative myocardial perfusion and major adverse cardiovascular event? J Nucl Cardiol 2023; 30:1528-1539. [PMID: 36639611 DOI: 10.1007/s12350-022-03184-1] [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] [Received: 03/01/2022] [Accepted: 11/25/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Data on impact of financial hardship on coronary artery disease (CAD) remain incomplete. METHODS Consecutive subjects referred for clinical rest/stress cardiac positron emission tomography (PET) were enrolled. Financial hardship is defined as patients' inability to pay for their out-of-pocket expense for cardiac PET. Abnormal cardiac PET is defined as at least moderate relative perfusion defects at stress involving > 10% of the left ventricle or global coronary flow reserve ≤ 2.0. Patients were followed for major adverse cardiovascular event (MACE) comprised of all-cause mortality, non-fatal myocardial infarction, and late coronary revascularization. RESULTS We analyzed a total of 4173 patients with mean age 65.6 ± 11.3 years, 72.2% men, and 93.6% reported as having medical insurance. Of these, 504 (12.1%) patients had financial hardship. On multivariable analysis, financial hardship associated with abnormal cardiac PET (odds ratio 1.377, p = 0.004) and MACE (hazard ratio 1.432, p = 0.010) and its association with MACE was mostly through direct effect with small proportion mediated by abnormal cardiac PET or known CAD. CONCLUSION Among patients referred for cardiac rest/stress PET, financial hardship independently associates with myocardial perfusion abnormalities and MACE; however, its effect on MACE is largely not mediated by abnormal myocardial perfusion or known CAD suggesting distinct impact of financial hardship beyond traditional risk factors and CAD that deserves attention and intervention to effectively reduced adverse outcomes. Having medical insurance does not consistently protect from financial hardship and a more preventive-oriented restructuring may provide better outcomes at lower cost.
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Affiliation(s)
- Danai Kitkungvan
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nils P Johnson
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Linh Bui
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Monica B Patel
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amanda E Roby
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mary Haynie
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Richard Kirkeeide
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Susan Hood
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K Lance Gould
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
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Kitagawa T, Sasaki K, Fujii Y, Tatsugami F, Awai K, Hirokawa Y, Nakano Y. A longitudinal pilot study to assess temporal changes in coronary arterial 18F-sodium fluoride uptake. J Nucl Cardiol 2023; 30:1158-1165. [PMID: 35488027 DOI: 10.1007/s12350-022-02975-w] [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] [Received: 01/18/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE How coronary arterial 18F-sodium fluoride (18F-NaF) uptake on positron emission tomography changes over the long term and what clinical factors impact the changes remain unclear. We sought to investigate the topics in this study. METHODS We retrospectively studied 15 patients with ≥1 coronary atherosclerotic lesion/s detected on cardiac computed tomography who underwent baseline and follow-up (interval of >3 years) 18F-NaF positron emission tomography/computed tomography scans. Focal 18F-NaF uptake in each lesion was quantified using maximum tissue-to-background ratio (TBRmax). The temporal change in TBRmax was assessed using a ratio of follow-up to baseline TBRmax (R-TBRmax). RESULTS A total of 51 lesions were analyzed. Mean R-TBRmax was 0.96 ± 0.21. CT-based lesion features (location, obstructive stenosis, plaque types, features of high-risk plaque) did not correlate with an increase in R-TBRmax. In multivariate analysis, baseline TBRmax significantly correlated with higher follow-up TBRmax (β = 0.57, P < 0.0001), and the presence of diabetes mellitus significantly correlated with both higher follow-up TBRmax (β = 0.34, P = 0.001) and elevated R-TBRmax (β = 0.40, P = 0.003). CONCLUSION Higher coronary arterial 18F-NaF uptake is likely to remain continuously high. Diabetes mellitus affects the long-term increase in coronary arterial 18F-NaF uptake.
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Affiliation(s)
- Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Ko Sasaki
- Hiroshima Heiwa Clinic, Hiroshima, Japan
| | - Yuto Fujii
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Jayadeva PS, Stowers S, Tang EW, Vitola J, Cerci R, Yao J, Westcott J, Elison B, Better N. The impact of coronary calcium score as an addition to myocardial perfusion imaging in altering clinical management (ICCAMPA trial). J Nucl Cardiol 2023; 30:1004-1018. [PMID: 36097241 DOI: 10.1007/s12350-022-03086-2] [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] [Received: 01/21/2022] [Accepted: 07/20/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AIM: Myocardial perfusion imaging (MPI) is a key tool for the identification and risk stratification of patients with coronary artery disease. The use of a coronary calcium score further adds to prognostic data above MPI alone. In this study, our aim was to evaluate the extent to which the use of a coronary artery calcium (CAC) score, when co-reported with MPI, impacts changes in clinical management in patients without a history of coronary artery disease (CAD) undergoing functional imaging. METHODS This is a multicenter international study which incorporated a standardized questionnaire to evaluate changes in clinician management after MPI results were given with and without the additional information of a CAC score. Calcium scoring on a SPECT-CT system was performed via a semiquantitative Shemesh score (0-12) with a 0-3 score from the left main, left anterior descending, left circumflex, and right coronary arteries. CT of the chest was read independently, and non-coronary findings were reported alongside the CAC score. RESULTS A total of 281 patients were enrolled across 3 international centers (Brazil, Australia, New Zealand). Of the 281 patients, 133 (47%) had management altered after the clinician was made aware of the CAC score. The impact of the CAC in changing clinical management was significant, particularly in patients with a negative MPI (P < 0.0001), but also in MPI-positive patients (P = 0.0021). The most common management change was the addition or intensification of statin therapy. CONCLUSION The addition of the CAC component to MPI yielded significant management changes in nearly half of all patients undergoing MPI for suspected CAD. This trend was observed across all centers in the three countries involved and was particularly evident in patient with a negative MPI.
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Affiliation(s)
- Pavithra S Jayadeva
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - Stephen Stowers
- Department of Cardiology, Palmerston North Hospital, Palmerston North, New Zealand
| | - E W Tang
- Department of Cardiology, Palmerston North Hospital, Palmerston North, New Zealand
| | - Joao Vitola
- Department of Nuclear Medicine, Quanta Diagnostico por Imagem, Curitiba, Brazil
| | - Rodrigo Cerci
- Department of Nuclear Medicine, Quanta Diagnostico por Imagem, Curitiba, Brazil
| | - Jessica Yao
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - James Westcott
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Barry Elison
- Department of Nuclear Medicine, Wollongong Hospital, Wollongong, NSW, Australia
| | - Nathan Better
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Departments of Nuclear Medicine and Cardiology, Royal Melbourne Hospital, Parkville, Australia
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Scrima G, D'Amico M, Bertuccio G, Canavese G, De Sanctis P. Safety measures and clinical outcome of Nuclear Cardiology Department during Covid-19 lockdown pandemic: Northern Italy experience. J Nucl Cardiol 2021; 28:331-335. [PMID: 32737838 PMCID: PMC7394269 DOI: 10.1007/s12350-020-02286-y] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Covid-19 pandemic led to a complete renewal of clinical activities of Italian hospitals. During the lockdown, all hospitals in Italy had to suspend non-urgent clinical activities. The prolonged suspension of elective activities could have caused a series of problems. METHODS A new ad hoc protocol was designed. Single-day fast-imaging protocol with regadenoson-stress 99mTc-tetrofosmin imaging was preferred. Patients were contacted by phone 4 days before the test and answered to a questionnaire which will be repeated on the day of the exam. Body temperature <37.5 degrees C and no Covid-19 symptoms were necessary to enter the unit. Patients wore surgical mask and gloves. Social distancing was maintained throughout the examination. Healthcare professionals wore a personal protective equipment. RESULTS A total of 46 patients were studied from April 7 to May 15, 2020, before the publication of the recommendations from ASNC and SNMMI. None of the patients experienced complications. Follow-up of patients discharged was carried by phone. No Covid-19 infection symptoms were reported. On May 18, 2020 all the healthcare providers of nuclear cardiology department underwent serological testing IgG and IgM and none were positive. CONCLUSION Strict ad hoc hygiene protocol for Covid-19 pandemic avoids diagnostic-therapeutic delay and lengthening of waiting lists. Our experience confirms that pursuing WHO recommendations and recent indication of ASNC and SNMMI is safe for both health providers and patients. Moreover, the incidence of significant inducible ischemia rises when correct stratification of patients is performed.
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Affiliation(s)
- Giovanni Scrima
- Department of Cardiology, Santa Croce Hospital, Piazza Amedeo Ferdinando 3, 10024, Moncalieri, TO, Italy.
| | - Maurizio D'Amico
- Department of Cardiology, Santa Croce Hospital, Piazza Amedeo Ferdinando 3, 10024, Moncalieri, TO, Italy
| | - Giovanni Bertuccio
- Department of Nuclear Medicine, Santa Croce Hospital, Moncalieri, TO, Italy
| | - Giacomo Canavese
- Department of Nuclear Medicine, Santa Croce Hospital, Moncalieri, TO, Italy
| | - Paolo De Sanctis
- Humanitas University and Humanitas Research Hospital, Milan, MI, Italy
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Bhambhvani P, Hage FG, Iskandrian AE. A quick glance at selected topics in this issue. J Nucl Cardiol 2020; 27:1425-1428. [PMID: 32978710 PMCID: PMC7518404 DOI: 10.1007/s12350-020-02384-x] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022]
Abstract
"A quick glance at selected topics in this issue" aims to highlight contents of the Journal and provide a quick review to the readers.
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Affiliation(s)
- Pradeep Bhambhvani
- Division of Molecular Imaging and Therapeutics, Department of Radiology, The University of Alabama at Birmingham, 619 19th Street South JT 777, Birmingham, AL, 35249, USA.
| | - Fadi G Hage
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, USA
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Bhambhvani P, Hage FG, Iskandrian AE. A quick glance at selected topics in this issue. J Nucl Cardiol 2019; 26:1792-1795. [PMID: 31773563 DOI: 10.1007/s12350-019-01936-0] [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: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
"A quick glance at selected topics in this issue" aims to highlight contents of the Journal and provide a quick review to the readers.
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Affiliation(s)
- Pradeep Bhambhvani
- Division of Molecular Imaging and Therapeutics, Department of Radiology, The University of Alabama at Birmingham, 619 19th Street South, JT 777, Birmingham, AL, 35249, USA.
| | - Fadi G Hage
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, USA
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Abstract
Coronary microvascular dysfunction and, its functional consequence, myocardial ischemia are common pathologic features in patients with hypertrophic cardiomyopathy (HCM). Both have been commonly invoked as potential triggers of and/or contributors to the underlying pathophysiological processes leading to heart failure, and malignant ventricular arrhythmias. Positron emission tomography (PET) with myocardial blood flow quantification provides a unique opportunity to evaluate the integrity and function of the coronary microcirculation in HCM. The purpose of the present review is to summarize all the pertinent literature and future perspectives of the role of PET in the evaluation and risk stratification of patients with HCM.
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Affiliation(s)
- Paco E Bravo
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- , 3400 Civic Center Boulevard, 11-154 South Pavilion, Philadelphia, PA, 19104, USA.
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