Journal: J Nucl Cardiol

Sorted by: date / impact
Abstract

Metabolic activity of the left and right atria are differentially altered in patients with atrial fibrillation and LV dysfunction.

Santi ND, Wu KY, Redpath CJ, Nery PB, ... deKemp RA, Beanlands RSB
Background
Alterations in atrial metabolism may play a role in the perpetuation of atrial fibrillation (AF). This study sought to compare 18F-fluorodeoxyglucose (FDG) uptake on PET, in patients with LV dysfunction versus those without AF.
Methods
Seventy-two patients who underwent myocardial viability assessment were evaluated. AF patients (36) had persistent or permanent AF based on history and ECG. Patients without AF (36) were matched to AF patients based on sex, diabetes, age, and LVEF. Maximum and mean FDG Standard Uptake Values (SUV) in the left atrial (LA) wall and right atrial (RA) wall were measured. Tissue-to-blood ratios (TBR) were calculated as atrial wall to blood-pool activity. Atrial volumes were measured by echocardiography.
Results
Maximum and mean FDG SUV and TBRs were significantly increased in the RA (but not the LA) of patients with AF compared to those without (P < 0.01). When accounting for changes in atrial volume, the presence of AF remained a significant predictor of higher RAMAX, but not RAMEAN FDG uptake.
Conclusion
In patients with LV dysfunction from ischemic cardiomyopathy, LA and RA glucose metabolism are differentially altered in those with persistent atrial fibrillation. Further investigations should elucidate the temporal relationship between AF and glucose metabolic changes, as a potential target for therapy.

© 2022. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 05 Jan 2022; epub ahead of print
Santi ND, Wu KY, Redpath CJ, Nery PB, ... deKemp RA, Beanlands RSB
J Nucl Cardiol: 05 Jan 2022; epub ahead of print | PMID: 34993894
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Abstract

F-18 meta-fluorobenzylguanidine PET imaging of myocardial sympathetic innervation.

Grkovski M, Zanzonico PB, Modak S, Humm JL, Narula J, Pandit-Taskar N
Background
I-123 meta-iodobenzylguanidine (MIBG) imaging has long been employed to noninvasively assess the integrity of human norepinephrine transporter-1 and, hence, myocardial sympathetic innervation. Positron-emitting F-18 meta-fluorobenzylguanidine (MFBG) has recently been developed for potentially superior quantitative characterization. We assessed the feasibility of MFBG imaging of myocardial sympathetic innervation.
Methods
16 patients were imaged with MFBG PET (30-minute dynamic imaging of chest, followed by 3 whole-body acquisitions between 30 minutes and 4-hour post-injection). Blood kinetics were assessed from multiple samples. Pharmacokinetic modeling with reversible 1- and 2-compartment models was performed. Kinetic rate constants were re-calculated from truncated datasets. All patients underwent concurrent MIBG SPECT.
Results
MFBG myocardial uptake was rapid and sustained; the mean standardized uptake value (SUV (mean ± standard deviation)) was 5.1 ± 2.2 and 3.4 ± 1.9 at 1 hour and 3-4-hour post-injection, respectively. The mean K1 and distribution volume (VT) were 1.1 ± 0.6 mL/min/g and 34 ± 22 mL/cm3, respectively. Both were reproducible when re-calculated from truncated 1-hour datasets (Intraclass Correlation Coefficient of 0.99 and 0.91, respectively). Spearman\'s ϱ = 0.86 between MFBG SUV and VT and 0.80 between MFBG PET-derived VT and MIBG SPECT-derived heart-to-mediastinum activity concentration ratio.
Conclusion
MFBG is a promising PET radiotracer for the assessment of myocardial sympathetic innervation.

© 2022. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 05 Jan 2022; epub ahead of print
Grkovski M, Zanzonico PB, Modak S, Humm JL, Narula J, Pandit-Taskar N
J Nucl Cardiol: 05 Jan 2022; epub ahead of print | PMID: 34993893
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Abstract

Regional myocardial sympathetic denervation precedes the development of left ventricular systolic dysfunction in chronic Chagas\' cardiomyopathy.

Gadioli LP, Miranda CH, Marin-Neto JA, Volpe GJ, ... de Figueiredo AB, Simões MV
Background
Regional myocardial sympathetic denervation is a conspicuous and early disorder in patients with chronic Chagas\' cardiomyopathy (CCC), potentially associated to the progression of myocardial dysfunction OBJECTIVE: To evaluate in a longitudinal study the association between the presence and the progression of regional myocardial sympathetic denervation with the deterioration of global and segmental left ventricular dysfunction in CCC.
Methods
18 patients with CCC were submitted at initial evaluation and after 5.5 years to rest myocardial scintigraphy with 123Iodo-metaiodobenzylguanidine and 99mTc-sestamibi and to two-dimensional echocardiography to assess myocardial sympathetic denervation, extent of fibrosis, and the left ventricular ejection fraction (LVEF) and wall motion abnormalities.
Results
In the follow-up evaluation, compared to the initial one, we observed a significant decrease in LVEF (56 ± 11 to 49% ± 12; P = .01) and increased summed defects scores in the myocardial innervation scintigraphy (15 ± 10 to 20 ± 9; P < .01). The presence of regional myocardial sympathetic denervation in ventricular regions of viable non-fibrotic myocardium presented an odds ratio of 4.25 for the development of new wall motion abnormalities (P = .001).
Conclusion
Regional and global myocardial sympathetic denervation is a progressive derangement in CCC. In addition, the regional denervation is topographically associated with areas of future development of regional systolic dysfunction in patients with CCC.

© 2022. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 03 Jan 2022; epub ahead of print
Gadioli LP, Miranda CH, Marin-Neto JA, Volpe GJ, ... de Figueiredo AB, Simões MV
J Nucl Cardiol: 03 Jan 2022; epub ahead of print | PMID: 34981413
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Abstract

Semi-quantitative assessment of ischemia with rubidium-82 PET myocardial perfusion imaging.

Borren NM, Gerritse TJ, Ottervanger JP, Mouden M, ... Jager PL, van Dijk JD
Purpose
Semi-quantitative scores can be used as an adjunct to visual assessment in rubidium-82 positron emission tomography (82Rb PET). The semi-quantitative cut-off values used in 82Rb PET are derived from single-photon emission computed tomography (SPECT). It is unknown whether these cut-off values can be extrapolated to 82Rb PET. We compared the semi-quantitative with the visual assessment of ischemia and determined which summed difference score (SDS) score predicts ischemia best.
Methods
We included 108 patients who underwent 82Rb PET imaging and performed visual and semi-quantitative assessment. A scan with a SDS ≥ 2 and a summed stress score (SSS) ≥ 4 was considered to demonstrate ischemia. We compared the semi-quantitative with the visual assessment.
Results
41 (38%) Normal scans, and 67 (62%) scans with ischemia and/or an irreversible defect were included. The semi-quantitative assessment showed ischemia more often than the visual assessment (51% vs 29%, P < .001). Patients with a low or intermediate pre-test probability of coronary artery disease (CAD) and a SDS < 4 did not demonstrate ischemia by visual assessment.
Conclusion
Semi-quantitative assessment in 82Rb PET imaging clearly demonstrates the presence of ischemia. Ischemia is unlikely in patients with low and intermediate pre-test probability of CAD and a SDS < 4.

© 2021. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 29 Dec 2021; epub ahead of print
Borren NM, Gerritse TJ, Ottervanger JP, Mouden M, ... Jager PL, van Dijk JD
J Nucl Cardiol: 29 Dec 2021; epub ahead of print | PMID: 34970710
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Abstract

Amyloid deposit corresponds to technetium-99m-pyrophosphate accumulation in abdominal fat of patients with transthyretin cardiac amyloidosis.

Takahashi K, Sasaki D, Yamashita M, Sakaue T, ... Yamashita T, Ueda M
Background
Radionuclide imaging using bone-avid tracers plays a critical role in diagnosing transthyretin cardiac amyloidosis (ATTR-CA), but technetium-99m-pyrophosphate (PYP) rarely allows the detection of extracardiac amyloid infiltration. We retrospectively investigated the frequency of PYP uptake in the subcutaneous abdominal fat of patients with ATTR-CA and its relevance to the results of fine-needle aspiration biopsy (FNAB) of this tissue.
Methods
Chest-centered images of PYP scintigraphy were obtained 2 h after the intravenous injection of the tracer (20 mCi), and the frequency of PYP uptake in the subcutaneous abdominal fat was evaluated. Amyloid deposits of fat smears taken by subcutaneous abdominal fat FNAB were assessed by Congo red staining.
Results
Twenty-four patients with ATTR-CA were included. Ten (41.7%) patients showed some PYP uptake in the subcutaneous abdominal fat (positive PYP group), and 14 patients did not (negative PYP group). Amyloid deposits were detected by subcutaneous abdominal fat FNAB in 7/10 patients (70.0%) of the positive PYP group versus 0/14 patients (0%) of the negative PYP group, and the difference was significant.
Conclusions
In patients with ATTR-CA, abnormal PYP uptake in the subcutaneous abdominal fat could reflect the regional amyloid deposition confirmed by FNAB of this tissue.

© 2021. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 27 Dec 2021; epub ahead of print
Takahashi K, Sasaki D, Yamashita M, Sakaue T, ... Yamashita T, Ueda M
J Nucl Cardiol: 27 Dec 2021; epub ahead of print | PMID: 34964085
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Abstract

Prognostic value of divergent pattern detection by 99mTc-sestamibi gated SPECT in patients with anterior acute myocardial infarction.

Calabretta R, Castello A, Giglioli C, Cecchi E, ... Hacker M, Sciagrà R
Purpose
In gated myocardial perfusion SPECT, apical remodeling may be identified by the presence of a divergent pattern (DP) of the left ventricle (LV).
Methods and results
We examined 150 anterior ST-elevation myocardial infarction (STEMI) patients, all successfully treated with primary percutaneous coronary interventions (PCI). Perfusion gated-SPECT to measure infarct size, LV end-diastolic (ED) and end-systolic (ES) volumes and ejection fraction (EF) was acquired before hospital discharge and repeated at 6-month follow-up. DP was observed in 26 patients, who had larger infarct size (28 ± 19% vs. 15.7 ± 17%, P < 0.02), and lower EF (33 ± 7% vs. 41 ± 10%, P < 0.001) than patients without DP. At follow-up, DP patients had significantly larger EDV (156 ± 54 vs. 107 ± 44 mL, P < 0.0001), ESV (104 ± 47 vs. 59 ± 36 mL, P < 0.0001) and lower EF (35 ± 12% vs. 48 ± 13%, P < 0.0001). 54% of DP patients developed remodeling at follow-up vs. 12% of those without DP (P < 0.001). During follow up, 7 events in the DP group (27%) and 11 events in patients without DP (9%; P < 0.02) occurred. Kaplan-Meier survival curves showed a worse prognosis for DP patients.
Conclusion
In patients with anterior AMI, early DP detection is related to subsequent LV dysfunction, larger infarct size, and worse severity. It is helpful for predicting LV remodeling at short-term follow-up and has prognostic implications.

© 2021. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 15 Dec 2021; epub ahead of print
Calabretta R, Castello A, Giglioli C, Cecchi E, ... Hacker M, Sciagrà R
J Nucl Cardiol: 15 Dec 2021; epub ahead of print | PMID: 34914082
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Abstract

Volumetric evaluation of Tc-pyrophosphate SPECT/CT for transthyretin cardiac amyloidosis: Methodology and correlation with cardiac functional parameters.

Watanabe S, Nakajima K, Wakabayashi H, Yoneyama H, ... Inaki A, Kinuya S
Background
Volumetric evaluation of 99mTechnetium-pyrophosphate (99mTc-PYP) SPECT/CT is a useful method for assessing transthyretin cardiac amyloidosis (ATTR-CA). We investigated the methodology and assessed its relationship with conventional parameters.
Methods and results
We retrospectively evaluated 99mTc-PYP SPECT/CT scans of 25 patients who underwent endomyocardial biopsy and/or gene testing. Fourteen (56%) patients were diagnosed with ATTR-CA. SPECT/CT images were acquired at 3 hours after injection. Total volumes of the myocardial regions where uptakes were > 1.2 and 1.4 × aortic blood pool SUVmax were evaluated and defined as cardiac pyrophosphate volume (CPV1.2 and CPV1.4). The heart-to-contralateral lung (H/CL) ratio and myocardial SUVmax were also calculated. CPV1.2 achieved the highest sensitivity and specificity in diagnosing ATTR-CA. In patients diagnosed with ATTR-CA (n = 14), CPV1.2 negatively correlated with left ventricular ejection fraction and positively correlated with left ventricular posterior wall thickness and QRS duration. The correlation was stronger in CPV1.2 than in the H/CL ratio and SUVmax.
Conclusion
Volumetric evaluation of 99mTc-PYP SPECT/CT may be superior to the H/CL ratio and SUVmax in assessing the disease burden of ATTR-CA. Larger studies are warranted to clarify whether volumetric measurement can assess prognosis and disease progression.

© 2021. The Author(s).

J Nucl Cardiol: 13 Dec 2021; epub ahead of print
Watanabe S, Nakajima K, Wakabayashi H, Yoneyama H, ... Inaki A, Kinuya S
J Nucl Cardiol: 13 Dec 2021; epub ahead of print | PMID: 34907500
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Abstract

Phase analysis for ventricular arrhythmia prediction: A retrospective monocentric cohort study.

Beneyto M, Maury P, Rollin A, Mondoly P, ... Galinier M, Lairez O
Background
Prediction of ventricular arrhythmias (VA) mostly relies on left ventricular ejection fraction (LVEF), but with limited performance. New echocardiographic parameters such as mechanical dispersion have emerged, but acoustic window sometimes precludes this measurement. Nuclear imaging may be an alternative. We aimed to assess the ability of mechanical dispersion, measured with phase standard deviation (PSD) on radionuclide angiocardiography (RNA), to predict VAs.
Methods
This retrospective monocentric observational study included all patients who underwent a tomographic RNA from 2015 to 2019. Phase analysis yielded PSD and follow-up was examined to identify VAs, heart transplantation, and death.
Results
The study population consisted of 937 patients, mainly with LVEF ≤ 35% (425, 45%). Most had ischemic (334, 36%) or dilated cardiomyopathies (245, 26%). We identified 86 (9%) VAs. PSD was strongly associated with the occurrence of VA [hazard ratio per 10 ms increase (HR10) 1.12 (1.09-1.16)], heart transplantation [HR10 1.09 (1.06-1.12)], and death [HR10 1.03 (1.00-1.05)]. The association between PSD and VA persisted after adjustment for age, sex, QRS duration, LVEF, global longitudinal strain (GLS), and echocardiography-assessed mechanical dispersion.
Conclusion
The occurrence of ventricular arrhythmias was predicted by mechanical dispersion assessed by RNA, even after adjustment for LVEF and GLS.

© 2021. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 06 Dec 2021; epub ahead of print
Beneyto M, Maury P, Rollin A, Mondoly P, ... Galinier M, Lairez O
J Nucl Cardiol: 06 Dec 2021; epub ahead of print | PMID: 34877639
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Abstract

Multimodality imaging for diagnosis of subclinical hereditary transthyretin cardiac amyloidosis.

Asif T, Vij A, Radzik B, Stern H, ... Ghadiali Q, Malhotra S
We present a case of a patient with worsening visual acuity and dense vitreal debris who was found to have vitreal transthyretin amyloid (ATTR) infiltration. Cardiac workup, performed to identify systemic amyloidosis, demonstrated focal myocardial amyloid infiltration on pyrophosphate (PYP) scintigraphy and cardiac magnetic resonance (CMR), resulting in a diagnosis of subclinical ATTR cardiac amyloidosis (ATTR-CA). Patient was identified as a carrier of p.S70R mutation which results in an aggressive ATTR phenotype. Patient is tolerating transthyretin silencer therapy well. Through this case, we discuss the role of a multimodality imaging approach for the diagnosis of subclinical ATTR-CA.

© 2021. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.

J Nucl Cardiol: 05 Dec 2021; epub ahead of print
Asif T, Vij A, Radzik B, Stern H, ... Ghadiali Q, Malhotra S
J Nucl Cardiol: 05 Dec 2021; epub ahead of print | PMID: 34873643
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Abstract

An optimized imaging protocol for [Tc]Tc-DPD scintigraphy and SPECT/CT quantification in cardiac transthyretin (ATTR) amyloidosis.

Schatka I, Bingel A, Schau F, Bluemel S, ... Rogasch JMM, Wetz C
Background
In [99mTc]Tc-DPD scintigraphy for myocardial ATTR amyloidosis, planar images 3 hour p.i. and SPECT/CT acquisition in L-mode are recommended. This study investigated if earlier planar images (1 hour p.i.) are beneficial and if SPECT/CT acquisition should be preferred in H-mode (180° detector angle) or L-mode (90°).
Methods
In SPECT/CT phantom measurements (NaI cameras, N = 2; CZT, N = 1), peak contrast recovery (CRpeak) was derived from sphere inserts or myocardial insert (cardiac phantom; signal-to-background ratio [SBR], 10:1 or 5:1). In 25 positive and 38 negative patients (reference: endomyocardial biopsy or clinical diagnosis), Perugini scores and heart-to-contralateral (H/CL) count ratios were derived from planar images 1 hour and 3 hour p.i.
Results
In phantom measurements, accuracy of myocardial CRpeak at SBR 10:1 (H-mode, 0.95-0.99) and reproducibility at 5:1 (H-mode, 1.02-1.14) was comparable for H-mode and L-mode. However, L-mode showed higher variability of background counts and sphere CRpeak throughout the field of view than H-mode. In patients, sensitivity/specificity were ≥ 95% for H/CL ratios at both time points and visual scoring 3 hour. At 1 hour, visual scores showed specificity of 89% and reduced reader\'s confidence.
Conclusions
Early DPD images provided no additional value for visual scoring or H/CL ratios. In SPECT/CT, H-mode is preferred over L-mode, especially if quantification is applied apart from the myocardium.

© 2021. The Author(s).

J Nucl Cardiol: 29 Nov 2021; 28:2483-2496
Schatka I, Bingel A, Schau F, Bluemel S, ... Rogasch JMM, Wetz C
J Nucl Cardiol: 29 Nov 2021; 28:2483-2496 | PMID: 34331215
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Abstract

Anti-inflammatory effect of rosuvastatin in patients with HIV infection: An FDG-PET pilot study.

Boczar KE, Faller E, Zeng W, Wang J, ... MacPherson P, Dwivedi G
Aims
This study aimed to evaluate markers of systemic as well as imaging markers of inflammation in the ascending aorta, bone marrow, and spleen measured by 18F-FDG PET/CT, in HIV+ patients at baseline and following therapy with rosuvastatin.
Methods and results
Of the 35 HIV+ patients enrolled, 17 were randomized to treatment with 10 mg/day rosuvastatin and 18 to usual care for 6 months. An HIV- control cohort was selected for baseline comparison of serum inflammatory markers and monocyte markers of inflammation. 18F-FDG-PET/CT imaging of bone marrow, spleen, and thoracic aorta was performed in the HIV+ cohort at baseline and 6 months. While CD14++CD16- and CCR2 expressions were reduced, serum levels of IL-7, IL-8, and MCP-1 were elevated in the HIV+ population compared to the controls. There was a significant drop in FDG uptake in the bone marrow (TBRmax), spleen (SUVmax) and thoracic aortic (TBRmax) in the statin-treated group compared to the control group (bone marrow: - 10.3 ± 16.9% versus 5.0 ± 18.9%, p = .0262; spleen: - 9.8 ± 20.3% versus 11.3 ± 28.8%, p = .0497; thoracic aorta: - 19.1 ± 24.2% versus 4.3 ± 15.4%, p = .003).
Conclusions
HIV+ patients had significantly markers of systemic inflammation including monocyte activation. Treatment with low-dose rosuvastatin in the HIV+ cohort significantly reduced bone marrow, spleen and thoracic aortic FDG uptake.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 23 Nov 2021; epub ahead of print
Boczar KE, Faller E, Zeng W, Wang J, ... MacPherson P, Dwivedi G
J Nucl Cardiol: 23 Nov 2021; epub ahead of print | PMID: 34820771
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Abstract

Coronary vasomotor dysfunction portends worse outcomes in patients with breast cancer.

Divakaran S, Caron JP, Zhou W, Hainer J, ... Nohria A, Di Carli MF
Background
Impaired MFR in the absence of flow-limiting CAD is associated with adverse events. Cardiovascular disease is an important cause of morbidity and mortality in patients with breast cancer. We sought to test the utility of MFR to predict outcomes in a cohort of patients with breast cancer.
Methods
We retrospectively studied consecutive patients with breast cancer or breast cancer survivors who underwent cardiac stress PET imaging from 2006 to 2017 at Brigham and Women\'s Hospital. Patients with a history of clinically overt CAD, LVEF < 45%, or abnormal myocardial perfusion were excluded. Subjects were followed from time of PET to the occurrence of a first major adverse cardiovascular event (MACE) and all-cause death.
Results
The final cohort included 87 patients (median age 69.0 years, 98.9% female, mean MFR 2.05). Over a median follow-up of 7.6 years after PET, the lowest MFR tertile was associated with higher cumulative incidence of MACE (adjusted subdistribution hazard ratio 4.91; 95% CI 1.68-14.38; p = 0.004) when compared with the highest MFR tertile.
Conclusions
In patients with breast cancer, coronary vasomotor dysfunction was associated with incident cardiovascular events. MFR may have potential as a risk stratification biomarker among patients with/survivors of breast cancer.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 23 Nov 2021; epub ahead of print
Divakaran S, Caron JP, Zhou W, Hainer J, ... Nohria A, Di Carli MF
J Nucl Cardiol: 23 Nov 2021; epub ahead of print | PMID: 34820770
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Abstract

Incremental value of F-FDG cardiac PET imaging over dobutamine stress echocardiography in predicting myocardial ischemia in patients with suspected coronary artery disease.

Zampella E, Assante R, Acampa W, Gaudieri V, ... Petretta M, Cuocolo A
Background
To assess the incremental value of 18F-fluorodeoxyglucose (FDG) cardiac positron emission tomography (PET) over dobutamine stress echocardiography (DSE) in predicting myocardial ischemia in patients with suspected coronary artery disease (CAD).
Methods
Forty-one patients with suspected CAD underwent within 7 days apart rest-stress cardiac PET with 82Rb and DSE followed by cardiac 18F-FDG PET imaging. 18F-FDG images were scored on a 0 (no discernible uptake) to 2 (intense uptake) scale. Logistic regression analysis was performed to identify predictors of stress-induced ischemia. The incremental value of 18F-FDG PET over DSE in detecting ischemia at 82Rb PET cardiac imaging was assessed by the likelihood ratio chi-square and net reclassification index.
Results
On 82Rb-PET imaging, myocardial ischemia (ischemic total perfusion defect ≥ 5%) was detected in 20 (49%) patients. Inducible ischemia was found in 22 (54%) patients on DSE (biphasic or worsening response pattern in ≥ 1 segment) and in 21 (51%) patients on 18F-FDG PET (uptake score of 2 in ≥ 1 segment). 18F-FDG PET resulted as statistically significant predictor of ischemia on 82Rb-PET. The addition of 18F-FDG PET to DSE increased the likelihood of ischemia on 82Rb-PET (P < .05). 18F-FDG PET was able to reclassify the probability of stress-induced myocardial ischemia on both patient and vessel analyses.
Conclusion
18F-FDG PET performed after dobutamine stress test may provide incremental value to DSE in the evaluation of myocardial ischemia. These results suggest that stress-induced myocardial ischemia can be imaged directly using 18F-FDG PET after dobutamine stress test.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 16 Nov 2021; epub ahead of print
Zampella E, Assante R, Acampa W, Gaudieri V, ... Petretta M, Cuocolo A
J Nucl Cardiol: 16 Nov 2021; epub ahead of print | PMID: 34791621
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Abstract

Impact of residual subtraction on myocardial blood flow and reserve estimates from rapid dynamic PET protocols.

Poitrasson-Rivière A, Moody JB, Renaud JM, Hagio T, ... Ficaro EP, Murthy VL
Background
13N-ammonia and 18F-flurpiridaz require longer delays between rest and stress studies to allow for decay, lowering clinical throughput. In this study, we investigated the impact of residual subtraction on MBF and MFR estimates, as well as its effects on diagnostic accuracy.
Methods
We retrospectively analyzed 63 patients who underwent a dynamic ammonia rest/stress study and 231 patients from the flurpiridaz 301 trial. Residual subtraction was performed by subtracting the mean pre-injection activity in each sampled region from that region\'s time activity curve. Corrected and uncorrected MBF and MFR were analyzed. Diagnostic accuracy was compared to quantitative coronary angiograms (QCA) for the flurpiridaz population.
Results
With delays between injections above 3 half-lives, and a doubled stress dose, residual activity did not meaningfully increase ammonia MBF (< 5%). For shorter injection delays, stress MBF was overestimated by 13.6% ± 5.0% (P < .001). Residual activity had a large effect on flurpiridaz stress MBF, overestimating it by 37.9% ± 23.2% (P < .001). Comparison to QCA showed a significant improvement in AUC with residual subtraction (from 0.748 to 0.831, P = .001). MFR yielded similar results.
Conclusions
Accounting for residual activity has a marked impact on stress MBF and MFR and improves diagnostic accuracy relative to QCA.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 14 Nov 2021; epub ahead of print
Poitrasson-Rivière A, Moody JB, Renaud JM, Hagio T, ... Ficaro EP, Murthy VL
J Nucl Cardiol: 14 Nov 2021; epub ahead of print | PMID: 34780036
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Abstract

Prognostic value of cardiac inflammation in ST-segment elevation myocardial infarction: A F-fluorodeoxyglucose PET/CT study.

Xi XY, Liu Z, Wang LF, Yang MF
Background
18F-fluorodeoxyglucose (FDG) imaging is used to detect cardiac inflammation and predict functional outcome in acute myocardial infarction (MI). However, data on the correlation of post-MI acute cardiac inflammation evaluated by 18F-FDG imaging and major adverse cardiac events (MACE) are limited. Therefore, we sought to explore the prognostic value of cardiac 18F-FDG imaging in patients with acute ST-segment elevation MI (STEMI).
Methods
Thirty-six patients with STEMI underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) 5 days after primary percutaneous coronary intervention. 18F-FDG activity in infarcted and remote regions, as well as peri-coronary adipose tissue (PCAT), were measured and expressed as the maximum standardized uptake value (SUVmax). Patients were followed to determine the occurrence of MACE.
Results
The infarcted myocardium had a higher 18F-FDG intensity than the remote area. Moreover, the PCAT of culprit coronary arteries showed a higher 18F-FDG uptake than that of non-culprit arteries. Multivariate Cox regression analysis showed that increased SUVmax of PCAT [HR 5.198; 95% CI (1.058, 25.537), P = .042] was independently associated with a higher risk of MACE.
Conclusions
Enhanced PCAT activity after acute MI is related to the occurrence of MACE, and 18F-FDG PET/CT plays a promising role in providing prognostic information in patients with STEMI.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 11 Nov 2021; epub ahead of print
Xi XY, Liu Z, Wang LF, Yang MF
J Nucl Cardiol: 11 Nov 2021; epub ahead of print | PMID: 34773185
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Abstract

Comparison of diabetes to other prognostic predictors among patients referred for cardiac stress testing: A contemporary analysis from the REFINE SPECT Registry.

Han D, Rozanski A, Gransar H, Tzolos E, ... Berman DS, Slomka PJ
Background
Diabetes mellitus (DM) is increasingly prevalent among contemporary populations referred for cardiac stress testing, but its potency as a predictor for major adverse cardiovascular events (MACE) vs other clinical variables is not well delineated.
Methods and results
From 19,658 patients who underwent SPECT-MPI, we identified 3122 patients with DM without known coronary artery disease (CAD) (DM+/CAD-) and 3564 without DM with known CAD (DM-/CAD+). Propensity score matching was used to control for the differences in characteristics between DM+/CAD- and DM-/CAD+ groups. There was comparable MACE in the matched DM+/CAD- and DM-/CAD+ groups (HR 1.15, 95% CI 0.97-1.37). By Chi-square analysis, type of stress (exercise or pharmacologic), total perfusion deficit (TPD), and left ventricular function were the most potent predictors of MACE, followed by CAD and DM status. The combined consideration of mode of stress, TPD, and DM provided synergistic stratification, an 8.87-fold (HR 8.87, 95% CI 7.27-10.82) increase in MACE among pharmacologically stressed patients with DM and TPD > 10% (vs non-ischemic, exercised stressed patients without DM).
Conclusions
Propensity-matched patients with DM and no known CAD have similar MACE risk compared to patients with known CAD and no DM. DM is synergistic with mode of stress testing and TPD in predicting the risk of cardiac stress test patients.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 09 Nov 2021; epub ahead of print
Han D, Rozanski A, Gransar H, Tzolos E, ... Berman DS, Slomka PJ
J Nucl Cardiol: 09 Nov 2021; epub ahead of print | PMID: 34757571
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Abstract

Prognostic implication of myocardial perfusion and contractile reserve in end-stage renal disease: A direct comparison of myocardial perfusion scintigraphy and dobutamine stress echocardiography.

Bautz J, Stypmann J, Reiermann S, Pavenstädt HJ, ... Reuter S, Schäfers M
Background
We aimed to compare the prognostic value of myocardial perfusion scintigraphy (MPS) and dobutamine stress echocardiography (DSE) in patients with end-stage renal disease (ESRD) without known coronary artery disease.
Methods
Two-hundred twenty-nine ESRD patients who applied for kidney transplantation at our centre were prospectively evaluated by MPS and DSE. The primary endpoint was a composite of myocardial infarction (MI) or all-cause mortality. The secondary endpoint included MI or coronary revascularization (CR) not triggered by MPS or DSE at baseline.
Results
MPS detected reversible ischemia in 31 patients (13.5%) and fixed perfusion defects in 13 (5.7%) patients. DSE discovered stress-induced wall motion abnormalities (WMAs) in 28 (12.2%) and at rest in 18 (7.9%) patients. MPS and DSE results agreed in 85.6% regarding reversible defects (κ = 0.358; P < .001) and in 90.8% regarding fixed defects (κ = 0.275; P < .001). Coronary angiography detected relevant stenosis > 50% in only 15 of 38 patients (39.5%) with pathological findings in MPS and/or DSE. At a median follow-up of 8 years and 10 months, the primary endpoint occurred in 70 patients (30.6%) and the secondary endpoint in 24 patients (10.5%). The adjusted Cox hazard ratios (HRs) for the primary endpoint were 1.77 (95% CI 1.02-3.08; P = .043) for perfusion defects in MPS and 1.36 (95% CI 0.78-2.37; P = ns) for WMA in DSE. The secondary endpoint was significantly correlated with the findings of both modalities, MPS (HR 3.21; 95% CI 1.35-7.61; P = .008) and DSE (HR 2.67; 95% CI 1.15-6.20; P = .022).
Conclusion
Perfusion defects in MPS are a stronger determinant of all-cause mortality, MI and the need for future CR compared with WMAs in DSE. Given the complementary functional information provided by MPS vs DSE, results are sometimes contradictory, which may indicate differences in the underlying pathophysiology.

© 2021. The Author(s).

J Nucl Cardiol: 07 Nov 2021; epub ahead of print
Bautz J, Stypmann J, Reiermann S, Pavenstädt HJ, ... Reuter S, Schäfers M
J Nucl Cardiol: 07 Nov 2021; epub ahead of print | PMID: 34750727
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Abstract

Pulmonary perfusion and NYHA classification improve after cardiac resynchronization therapy.

Al-Mashat M, Borgquist R, Carlsson M, Arheden H, Jögi J
Background
Evaluation of cardiac resynchronization therapy (CRT) often includes New York Heart Association (NYHA) classification, and echocardiography. However, these measures have limitations. Perfusion gradients from ventilation/perfusion single-photon emission computed tomography (V/P SPECT) are related to left-heart filling pressures and have been validated against invasive right-heart catheterization. The aim was to assess if changes in perfusion gradients are associated with improvements in heart failure (HF) symptoms after CRT, and if they correlate with currently used diagnostic methods in the follow-up of patients with HF after receiving CRT.
Methods and results
Nineteen patients underwent V/P SPECT, echocardiography, NYHA classification, and the quality-of-life scoring system \"Minnesota living with HF\" (MLWHF), before and after CRT. CRT caused improvement in perfusion gradients from V/P SPECT which were associated with improvements in NYHA classification (P = .0456), whereas improvements in end-systolic volume (LVESV) from echocardiography were not. After receiving CRT, the proportion of patients who improved was lower using LVESV (n = 7/19, 37%) than perfusion gradients (n = 13/19, 68%). Neither change in perfusion gradients nor LVESV was associated with changes in MLWHF (P = 1.0, respectively).
Conclusions
Measurement of perfusion gradients from V/P SPECT is a promising quantitative user-independent surrogate measure of left-sided filling pressure in the assessment of CRT response in patients with HF.

© 2021. The Author(s).

J Nucl Cardiol: 07 Nov 2021; epub ahead of print
Al-Mashat M, Borgquist R, Carlsson M, Arheden H, Jögi J
J Nucl Cardiol: 07 Nov 2021; epub ahead of print | PMID: 34750725
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Abstract

External validation of the CRAX2MACE model in an Italian cohort of patients with suspected coronary artery disease undergoing stress myocardial perfusion imaging.

Megna R, Petretta M, Assante R, Zampella E, ... Acampa W, Cuocolo A
Background
Prevention and development of diagnostic and therapeutic techniques reduced morbidity and mortality for coronary artery disease (CAD). In this context, the cardiovascular risk assessment for major adverse cardiac events (MACE) at 2-year (CRAX2MACE) model for prediction of 2-year major adverse cardiac events was developed. We performed an external validation of this model.
Methods
We included 1003 patients with suspected CAD undergoing stress-rest single-photon emission computed tomography myocardial perfusion imaging at our academic center between March 2015 and April 2019.
Results
Considering the occurrence of MACE (death from any cause, acute myocardial infarction, or late coronary revascularization), for the CRAX2MACE model the area under the receiver operating characteristic curve was 0.612 and the Brier score was 0.061. The Hosmer-Lemeshow test estimated a non-optimal fit (χ2 28, P < .001). Considering only hard events (cardiac death, acute myocardial infarction), the external validation of the CRAX2MACE model revealed a Brier score of 0.053 and an area under the receiver operating characteristic curve of 0.621. Hosmer-Lemeshow test was calculated by deciles and showed a poor fit (χ2 31, P < .001).
Conclusion
CRAX2MACE model had a limited value for predicting 2-year major adverse cardiovascular events in an external validation cohort of patients with suspected CAD.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 02 Nov 2021; epub ahead of print
Megna R, Petretta M, Assante R, Zampella E, ... Acampa W, Cuocolo A
J Nucl Cardiol: 02 Nov 2021; epub ahead of print | PMID: 34734366
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Abstract

Potential novel imaging targets of inflammation in cardiac sarcoidosis.

Park J, Young BD, Miller EJ
Cardiac sarcoidosis (CS) is an inflammatory disease with high morbidity and mortality, with a pathognomonic feature of non-caseating granulomatous inflammation. While 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established modality to image inflammation and diagnose CS, there are limitations to its specificity and reproducibility. Imaging focused on the molecular processes of inflammation including the receptors and cellular microenvironments present in sarcoid granulomas provides opportunities to improve upon FDG-PET imaging for CS. This review will highlight the current limitations of FDG-PET imaging for CS while discussing emerging new nuclear imaging molecular targets for the imaging of cardiac sarcoidosis.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 02 Nov 2021; epub ahead of print
Park J, Young BD, Miller EJ
J Nucl Cardiol: 02 Nov 2021; epub ahead of print | PMID: 34734365
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Abstract

Effect of nitroglycerin on splanchnic and pulmonary blood volume.

Okamoto LE, Dupont WD, Biaggioni I, Kronenberg MW
Background
Sublingual nitroglycerin (SL NTG) is useful for treating acute decompensated heart failure, possibly by increasing splanchnic capacitance and reducing left ventricular (LV) preload. We evaluated a radionuclide method to study these effects, initially in subjects without heart failure.
Methods and results
Red blood cells were labelled by an in vitro method. Abdominal and chest images were obtained at rest, showing relative regional blood volumes. The abdomen was then re-imaged during progressive escalation of intrathoracic pressure using continuous positive airway pressure to assess baseline splanchnic capacitance (pressure-volume relationship, PVR) and compliance (slope of PVR). The procedure was repeated after 0.6 mg SL NTG, followed by chest images. Relative splanchnic blood volume increased at rest after SL NTG (P < .002), signifying an increase in splanchnic capacitance. The slope of the splanchnic PVR decreased in proportion to the baseline PVR (P = .0014), signifying increased compliance. The relative pulmonary blood volume decreased in proportion to the increase in splanchnic blood volume (P = .01).
Conclusions
A semi-quantitative radionuclide method demonstrated the effect of SL NTG for increasing splanchnic capacitance and compliance, with a proportional decrease in pulmonary blood volume. These data may be applied to quantitatively evaluate the importance of splanchnic vasodilation as a mechanism of LV preload reduction in the treatment of heart failure.
Clinical trials registration
NCT02425566.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 01 Nov 2021; epub ahead of print
Okamoto LE, Dupont WD, Biaggioni I, Kronenberg MW
J Nucl Cardiol: 01 Nov 2021; epub ahead of print | PMID: 34729682
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Abstract

Normal imaging findings after ascending aorta prosthesis implantation on F-Fluorodeoxyglucose Positron Emission Tomography with computed tomography.

Wahadat AR, Tanis W, Mulders TA, Graven LH, ... Roos-Hesselink JW, Budde RPJ
Background
To diagnose abnormal 18F-Fluorodeoxyglucose (18F-FDG) uptake in suspected endocarditis after aortic root and/or ascending aorta prosthesis (ARAP) implantation, it is important to first establish the normal periprosthetic uptake on positron emission tomography with computed tomography (PET/CT).
Methods
Patients with uncomplicated ARAP implantation were prospectively included and underwent 18F-FDG-PET/CT at either 12 (± 2) weeks (group 1) or 52 (± 8) weeks (group 2) after procedure. Uptake on three different locations of the prosthesis (\"cranial anastomosis (CA),\" \"prosthetic heart valve (PHV),\" \"ascending aorta prosthesis (AAP)\") was scored visually (none/low/intermediate/high) and quantitatively (maximum standardized uptake value (SUVmax) and target-to-background ratio (SUVratio).
Results
In total, 20 patients (group 1: n = 10, group 2: n = 10) (mean age 64±7 years, 70% male) were included. Both groups had similar visual uptake intensity for all measured areas (CA: mostly low-intermediate (16/20 (80%)), p = .17; PHV: low-intermediate (16/20 (80%)), p = .88; AAP: low-intermediate (19/20 (95%)), p = .48). SUVmax for CA was 5.6 [4.1-6.1] and 3.8 [3.1-5.9] (median [IQR], p = .19), and around PHV 5.0 [4.1-5.7] and 6.3 [4.6-7.1] (p = .11) for groups 1 and 2, respectively. SUVratio for CA was 2.8 [2.3-3.2] and 2.0 [1.7-2.6] (median [IQR], p = .07) and around PHV 2.5 [2.4-2.8] and 2.9 [2.3-3.5] (median [IQR], p = .26) for groups 1 and 2, respectively.
Conclusion
No significant differences were observed between PET/CT findings at 3 months and 1 year after ARAP implantation, warranting caution in interpretation of PET/CT in the first year after implantation.

© 2021. The Author(s).

J Nucl Cardiol: 26 Oct 2021; epub ahead of print
Wahadat AR, Tanis W, Mulders TA, Graven LH, ... Roos-Hesselink JW, Budde RPJ
J Nucl Cardiol: 26 Oct 2021; epub ahead of print | PMID: 34708302
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Abstract

Vascular/perivascular inflammation in IgG4-related disease.

Imai S, Tahara N, Igata S, Tahara A, ... Fukumoto Y, Tayama E
Background
Immunoglobulin G4-related disease (IgG4-RD) is characterized by the infiltration of IgG4-positive plasma cells and fibrosclerotic inflammation in multiple organs. Although vascular complications are present in some patients with IgG4-RD, vascular and/or perivascular inflammatory activity compared to control subjects remains unknown. This study sought to investigate vascular/perivascular inflammation in IgG4-RD patients compared to control subjects using 18F-fluorodeoxyglucose-positron emission tomography combined with computed tomography (FDG-PET/CT).
Methods
We examined 37 consecutive patients diagnosed as IgG4-RD (29 males, mean age of 64.3 ± 8.3 years old), who underwent FDG-PET/CT. Thirty-seven age- and gender-matched subjects without IgG4-RD were employed as controls. Vascular/perivascular inflammation was quantified by blood-normalized standardized uptake value, known as a target-to-background ratio (TBR).
Results
All IgG4-RD patients presented with multiple region involvements. Twelve (32.4%) of the IgG4-RD patients had vascular complications, all of which appeared in the abdominal aorta. IgG4-RD patients had significantly higher TBR values in the descending aorta, abdominal aorta, and common iliac artery than control subjects. Also, IgG4-RD patients with vascular complication exhibited higher TBR values in the infra-renal aorta and common iliac artery than those without vascular complication.
Conclusions
We found that vascular FDG activity is significantly elevated in IgG4-RD patients regardless of vascular complication than control subjects. FDG-PET/CT is a useful modality for assessing vascular/perivascular inflammation, which may contribute vascular complication in IgG4-RD patients.

© 2021. American Society of Nuclear Cardiology.

J Nucl Cardiol: 25 Oct 2021; epub ahead of print
Imai S, Tahara N, Igata S, Tahara A, ... Fukumoto Y, Tayama E
J Nucl Cardiol: 25 Oct 2021; epub ahead of print | PMID: 34704218
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This program is still in alpha version.