Diaphragmatic eventration is the elevation of hemi-diaphragm without any disruption to diaphragmatic continuity which can be congenital or acquired. The most common acquired cause is phrenic nerve paralysis due to traumatic causes and is usually incidentally diagnosed on chest radiograph or computed tomography. We hereby report a case of a patient who had road traffic accident with fracture of the left proximal femur. Stress Myocardial Perfusion Imaging (MPI) done for pre-operative clearance showed an incidental tracer avidity adjoining to left myocardium in the thorax. It was confirmed on anatomical imaging to be gastric cavity uptake due to diaphragm eventration.
{"title":"Incidentally detected diaphragmatic eventration as para-cardiac thoracic activity on myocardial perfusion imaging","authors":"Hardik Veerwal MD, Komal Preet MBBS, Ashwani Sood DNB, Harpreet Singh MD, Madan Parmar MSc, Bhagwant R. Mittal MD, DNB","doi":"10.1016/j.nuclcard.2024.101817","DOIUrl":"10.1016/j.nuclcard.2024.101817","url":null,"abstract":"<div><div>Diaphragmatic eventration<span><span> is the elevation of hemi-diaphragm without any disruption to diaphragmatic continuity which can be congenital or acquired. The most common acquired cause is phrenic nerve paralysis<span> due to traumatic causes and is usually incidentally diagnosed on chest radiograph or </span></span>computed tomography<span><span>. We hereby report a case of a patient who had road traffic accident with fracture of the left proximal femur<span>. Stress Myocardial Perfusion Imaging (MPI) done for pre-operative clearance showed an incidental </span></span>tracer<span><span> avidity adjoining to left myocardium in the </span>thorax. It was confirmed on anatomical imaging to be gastric cavity uptake due to diaphragm eventration.</span></span></span></div></div>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"43 ","pages":"Article 101817"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139672026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.nuclcard.2024.102091
Manish Motwani MB ChB, PhD
{"title":"I can see clearly now the blur has gone: Deep learning efficiencies in single-photon emission computed tomography myocardial perfusion imaging","authors":"Manish Motwani MB ChB, PhD","doi":"10.1016/j.nuclcard.2024.102091","DOIUrl":"10.1016/j.nuclcard.2024.102091","url":null,"abstract":"","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"43 ","pages":"Article 102091"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.nuclcard.2025.102127
Marcelo F. Di Carli MD, MASNC
{"title":"Expanding best practices in nuclear cardiology: A blueprint for growth","authors":"Marcelo F. Di Carli MD, MASNC","doi":"10.1016/j.nuclcard.2025.102127","DOIUrl":"10.1016/j.nuclcard.2025.102127","url":null,"abstract":"","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"43 ","pages":"Article 102127"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.nuclcard.2024.102082
Chaitanya Rojulpote MD , Abhijit Bhattaru BA , Shivaraj Patil MD , Sarah L. Adams DO , Jonathan A. Salas BS , Mahesh K. Vidula MD , Raul Porto Perez MD , Wumesh Kc MD, PhD , Karen Patterson MD , Caitlin B. Clancy MD , Milton Rossman MD , Lee Goldberg MD , Paco E. Bravo MD
Background
Serial positron emission tomography (PET) imaging is routinely used to monitor treatment response in patients with suspected cardiac sarcoidosis (CS). Corticosteroids remain the mainstay of therapy in CS. However, there are no data available on the cardiovascular outcomes and optimal timing interval to obtain repeat PET while factoring in the influence of corticosteroid taper in relation to surveillance imaging.
Methods
We identified 81 patients with suspected CS (age: 56.3 ± 1.9, 67% male, left ventricle ejection fraction: 46.5 ± 3) who were not on immunosuppression treatment and demonstrated inflammation on baseline PET, subsequently started on moderate-dose prednisone monotherapy (i.e., 30-40 mg/day), and had a diagnostic follow-up PET. Treatment response was graded as complete treatment response (CTR) or partial treatment response (PTR) vs no response. Patients were divided into tertiles based on follow-up time between PET scans; tertile-1 (<3.2 months; median: 3.1 months), tertile-2 (3.2-6.8 months; median: 5.9 months), and tertile-3 (>6.8 months; median: 9.8 months). Corticosteroid taper was captured by measuring weekly changes in prednisone from the start of treatment to up to one-year follow-up. Major adverse cardiovascular events (MACEs), defined as sustained ventricular arrhythmias, were documented during the first year post baseline PET.
Results
Treatment response CTR/PTR rates were similar across tertiles: (tertile-1 [92%] vs tertile-2 [86.2%] vs tertile-3 [85.2%]; P = .76). Taper rates and one-year cumulative prednisone dose were similar between the three groups (P = .9). No significant difference was found in short-term MACEs between the tertile groups (P = .89). Similarly, MACEs did not differ significantly according to treatment response status (P = .39).
Conclusions
Surveillance time and taper rates do not seem to influence treatment response on PET scans among patients initiated on moderate-dose prednisone only. Similar MACE rates were observed despite variations in follow-up time and treatment response status.
简介：对疑似心脏肉样瘤病（CS）患者进行连续 PET 成像检查是监测治疗反应的常规方法。皮质类固醇仍是治疗 CS 的主要手段。然而，目前还没有关于心血管后果和重复 PET 的最佳时间间隔的数据，同时也没有考虑到皮质类固醇减量对监测成像的影响：我们确定了81例疑似CS患者（年龄：56.3 ± 1.9，67%为男性，LVEF 46.5 ± 3），这些患者均未经治疗且基线PET显示有炎症，随后开始接受中等剂量泼尼松单药治疗（即30-40毫克/天），并进行了诊断性随访PET。治疗反应分为完全反应（CTR）、部分反应（PTR）和无反应（NTR）。根据 PET 扫描之间的随访时间将患者分为三等分；三等分-1（6.8 个月；中位数为 9.8 个月）。通过测量泼尼松从治疗开始到随访一年期间的每周变化情况来了解皮质类固醇的减量情况。主要心血管不良事件（MACE）定义为基线 PET 治疗后第一年内出现的持续性室性心律失常：不同分层的治疗反应 CTR/PTR/NTR 率相似：（1 层（92%） vs 2 层（86.2%） vs 3 层（85.2%）；P=0.76）。三组的减量率和一年的泼尼松累积剂量相似（P=0.9）。三等分组之间的短期 MACE 无明显差异（P=0.89）。同样，根据治疗反应状态，MACE也无明显差异（P=0.39）：结论：对于仅开始使用中等剂量泼尼松的患者，监视时间和减量率似乎并不影响 PET 扫描的治疗反应。尽管随访时间和治疗反应状态不同，但观察到的 MACE 发生率相似。
{"title":"Assessing the effect of repeat positron emission tomography imaging on treatment response and cardiovascular outcomes among a homogenously treated cohort of patients with suspected cardiac sarcoidosis","authors":"Chaitanya Rojulpote MD , Abhijit Bhattaru BA , Shivaraj Patil MD , Sarah L. Adams DO , Jonathan A. Salas BS , Mahesh K. Vidula MD , Raul Porto Perez MD , Wumesh Kc MD, PhD , Karen Patterson MD , Caitlin B. Clancy MD , Milton Rossman MD , Lee Goldberg MD , Paco E. Bravo MD","doi":"10.1016/j.nuclcard.2024.102082","DOIUrl":"10.1016/j.nuclcard.2024.102082","url":null,"abstract":"<div><h3>Background</h3><div>Serial positron emission tomography (PET) imaging is routinely used to monitor treatment response in patients with suspected cardiac sarcoidosis (CS). Corticosteroids remain the mainstay of therapy in CS. However, there are no data available on the cardiovascular outcomes and optimal timing interval to obtain repeat PET while factoring in the influence of corticosteroid taper in relation to surveillance imaging.</div></div><div><h3>Methods</h3><div>We identified 81 patients with suspected CS (age: 56.3 ± 1.9, 67% male, left ventricle ejection fraction: 46.5 ± 3) who were not on immunosuppression treatment and demonstrated inflammation on baseline PET, subsequently started on moderate-dose prednisone monotherapy (i.e., 30-40 mg/day), and had a diagnostic follow-up PET. Treatment response was graded as complete treatment response (CTR) or partial treatment response (PTR) vs no response. Patients were divided into tertiles based on follow-up time between PET scans; tertile-1 (<3.2 months; median: 3.1 months), tertile-2 (3.2-6.8 months; median: 5.9 months), and tertile-3 (>6.8 months; median: 9.8 months). Corticosteroid taper was captured by measuring weekly changes in prednisone from the start of treatment to up to one-year follow-up. Major adverse cardiovascular events (MACEs), defined as sustained ventricular arrhythmias, were documented during the first year post baseline PET.</div></div><div><h3>Results</h3><div>Treatment response CTR/PTR rates were similar across tertiles: (tertile-1 [92%] vs tertile-2 [86.2%] vs tertile-3 [85.2%]; <em>P</em> = .76). Taper rates and one-year cumulative prednisone dose were similar between the three groups (<em>P</em> = .9). No significant difference was found in short-term MACEs between the tertile groups (<em>P</em> = .89). Similarly, MACEs did not differ significantly according to treatment response status (<em>P</em> = .39).</div></div><div><h3>Conclusions</h3><div>Surveillance time and taper rates do not seem to influence treatment response on PET scans among patients initiated on moderate-dose prednisone only. Similar MACE rates were observed despite variations in follow-up time and treatment response status.</div></div>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"43 ","pages":"Article 102082"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.nuclcard.2024.102107
Panithaya Chareonthaitawee MD
{"title":"Charting a responsible path to innovation: Embracing the next chapter in nuclear cardiology – The greatest adventures still lie ahead","authors":"Panithaya Chareonthaitawee MD","doi":"10.1016/j.nuclcard.2024.102107","DOIUrl":"10.1016/j.nuclcard.2024.102107","url":null,"abstract":"","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"43 ","pages":"Article 102107"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143105325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.nuclcard.2024.102050
Andrea Torres MD , Alex Yerkan BS , Ayesha Abbasi MD , Rami Doukky MD, MSc, MBA, FASNC
Background
Although heart rate response (HRR) to regadenoson stress has been shown to be a strong predictor of outcome, it has not been investigated in a large all-comers cohort. The prognostic utility of systolic blood pressure response (SBPR) has not been investigated in comparison with HRR.
Methods and results
In a retrospective cohort of 10,227 patients undergoing regadenoson stress single-photon emission computed tomography myocardial perfusion imaging (MPI), HRR, and SBPR were calculated as 100×(peak hyperemia value–baseline value)/baseline value. During 35 ± 21 months follow-up, 921 (8.8%) deaths were observed. The median HRR was 35% (interquartile range [IQR], 21% to 51%). The median SBPR was −9% (IQR, −17% to −2%). HRR and SBPR were independently associated with all-cause mortality with adjusted hazard ratio [HR] of .980 per 1% increment in HRR (CI, .977-.984) and .994 per 1% increment in SBPR (CI, .988-.999). Mortality rates increased with decreasing HRR quartile and SBPR tertile. HRR provided incremental prognostic value for all-cause mortality beyond clinical and imaging parameters (area under the curve [AUC] increase, .03; P < .001) and SBPR data (AUC increase, .11; P < 0001). SBPR did not provide significant incremental prognostic value beyond clinical and imaging parameters or HRR data. We derived and validated HRR of <20% as a cut-off that can improve risk stratification beyond clinical and MPI findings.
Conclusion
Among patients undergoing stress MPI, impaired HRR to regadenoson provided independent and incremental prognostic value for all-cause mortality beyond clinical, imaging, and SBPR data. SBPR positively correlates with HRR, but it does not provide incremental prognostic utility. HRR, but not SBPR, should be routinely reported and considered in assessing patients' overall risk. An abnormal HRR threshold of <20% can improve risk stratification.
{"title":"The prognostic utility of heart rate and blood pressure response to regadenoson stress","authors":"Andrea Torres MD , Alex Yerkan BS , Ayesha Abbasi MD , Rami Doukky MD, MSc, MBA, FASNC","doi":"10.1016/j.nuclcard.2024.102050","DOIUrl":"10.1016/j.nuclcard.2024.102050","url":null,"abstract":"<div><h3>Background</h3><div>Although heart rate response (HRR) to regadenoson stress has been shown to be a strong predictor of outcome, it has not been investigated in a large all-comers cohort. The prognostic utility of systolic blood pressure response (SBPR) has not been investigated in comparison with HRR.</div></div><div><h3>Methods and results</h3><div>In a retrospective cohort of 10,227 patients undergoing regadenoson stress single-photon emission computed tomography myocardial perfusion imaging (MPI), HRR, and SBPR were calculated as 100×(peak hyperemia value–baseline value)/baseline value. During 35<!--> <!-->±<!--> <!-->21 months follow-up, 921 (8.8%) deaths were observed. The median HRR was 35% (interquartile range [IQR], 21% to 51%). The median SBPR was −9% (IQR, −17% to −2%). HRR and SBPR were independently associated with all-cause mortality with adjusted hazard ratio [HR] of .980 per 1% increment in HRR (CI, .977-.984) and .994 per 1% increment in SBPR (CI, .988-.999). Mortality rates increased with decreasing HRR quartile and SBPR tertile. HRR provided incremental prognostic value for all-cause mortality beyond clinical and imaging parameters (area under the curve [AUC] increase, .03; <em>P</em> <!--><<!--> <!-->.001) and SBPR data (AUC increase, .11; <em>P</em> <!--><<!--> <!-->0001). SBPR did not provide significant incremental prognostic value beyond clinical and imaging parameters or HRR data. We derived and validated HRR of <20% as a cut-off that can improve risk stratification beyond clinical and MPI findings.</div></div><div><h3>Conclusion</h3><div>Among patients undergoing stress MPI, impaired HRR to regadenoson provided independent and incremental prognostic value for all-cause mortality beyond clinical, imaging, and SBPR data. SBPR positively correlates with HRR, but it does not provide incremental prognostic utility. HRR, but not SBPR, should be routinely reported and considered in assessing patients' overall risk. An abnormal HRR threshold of <20% can improve risk stratification.</div></div>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"43 ","pages":"Article 102050"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-11DOI: 10.1016/j.nuclcard.2024.102106
Krithika Loganath, Neil Craig, Anna Barton, Shruti Joshi, Constantinos Anagnostopoulos, Paola Anna Erba, Andor W J M Glaudemans, Antti Saraste, Jan Bucerius, Mark Lubberink, Olivier Gheysens, Ronny R Buechel, Gilbert Habib, Oliver Gaemperli, Alessia Gimelli, Fabien Hyafil, David E Newby, Riemer H J A Slart, Marc R Dweck
Fibrosis is one of the key healing responses to injury, especially within the heart, where it helps to maintain structural integrity following acute insults such as myocardial infarction. However, if it becomes dysregulated, then fibrosis can become maladaptive, leading to adverse remodelling, impaired cardiac function and heart failure. Fibroblast activation protein is exclusively expressed by activated fibroblasts, the key effector cells of fibrogenesis, and has a unique extracellular domain that is an ideal ligand for novel molecular imaging probes. Fibroblast activation protein inhibitor (FAPI) radiotracers have been developed for positron emission tomography (PET) imaging, demonstrating high selectivity for activated fibroblasts across a range of different pathologies and disparate organ systems. In this review, we will summarise the role of fibroblast activation protein in cardiovascular disease and how FAPI radiotracers might improve the assessment and treatment of patients with cardiovascular diseases.
纤维化是损伤后的主要愈合反应之一，尤其是在心脏中，它有助于在心肌梗塞等急性损伤后保持结构的完整性。然而，如果纤维化调节失调，就会产生适应不良，导致不良重塑、心脏功能受损和心力衰竭。成纤维细胞活化蛋白专门由活化的成纤维细胞（纤维形成的关键效应细胞）表达，具有独特的胞外结构域，是新型分子成像探针的理想配体。目前已开发出用于 PET 成像的成纤维细胞活化蛋白抑制剂（FAPI）放射性同位素，在一系列不同病理和不同器官系统中显示出对活化成纤维细胞的高度选择性。在这篇综述中，我们将总结成纤维细胞活化蛋白在心血管疾病中的作用，以及 FAPI 放射性racers 如何改善心血管疾病患者的评估和治疗。
{"title":"Cardiovascular positron emission tomography imaging of fibroblast activation: A review of the current literature.","authors":"Krithika Loganath, Neil Craig, Anna Barton, Shruti Joshi, Constantinos Anagnostopoulos, Paola Anna Erba, Andor W J M Glaudemans, Antti Saraste, Jan Bucerius, Mark Lubberink, Olivier Gheysens, Ronny R Buechel, Gilbert Habib, Oliver Gaemperli, Alessia Gimelli, Fabien Hyafil, David E Newby, Riemer H J A Slart, Marc R Dweck","doi":"10.1016/j.nuclcard.2024.102106","DOIUrl":"10.1016/j.nuclcard.2024.102106","url":null,"abstract":"<p><p>Fibrosis is one of the key healing responses to injury, especially within the heart, where it helps to maintain structural integrity following acute insults such as myocardial infarction. However, if it becomes dysregulated, then fibrosis can become maladaptive, leading to adverse remodelling, impaired cardiac function and heart failure. Fibroblast activation protein is exclusively expressed by activated fibroblasts, the key effector cells of fibrogenesis, and has a unique extracellular domain that is an ideal ligand for novel molecular imaging probes. Fibroblast activation protein inhibitor (FAPI) radiotracers have been developed for positron emission tomography (PET) imaging, demonstrating high selectivity for activated fibroblasts across a range of different pathologies and disparate organ systems. In this review, we will summarise the role of fibroblast activation protein in cardiovascular disease and how FAPI radiotracers might improve the assessment and treatment of patients with cardiovascular diseases.</p>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":" ","pages":"102106"},"PeriodicalIF":3.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-07DOI: 10.1016/j.nuclcard.2024.102121
Jing Wu, Bryan D Young, Hui Liu, Mehran M Sadeghi, Edward J Miller, Chi Liu
{"title":"Parametric FDG positron emission tomography K<sub>i</sub> images using dual-time-point imaging data for cardiac sarcoidosis: A proof of concept study.","authors":"Jing Wu, Bryan D Young, Hui Liu, Mehran M Sadeghi, Edward J Miller, Chi Liu","doi":"10.1016/j.nuclcard.2024.102121","DOIUrl":"10.1016/j.nuclcard.2024.102121","url":null,"abstract":"","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":" ","pages":"102121"},"PeriodicalIF":3.0,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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