Journal of Nuclear Cardiology最新文献

英文中文

Looking beyond the valve: Myocardial ischemia, left ventricular remodeling, and adverse outcomes in aortic stenosis 超越瓣膜：主动脉瓣狭窄的心肌缺血、左心室重塑和不良预后。

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2024-10-01 DOI: 10.1016/j.nuclcard.2024.102037

Wunan Zhou MD, MPH

引用次数: 0

Comparative effectiveness of positron emission tomography and single-photon emission computed tomography myocardial perfusion imaging for predicting risk in patients with cardiometabolic disease pet 和 spect mpi 预测心脏代谢疾病患者风险的效果比较。

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2024-10-01 DOI: 10.1016/j.nuclcard.2024.101908

Background

The epidemiology of coronary artery disease (CAD) has shifted, with increasing prevalence of cardiometabolic disease and decreasing findings of obstructive CAD on myocardial perfusion imaging (MPI). Coronary microvascular dysfunction (CMD), defined as impaired myocardial flow reserve (MFR) by positron emission tomography (PET), has emerged as a key mediator of risk. We aimed to assess whether PET MFR provides additive value for risk stratification of cardiometabolic disease patients compared with single-photon emission computed tomography (SPECT) MPI.

Methods

We retrospectively followed patients referred for PET, exercise SPECT, or pharmacologic SPECT MPI with cardiometabolic disease (obesity, diabetes, or chronic kidney disease) and without known CAD. We compared rates and hazards of composite major adverse cardiovascular events (MACEs) (annualized cardiac mortality or acute myocardial infarction) among propensity-matched PET and SPECT patients using Poisson and Cox regression. Normal SPECT was defined as a total perfusion deficit (TPD) of <5%, reflecting the absence of obstructive CAD. Normal PET was defined as a TPD of <5% plus an MFR of ≥2.0.

Results

Among 21,544 patients referred from 2006 to 2020, cardiometabolic disease was highly prevalent (PET: 2308 [67%], SPECT: 9984 [55%]) and higher among patients referred to PET (P < 0.001). Obstructive CAD findings (TPD > 5%) were uncommon (PET: 21% and SPECT: 11%). Conversely, impaired MFR on PET (<2.0) was common (62%). In a propensity-matched analysis over a median 6.4-year follow-up, normal PET identified low-risk (0.9%/year MACE) patients, and abnormal PET identified high-risk (4.2%/year MACE) patients with cardiometabolic disease; conversely, those with normal pharmacologic SPECT remained moderate-risk (1.6%/year, P < 0.001 compared to normal PET).

Conclusions

Cardiometabolic disease is common among patients referred for MPI and is associated with a heterogenous level of risk. Compared with pharmacologic SPECT, PET with MFR can detect nonobstructive CAD including CMD and can more accurately discriminate low-risk from higher-risk individuals.

背景：冠状动脉疾病（CAD）的流行病学发生了变化，心血管代谢疾病的发病率越来越高，而心肌灌注成像（MPI）发现的阻塞性冠状动脉疾病却越来越少。冠状动脉微血管功能障碍（CMD）通过正电子发射断层扫描（PET）被定义为心肌血流储备（MFR）受损，它已成为风险的一个关键介导因素。我们的目的是评估与单光子发射计算机断层扫描（SPECT）MPI 相比，正电子发射计算机断层扫描心肌血流储备是否能为心脏代谢疾病患者的风险分层提供附加价值：我们对转诊至 PET、运动 SPECT 或药物 SPECT MPI 的患有心脏代谢疾病（肥胖、糖尿病或慢性肾脏病）但未发现 CAD 的患者进行了回顾性跟踪。我们使用泊松回归和 Cox 回归比较了倾向匹配的 PET 和 SPECT 患者的复合 MACE（年化心脏死亡率或急性心肌梗死）发生率和危险度。正常 SPECT 被定义为总灌注不足 (TPD) 结果：在2006-2020年转诊的21544名患者中，心脏代谢疾病的发病率很高（PET：2308人[67%]，SPECT：9984人[55%]），在转诊到PET（P 5%）的患者中发病率较高（PET：21%，SPECT：11%），而在转诊到SPECT（P 5%）的患者中发病率较低（PET：21%，SPECT：11%）。相反，PET 显示的 MFR 受损（结论：心脏代谢疾病在转诊的 MPI 患者中很常见，且与不同的风险水平相关。与药物 SPECT 相比，正电子发射计算机断层显像与 MFR 可检测包括 CMD 在内的非阻塞性 CAD，并能更准确地区分低风险和高风险人群。

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引用次数: 0

American Society of Nuclear Cardiology quality metrics for cardiac amyloid radionuclide imaging 美国核心脏病学会心脏淀粉样放射性核素成像质量标准

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2024-10-01 DOI: 10.1016/j.nuclcard.2024.102041

Fadi G. Hage MD, MASNC , Jamieson M. Bourque , Shivda Pandey , Nishant R. Shah , Prem Soman , Brian G. Abbott , Aiden Abidov , Niti R. Aggarwal , Wael AlJaroudi , Pradeep G. Bhambhvani , Sabahat Bokhari , Sharmila Dorbala , Rami Doukky , Jessica M. Duran , Andrew J. Einstein , Dennis Gallagher , Robert C. Hendel , Wael Jaber , Cesia Gallegos Kattan , Saurabh Malhotra , Brett W. Sperry

This document from the American Society of Nuclear Cardiology develops metrics for the assessment of quality for laboratories that perform cardiac amyloid radionuclide imaging. These metrics are based on clinical guidelines, appropriate use criteria, information and position statements, and expert opinion. The document introduces 15 quality metrics that address current gaps in care organized around 4 axes: A) Appropriate indications; B) Patient experience and workflow; C) Instrumentation and protocols; and D) Interpretation and reporting. With the increasing use of imaging for cardiac amyloid, it is imperative that our laboratories maintain a high level of quality to preserve the value that imaging provides to patients. Laboratories should perform imaging in appropriately selected patients avoiding low-value imaging. Proper education should be provided to patients prior to performing testing, timely access to testing must be available, and periodic assessment of patient experience and satisfaction should be the norm. Strict adherence to established protocols with periodic assessment of laboratory quality control is essential. Laboratory studies to rule out plasma cell dyscrasia should be performed in all patients suspected of having cardiac amyloidosis. Crucially, interpretation should be based on SPECT rather than planar imaging in all patients. The study report should include sufficient technical details to allow for proper interpretation of study findings and its conclusion should be clear and unambiguous to guide clinical management. Laboratories can use data derived from these metrics to identify areas of deficiency and introduce quality improvement initiatives, which will ultimately improve patient outcomes.

美国核心脏病学会的这份文件为进行心脏淀粉样放射性核素成像的实验室制定了质量评估指标。这些指标基于临床指南、适当使用标准、信息和立场声明以及专家意见。该文件介绍了 15 项质量指标，这些指标围绕 4 个轴心来解决目前的医疗差距：A) 适当的适应症；B) 患者体验和工作流程；C) 仪器和协议；D) 解释和报告。随着心脏淀粉样蛋白成像技术的应用日益广泛，我们的实验室必须保持较高的质量水平，以维护成像技术为患者带来的价值。实验室应适当选择患者进行成像检查，避免低价值成像。在进行检查前应向患者提供适当的教育，必须及时提供检查机会，并定期评估患者的体验和满意度。严格遵守既定方案并定期评估实验室质量控制至关重要。所有疑似心脏淀粉样变性的患者都应进行实验室检查以排除浆细胞异常。最重要的是，所有患者的解释都应基于 SPECT 而非平面成像。研究报告应包括足够的技术细节，以便正确解读研究结果，其结论应清晰明确，以指导临床治疗。实验室可利用从这些指标中获得的数据找出不足之处，并采取质量改进措施，最终改善患者的预后。

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引用次数: 0

Head-to-head comparison of ¹⁸F-sodium fluoride coronary PET imaging between a silicon photomultiplier with digital photon counting and conventional scanners. 数字光子计数硅光电倍增管与传统扫描仪在 18F - 氟化钠冠状 PET 成像方面的正面比较。

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2024-09-27 DOI: 10.1016/j.nuclcard.2024.102045

Hidenobu Hashimoto, Keiichiro Kuronuma, Mark C Hyun, Donghee Han, Valerie Builoff, Sebastian Cadet, Damini Dey, Daniel S Berman, Jacek Kwiecinski, Piotr J Slomka

Background: We compared silicone photomultipliers with digital photon counting (SiPM) and photomultiplier tubes (PMT) positron emission tomography (PET) in imaging coronary plaque activity with ¹⁸F-sodium fluoride (¹⁸F-NaF) and evaluated comprehensively SiPM PET reconstruction settings.

Methods: In 25 cardiovascular disease patients (mean age 67 ± 12 years), we conducted ¹⁸F-NaF PET on a SiPM (Biograph Vision) and conventional PET (Discovery 710) on the same day as part of a prospective clinical trial (NCT03689946). Following administration of 250 MBq of ¹⁸F-NaF, patients underwent a contrast-enhanced CT angiography and a 30-min PET acquisition in list-mode on each PET consecutively. Image noise was defined as mean standard deviation of blood pool activity within the left atria. Target-to-background ratio (TBR) and signal-to-noise ratio (SNR) were measured within the whole-vessel tubular three-dimensional volumes of interest on the cardiac motion and attenuation-corrected ¹⁸F-NaF PET images using dedicated software.

Results: There were significant differences in image noise and background activity between the two PETs (Image noise (%), PMT: 7.6 ± 3.7 vs SiPM: 4.0 ± 2.3, P < 0.001; background activity, PMT: 1.4 ± 0.4 vs SiPM: 1.0 ± 0.3, P < 0.001). Similarly, the SNR and TBR were significantly higher in vessels scanned with the SiPM PET (SNR, PMT: 16.3 ± 11.5 vs SiPM: 32.7 ± 29.8, P < 0.001; TBR, PMT: 0.8 ± 0.4 vs SiPM: 1.1 ± 0.6, P < 0.001). SiPM PET image reconstruction with a 256 matrix, 1.4 mm pixel, and 2 mm Gaussian filter provided best trade off in terms of maximal SNR, TBR, and clinically practical file size.

Conclusions: In ¹⁸F-NaF coronary PET imaging, the SiPM PET showed superior image contrast and less image noise compared with PMT PET.

背景：我们比较了硅光电倍增管与数字光子计数（SiPM）和光电倍增管（PMT）PET在用18F-氟化钠（18F-NaF）成像冠状动脉斑块活动时的效果，并全面评估了SiPM PET重建设置：作为前瞻性临床试验（NCT03689946）的一部分，我们在同一天对 25 名心血管疾病患者（平均年龄 67±12 岁）在 SiPM（Biograph Vision）和传统 PET（Discovery 710）上进行了 18F-NaF PET 扫描。给药 250 MBq 18F-NaF 后，患者连续接受造影剂增强 CT 血管造影和 30 分钟的 PET 列表模式采集。图像噪声定义为左心房内血池活动的平均标准偏差。使用专用软件测量心脏运动和衰减校正 18F-NaF PET 图像上感兴趣的全血管管状三维体积内的目标-背景比（TBR）和信噪比（SNR）：结果：两种 PET 在图像噪声和背景活动方面存在明显差异（图像噪声（%），PMT：7.6±3.7 vs. SiPM：4.0±2.3，p结论：在 18F-NaF 冠状动脉 PET 成像中，与 PMT PET 相比，SiPM PET 的图像对比度更高，图像噪声更小。

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引用次数: 0

Detection of small vegetations in native bi-valvular (aortic + mitral) infective endocarditis with 4D ECG-gated cardiac [¹⁸F]FDG PET/CT. 利用 4D 心电图门控心脏[18F]FDG PET/CT 检测原发性双瓣（主动脉瓣+二尖瓣）感染性心内膜炎的小植被。

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2024-09-19 DOI: 10.1016/j.nuclcard.2024.102043

Juan P Suarez, Maria L Dominguez, Carmen Vigil, Belen Fernandez, Sara Naranjo, Laura Rodriguez, Noelia Martin, Francisco M Gonzalez

引用次数: 0

Transient ischemic dilatation in cardiac amyloidosis. 心脏淀粉样变性中的短暂缺血性扩张。

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2024-09-16 DOI: 10.1016/j.nuclcard.2024.102042

Bethlehem Mengesha,Gary Small,David Ian Paterson,Benjamin Chow

引用次数: 0

How to differentiate obstructive from non-obstructive CAD with quantitative PET MPI using Coronary Flow Capacity. 如何利用冠状动脉血流容量通过 PET MPI 定量区分阻塞性和非阻塞性 CAD。

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2024-09-10 DOI: 10.1016/j.nuclcard.2024.102039

Nils P Johnson,K Lance Gould

引用次数: 0

Regional variation in technetium pyrophosphate (PYP) uptake in transthyretin cardiac amyloidosis (ATTR-CA) and concomitant myocardial infarction: A case series. 转甲状腺素心脏淀粉样变性（ATTR-CA）和并发心肌梗死的焦磷酸锝（PYP）摄取区域差异：病例系列。

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2024-09-02 DOI: 10.1016/j.nuclcard.2024.102031

Simrat Kaur, Fatimah Chamseddine, Bryan Abadie, Vikas Sunder, Wael Jaber

- Diffuse and patchy myocardial uptake of Tc-99m PYP is well established in cases of ATTR-CA. - Chronic myocardial infarction leads to regional myocardial thinning and lack of vascular supply can present as regional sparing 'cold spot' on Tc-99m PYP imaging. - The absence of Tc-99m PYP uptake in vascular regions should raise the possibility of underlying scar.

- 在 ATTR-CA 病例中，Tc-99m PYP 的弥漫性和斑片状心肌摄取已得到证实。- 慢性心肌梗死会导致区域性心肌变薄，血管供应不足会在 Tc-99m PYP 成像中表现为区域性稀疏 "冷斑"。- 如果血管区域没有 Tc-99m PYP 摄取，则应考虑潜在瘢痕的可能性。

引用次数: 0

Cardiac positron emission tomography and other modalities for coronary artery disease assessment: A snapshot from the medicare data. 心脏正电子发射断层扫描和其他方式的 CAD 评估：医疗保险数据快照。

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2024-09-02 DOI: 10.1016/j.nuclcard.2024.102030

Mouaz Al-Mallah, Maria Alwan, Mahmoud Al Rifai, Ahmed Sayed

Background: Positron emission tomography (PET) is an important tool for assessing coronary artery disease (CAD), but its widespread utilization is limited due to various factors, including limited local champion availability. This study aims to compare the frequency of PET procedures and their interpreters with other common CAD assessment modalities.

Methods: Using Medicare data, we examined the number of cardiac PET procedures billed and compared them with single-photon emission computed tomography (SPECT), coronary computed tomography angiography (CCTA), stress magnetic resonance imaging (MRI), and stress echocardiography. Healthcare Common Procedure Coding System codes were used to identify procedures. We calculated the total number of PET myocardial perfusion imaging (MPI) procedures, the proportion of PET/CT and myocardial blood flow (MBF) assessments, and the median number of studies read per physician. We also analyzed the trends in the use of different CAD assessment modalities between 2018 and 2022. Descriptive statistics summarized the data.

Results: In 2022, Medicare billed for 212,106 PET MPI scans. SPECT was six times more frequent (1,343,519), whereas stress echocardiography (201,676) and CCTA (118,734) had similar or lower use. Stress MRI (3,932) was least used. Of the PET MPI scans, 46% were PET/CT, and 39% included MBF measurements. Cardiologists interpreted 86% of PET scans, with a median of 58 studies per reader; 23% interpreted ≤25 studies annually. SPECT had a median of 63 studies per reader, and CCTA, stress MRI, and stress echocardiography had medians of 27, 20, and 24, respectively. PET, CT, and MRI use increased from 2018 to 2022, whereas SPECT and stress echocardiography declined.

Conclusion: In the Medicare population, radionuclide perfusion imaging (SPECT and PET) remained the preferred method for assessment of CAD, with SPECT being the most frequently used modality and PET being the second most frequently used modality for this application. However, PET/CT and MBF are underutilized, limiting diagnostic and prognostic capabilities. Efforts to enhance education and awareness of PET's advantages and to address barriers to its wider adoption are essential to maximize its clinical benefits and improve patient outcomes.

背景：正电子发射断层扫描（PET）是评估冠状动脉疾病（CAD）的重要工具，但由于当地冠军彩票登录有限等各种因素，其广泛使用受到限制。本研究旨在比较正电子发射计算机断层扫描（PET）与其他常见冠状动脉疾病评估方法的使用频率及其解释者：利用医疗保险数据，我们检查了心脏 PET 手术的收费数量，并将其与单光子发射计算机断层扫描 (SPECT)、冠状动脉计算机断层扫描 (CCTA)、负荷磁共振成像 (MRI) 和负荷超声心动图进行了比较。医疗保健通用程序编码系统 (HCPCS) 代码用于识别程序。我们计算了 PET MPI 程序的总数、PET/CT 和 MBF 评估的比例以及每位医生阅读研究报告的中位数。我们还分析了 2018 年至 2022 年不同 CAD 评估模式的使用趋势。描述性统计对数据进行了总结：2022 年，医疗保险对 212,106 次 PET MPI 扫描进行了收费。SPECT 的使用频率高出六倍（1,343,519 次），而负荷超声心动图（201,676 次）和 CCTA（118,734 次）的使用频率相近或更低。负荷磁共振成像（3,932 次）的使用率最低。在 PET MPI 扫描中，46% 是 PET/CT，39% 包括 MBF 测量。86%的 PET 扫描由心脏病专家解读，每位解读者的中位数为 58 项研究；23% 的解读者每年解读的研究次数少于 25 次。SPECT 每位读者的中位数为 63 项研究，CCTA、负荷 MRI 和负荷超声心动图的中位数分别为 27、20 和 24。从 2018 年到 2022 年，PET、CT 和 MRI 的使用量有所增加，而 SPECT 和负荷超声心动图的使用量有所下降：在医疗保险人群中，PET 是第二种最常用的 CAD 评估方式。然而，PET/CT 和 MBF 利用率不足，限制了诊断和预后能力。为了最大限度地发挥 PET 的临床优势并改善患者预后，必须努力加强教育，提高人们对 PET 优势的认识，并解决广泛采用 PET 的障碍。

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引用次数: 0

Evolution of cardiac amyloidosis imaging with bone-avid tracers: From qualification to quantification 使用骨惰性示踪剂进行心脏淀粉样变性成像的演变：从定性到定量。

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2024-09-01 DOI: 10.1016/j.nuclcard.2024.102032

Saurabh Malhotra MD, MPH, FASNC , Albert J. Sinusas MD, MASNC

引用次数: 0

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