Journal of Nuclear Cardiology最新文献

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Dual assessment of coronary artery calcium and exercise ability enhances mortality prediction in stress single-photon emission computed tomography-myocardial perfusion imaging patients. CAC和运动能力的双重评估提高了应激谱- mpi患者的死亡率预测。

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2025-12-03 DOI: 10.1016/j.nuclcard.2025.102582

Hidesato Fujito, Heidi Gransar, Rebekah H Park, Donghee Han, Robert J H Miller, Alan C Kwan, Sean W Hayes, Piotr J Slomka, Damini Dey, John D Friedman, Daniel S Berman, Alan Rozanski

Background: The application of hybrid stress single-photon emission computed tomography/computed tomography (SPECT/CT) imaging allows for the combined assessment of patients' exercise ability and coronary artery calcium (CAC) burden. The prognostic utility of this combined information among patients undergoing stress SPECT-myocardial perfusion imaging (MPI) remains incompletely understood.

Methods: To simulate the prognostic information that can be provided by stress SPECT/CT, we assessed 2435 patients undergoing stress SPECT-MPI and CAC scanning within six months of each other. Patients were grouped into four groups of descending stress test performance: those exercising greater than or equal to 9 minutes, exercising less than 9 minutes, undergoing pharmacologic testing while performing a walk protocol, or pharmacologic testing without walking. Patients were followed for all-cause mortality (ACM) over a mean of 9.0 ± 6.4 years.

Results: During follow-up, 291 patients (12.0%) died. There was a stepwise decrease in survival with poorer stress test performance and with increasing CAC scores. Mortality was consistently higher in patients with lower stress test performance among all CAC categories. Conversely, higher CAC scores were associated with increased mortality risk across all four stress test performance groups. Patients with CAC scores greater than or equal to 400 but exercising greater than or equal to 9 minutes had a mortality rate similar to patients with zero CAC scores who could not walk during pharmacologic stress testing (8.8 vs 8.0 per 1000 person-years, P = 0.898). A multivariable analysis identified stress test performance as the strongest adverse ACM predictor, followed by age and CAC scores.

Conclusions: The combined assessment of stress test performance and the magnitude of CAC abnormality provides highly synergistic prognostic information among patients undergoing stress SPECT-MPI.

背景：应用混合应力SPECT/CT成像可以综合评估患者的运动能力和冠状动脉钙（CAC）负荷。这些综合信息在接受压力SPECT-MPI的患者中的预后效用仍然不完全清楚。方法：为了模拟应激SPECT/CT可以提供的预后信息，我们评估了2435例在6个月内进行应激SPECT- mpi和CAC扫描的患者。结果：随访期间，291例（12.0%）患者死亡。随着压力测试表现较差和CAC分数的增加，存活率逐步下降。在所有CAC类别中，压力测试表现较差的患者死亡率始终较高。相反，在所有四个压力测试表现组中，较高的CAC得分与死亡风险增加有关。在药物压力测试中，CAC评分为> - 400但运动> - 9分钟的患者的死亡率与CAC评分为零但不能行走的患者相似（每1000人年8.8 vs 8.0, p=0.898）。多变量分析发现，压力测试表现是最强的不良ACM预测因子，其次是年龄和CAC评分。结论：压力测试表现和CAC异常程度的综合评估在接受压力SPECT-MPI的患者中提供了高度协同的预后信息。

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引用次数: 0

2025 ACC/AHA/ASE/ASNC/SCCT/SCMR advanced training statement on advanced cardiovascular imaging 2025 ACC/AHA/ASE/ASNC/SCCT/SCMR高级心血管影像学培训声明：ACC能力管理委员会报告

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.nuclcard.2025.102535

引用次数: 0

CME instructions: Incremental diagnostic value of AI-derived coronary artery calcium in18F-flurpiridaz PET Myocardial Perfusion Imaging CME说明：人工智能衍生冠状动脉钙在18f -氟吡唑PET心肌灌注成像中的增量诊断价值

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.nuclcard.2025.102563

引用次数: 0

Beyond rest-stress: Expanding rapid 18F-flurpiridaz positron emission tomography to post-stress viability and quantifying coronary flow reserve 超越休息-压力：扩展快速18f -氟吡唑PET到应激后活力和量化冠状动脉血流储备。

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.nuclcard.2025.102529

Yiming Wang MD

引用次数: 0

Re-evaluating stress testing paradigms in older adults 对老年人压力测试范式的再评估。

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.nuclcard.2025.102560

Krishna K. Patel MD, MSc

引用次数: 0

Theranostics in nuclear cardiology: Approaching harbour or boundless horizon? 核心学的治疗：接近港湾还是无边无际？

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.nuclcard.2025.102481

James T. Thackeray PhD

引用次数: 0

Differential association of heart rate response to regadenoson with death and heart failure hospitalizations according to ejection fraction in patients undergoing positron emission tomography myocardial perfusion imaging 根据PET MPI患者的射血分数，再腺苷松的心率反应与死亡和心力衰竭住院的差异关系

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.nuclcard.2025.102508

Ahmed Sayed MD , Mahmoud Al Rifai MD, MPH , Ahmad El Yaman MD , Maria Alwan MD , Asim Shaikh MD , Faisal Nabi MD , Mouaz H. Al-Mallah MD, MSc

Background

Whether the prognostic value of heart rate responsiveness to pharmacological stress testing as assessed by stress or rest heart-rate ratio (HRR), adds prognostic value to contemporary PET MPI or varies according to ejection fraction (EF) has not been well-studied.

Methods

Consecutive patients undergoing Rb-82 positron emission tomography (PET) between 2019 and 2024 with regadenoson stress testing were included. The Andersen–Gill extension of the Cox model, which incorporates potentially recurrent events, was used to evaluate the association between HRR and the primary outcome, a composite of death or heart failure (HF) hospitalization. Univariable and multivariable models adjusted for clinical and PET-related variables were used. Restricted cubic splines were used to allow for nonlinearity. Interquartile hazard ratios (HRs) comparing the 75th (referent) vs the 25th percentiles of HRR were reported.

Results

Over a median follow-up of 553 days (IQR: 232 to 941 days), a total of 1,288 primary outcome events occurred among 7,808 patients. A greater HRR was associated with a lower incidence of the primary outcome in both the univariable (HR: 0.28; 95% CI: 0.23 to 0.36) and multivariable (HR: 0.60; 95% CI: 0.48 to 0.75) models. The association of HRR with the primary outcome was greater at higher EFs (P for interaction: .02), with HRs of 0.69, 0.55, 0.49, and 0.47 at EFs of 40%, 50%, 60%, and 70% respectively.

Conclusions

The prognostic value of HRR after pharmacological stress testing for death and HF hospitalization is most pronounced in patients with a preserved EF and is independent of traditional risk factors and PET parameters, including myocardial flow reserve.

背景：以应激/静息心率比（HRR）评估的心率对药理学应激试验反应性的预后价值是否随射血分数（EF）的变化而变化尚未研究。方法：纳入2019 - 2024年间连续接受Rb-82正电子发射断层扫描（PET）并进行regadenoson压力测试的患者。纳入潜在复发事件的Cox模型的Andersen-Gill扩展用于评估HRR与主要结局（死亡或心衰住院的复合结局）之间的关系。采用经临床和pet相关变量调整的单变量和多变量模型。限制三次样条用于考虑非线性。报告了第75（参考）百分位与第25百分位HRR的四分位数间比较。结果：中位随访553天（IQR: 232 ~ 941天），7808例患者共发生1288例主要结局事件。在单变量（HR: 0.28; 95% CI: 0.23 ~ 0.36）和多变量（HR: 0.60; 95% CI: 0.48 ~ 0.75）模型中，较高的HRR与较低的主要结局发生率相关。高EFs时，HRR与主要结局的相关性更大（相互作用的P值为0.02），在EFs为40%、50%、60%和70%时，HRR分别为0.69、0.55、0.49和0.47。结论：死亡和心衰住院药理学应激试验后HRR的预后价值在保留心衰患者中最为显著，且与传统危险因素和PET参数（包括心肌血流储备）无关。

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引用次数: 0

Another year we built together 又是我们共同创造的一年

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.nuclcard.2025.102590

Marcelo F. Di Carli MD, MASNC

引用次数: 0

Response to Letter to the Editor 对编辑的回应。

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.nuclcard.2025.102528

Dan J. Kadrmas PhD , Brad J. Kemp PhD , Arkadiusz Sitek PhD , Panithaya Chareonthaitawee MD

引用次数: 0

Accuracy of myocardial perfusion imaging in older patients: Insights from a sub-analysis of the AMICO registry 老年患者心肌灌注成像的准确性：来自AMICO登记亚分析的见解。

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.nuclcard.2025.102530

Riccardo Liga MD, PhD, FESC , Elena Filidei MD , Giusi Runza RT , Alessia Gimelli MD, FESC

Background

To assess the accuracy of myocardial perfusion imaging (MPI) on a cadmium–zinc-telluride camera in detecting coronary artery disease (CAD) and predicting prognosis in older patients.

Methods

Six hundred and twenty-seven older patients (aged >70 years) and the same number of matched controls were submitted to exercise or vasodilator-stress MPI and coronary angiography. The rate-pressure product (RPP) reserve (stress/rest) was computed as a measure of cardiac workload during exercise. Ischemia was defined as a summed difference score (SDS) >3. Coronary stenoses >70% were considered obstructive. Patients were followed (mean 4.1 ± 2.4 years) for a composite of cardiovascular death, nonfatal myocardial infarction, and urgent revascularization (MACE).

Results

Obstructive CAD was revealed in 426/627 patients (68%) and 410/627 controls (65%). While in the overall population MPI showed a significant accuracy for detecting obstructive CAD (AUC: .79, 95% confidence interval [CI]: .77-.82; P < .001), test accuracy seemed to decrease with older age, with older patients showing lower specificity than controls (72% vs 64%, respectively; P = .002). This difference was exclusively limited to patients undergoing exercise-stress, whereby the overall test accuracy was significantly lower in older patients than controls (AUC: .82 vs .75; P = .03). Older patients attained a significantly lower peak workload (101 ± 26 W vs 111 ± 34 W; P < .001) and RPP reserve during exercise than controls (1.9 ± .9 vs 2.2 ± .7, P < .001), resulting in an independent predictor of reduced diagnostic specificity (odds ratio: .68, 95% CI: .50-.96; P = .027). At multivariable Cox regression analysis, a higher SDS was an independent predictor of major adverse cardiac events (MACE) (HR 1.11, 95% CI: 1.07-1.14; P < .001).

Conclusions

In older patients, exercise-stress MPI shows a lower diagnostic accuracy than in controls because of an impaired exercise capacity.

背景：评价镉锌碲化照相机心肌灌注显像（MPI）检测老年冠心病及预测预后的准确性。方法和结果：627例老年患者（60 ~ 70岁）和相同数量的匹配对照进行运动或血管扩张剂应激MPI和冠状动脉造影。计算速率压力产生（RPP）储备（压力/休息）作为运动期间心脏负荷的测量。缺血定义为总差值>.3。70%的冠状动脉狭窄被认为是阻塞性的。对心血管死亡、非致死性心肌梗死和紧急血运重建术（MACE）患者进行随访（平均4.1±2.4年）。梗阻性CAD在426/627例（68%）和410/627例对照（65%）中发现。而在总体人群中，MPI在检测阻塞性CAD方面显示出显著的准确性（AUC 0.79, 95% CI 0.77-0.82）。结论：在老年患者中，由于运动能力受损，运动应激MPI的诊断准确性低于对照组。

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