Search Our Scientific Publications & Authors

J Cardiovasc Comput Tomogr 2019 Mar 28. Epub 2019 Mar 28.

Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States; Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, United States. Electronic address:

Background: The Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance.

Methods: We included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Read More

Cardiovasc Diagn Ther 2019 Feb;9(1):35-42

King Faisal Heart Institute, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.

Background: N-ammonia positron emission tomography-computed tomography (PET-CT) is being increasingly used as a non-invasive imaging modality for evaluating patients with known or suspected coronary artery disease (CAD), but information about the diagnostic accuracy of PET-MPI is sparse. Objectives: Our objective was to determine the accuracy of N-ammonia PET-CT myocardial perfusion imaging (MPI) for detecting CAD.

Methods: We retrospectively evaluated 383 patients with suspected CAD who underwent rest-stress N- ammonia PET-CT MPI. Read More

Am J Cardiol 2019 May 10;123(9):1435-1442. Epub 2019 Feb 10.

Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. Electronic address:

The prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Read More

J Nucl Cardiol 2019 Jan 25. Epub 2019 Jan 25.

Cardiology Department, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia.

Introduction: 18F-Sodium Fluoride Positron Emission Tomography (18F-NaF PET) is a novel molecular imaging modality with promise for use as a risk stratification tool in cardiovascular disease. There are limitations in the analysis of small and rapidly moving coronary arteries using traditional PET technology. We aimed to validate the use of a motion correction algorithm (eMoco) on coronary 18F-NaF PET outcome parameters. Read More

JACC Cardiovasc Imaging 2019 Jan 16. Epub 2019 Jan 16.

Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address:

Objectives: This study was designed to assess the prognostic value of a new comprehensive coronary computed tomography angiography (CTA) score compared with the stenosis severity component of the Coronary Artery Disease-Reporting and Data System (CAD-RADS).

Background: Current risk assessment with coronary CTA is mainly focused on maximal stenosis severity. Integration of plaque extent, location, and composition in a comprehensive model may improve risk stratification. Read More

EBioMedicine 2019 Jan 23;39:109-117. Epub 2018 Dec 23.

Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. Electronic address:

Background: Risk stratification is crucial to improve tailored therapy in patients with suspected coronary artery disease (CAD). This study investigated the ability of targeted proteomics to predict presence of high-risk plaque or absence of coronary atherosclerosis in patients with suspected CAD, defined by coronary computed tomography angiography (CCTA).

Methods: Patients with suspected CAD (n = 203) underwent CCTA. Read More

Eur Heart J 2018 Dec 18. Epub 2018 Dec 18.

Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.

Aims: We hypothesized that the modified Diamond-Forrester (D-F) prediction model overestimates probability of coronary artery disease (CAD). The aim of this study was to update the prediction model based on pre-test information and assess the model's performance in predicting prognosis in an unselected, contemporary population suspected of angina.

Methods And Results: We included 3903 consecutive patients free of CAD and heart failure and suspected of angina, who were referred to a single centre for assessment in 2012-15. Read More

J Cardiovasc Comput Tomogr 2018 Nov - Dec;12(6):451-466. Epub 2018 Oct 23.

Weill Cornell Medicine, USA.

This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. Read More

Int J Cardiovasc Imaging 2019 Mar 17;35(3):569-577. Epub 2018 Oct 17.

Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany.

The heart failure epidemic continues to rise with coronary artery disease as one of its main causes. Novel concepts for risk stratification to guide the referring cardiologist towards revascularization procedures are of significant value. Myocardial perfusion imaging using single-photon emission computed tomography (SPECT) agents has demonstrated high accuracy for the detection of clinically relevant stenoses. Read More

Curr Cardiovasc Imaging Rep 2018 Jan 19;11(1). Epub 2018 Jan 19.

Departments of Imaging, Medicine and Biomedical Sciences, Cedars-Sinai Medical Center; Los Angeles, CA.

Purpose Of Review: The use of quantitative analysis in single photon emission computed tomography (SPECT) and positron emission tomography (PET) has become an integral part of current clinical practice and plays a crucial role in the detection and risk stratification of coronary artery disease. Emerging technologies, new protocols, and new quantification methods have had a significant impact on the diagnostic performance and prognostic value of nuclear cardiology imaging, while reducing the need for clinician oversight. In this review, we aim to describe recent advances in automation and quantitative analysis in nuclear cardiology. Read More

J Cardiovasc Magn Reson 2018 09 24;20(1):68. Epub 2018 Sep 24.

University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.

Background: The purpose of this work is to describe the objectives and design of cardiovascular magnetic resonance (CMR) imaging in the single center, prospective, population-based Hamburg City Health study (HCHS). The HCHS aims at improving risk stratification for coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF).

Methods: The HCHS will finally include 45,000 inhabitants of the city of Hamburg (Germany) between 45 and 74 years who undergo an extensive cardiovascular evaluation and collection of biomaterials. Read More

J Formos Med Assoc 2019 Mar 19;118(3):721-729. Epub 2018 Sep 19.

Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.

Background: Some personality types are associated with cardiovascular (CV) diseases and may be related to clinical outcomes in coronary artery disease (CAD). This study investigates the association between type D personality and clinical outcomes in stable CAD patients in an Asian cohort.

Methods: Stable CAD patients were enrolled and prospectively followed up for at least 1 year in Taiwan. Read More

J Nucl Cardiol 2018 Sep 20. Epub 2018 Sep 20.

Nuclear Medicine Department, Royal Brompton & Harefield Trust, London, UK.

Background: Myocardial perfusion imaging (MPI) with Rb PET/CT is increasingly utilized in the evaluation of coronary artery disease with high diagnostic accuracy. Various softwares for data processing have been developed over the years with conflicting data regarding their reproducibility. In this study, we compared the quantitative results of myocardial perfusion and exam classification from three different softwares. Read More

JACC Clin Electrophysiol 2018 Sep 25;4(9):1200-1210. Epub 2018 Jul 25.

Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address:

Objectives: This study sought to investigate the association of myocardial scar and ischemia with major arrhythmic events (MAEs) in patients with left ventricular ejection fraction (LVEF) ≤35%.

Background: Although myocardial scar is a known substrate for ventricular arrhythmias, the association of myocardial ischemia with ventricular arrhythmias in stable patients with left ventricular dysfunction is less clear.

Methods: A total of 439 consecutive patients (median age, 70 years; 78% male; 55% with implantable cardioverter defibrillator [ICD]) referred for stress/rest positron emission tomography (PET) and resting LVEF ≤35% were included. Read More

JACC Cardiovasc Imaging 2018 Aug;11(8):1173-1186

Departments of Cardiology and Cardiovascular Surgery, Heart Valve Clinic, University of Liège Hospital, Grappe Interdisciplinaire de Génoprotéomique Appliquée Cardiovascular Sciences, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium, and Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy.

Cancer therapy can be associated with both cardiac and vascular toxicity. Advanced multi-modality imaging can be used to stratify patient risk, identify cardiovascular injury during and after therapy, and forecast recovery. Echocardiography continues to be the mainstay in the evaluation of cardiac toxicity. Read More

Clin Nucl Med 2018 Sep;43(9):e341-e342

From the Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Myocardial perfusion imaging (MPI) is one of the most commonly used nuclear medicine imaging modalities for coronary artery disease evaluation and risk stratification. The authors present incidental image findings in a patient who underwent MPI twice because of development of seizures just before the first SPECT-MPI acquisition. The projection images for first MPI done without medication (phenytoin) showed the retention of hepatic tracer activity. Read More

Circ Cardiovasc Imaging 2018 Jul;11(7):e007562

Division of Cardiology, Severance Cardiovascular Hospital (H.-J.C., S.-E.L., J.M.S.)

Background: Diagnosis of coronary artery disease and management strategies have relied solely on the presence of diameter stenosis ≥50%. We assessed whether direct quantification of plaque burden (PB) and plaque characteristics assessed by coronary computed tomography angiography could provide additional value in terms of predicting rapid plaque progression.

Methods And Results: From a 13-center, 7-country prospective observational registry, 1345 patients (60. Read More

J Nucl Cardiol 2018 Oct 15;25(5):1521-1545. Epub 2018 Jun 15.

Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene St., Baltimore, MD, 21201, USA.

Background: The effect of time-of-flight (TOF) and point spread function (PSF) modeling in image reconstruction has not been well studied for cardiac PET. This study assesses their separate and combined influence on Rb myocardial perfusion imaging in obese patients.

Methods: Thirty-six obese patients underwent rest-stress Rb cardiac PET. Read More

Eur J Nucl Med Mol Imaging 2018 10 19;45(11):1964-1974. Epub 2018 May 19.

Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.

Purpose: Evidence to date on the unique female determinants of cardiovascular risk is inadequate. Positron Emission Tomography (PET) is considered to have the highest accuracy for the assessment of myocardial perfusion in patients with suspected coronary artery disease (CAD), but its long-term prognostic accuracy in women has not been established.

Methods: A total of 619 consecutive patients (138 women, mean age 60. Read More

J Nucl Cardiol 2018 May 14. Epub 2018 May 14.

Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

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. Read More

J Cardiovasc Comput Tomogr 2018 May - Jun;12(3):204-209. Epub 2018 Apr 30.

Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA. Electronic address:

Introduction: Machine learning (ML) is a field in computer science that demonstrated to effectively integrate clinical and imaging data for the creation of prognostic scores. The current study investigated whether a ML score, incorporating only the 16 segment coronary tree information derived from coronary computed tomography angiography (CCTA), provides enhanced risk stratification compared with current CCTA based risk scores.

Methods: From the multi-center CONFIRM registry, patients were included with complete CCTA risk score information and ≥3 year follow-up for myocardial infarction and death (primary endpoint). Read More

BMJ Evid Based Med 2018 Aug 5;23(4):142-149. Epub 2018 May 5.

Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.

Background: Cardiovascular risk assessment and stratification of stable coronary artery disease represents a pivotal component of coronary artery disease management. The introduction of risk stratification tools has advanced the detection of patients with intermediate to high risk for coronary artery events. These patients will ultimately undergo non-invasive and invasive cardiovascular testing. Read More

Eur J Prev Cardiol 2018 Jul 3;25(11):1156-1166. Epub 2018 May 3.

1 Department of Cardiology, Odense University Hospital, Denmark.

Background Coronary artery calcium is important in cardiovascular risk stratification, but this knowledge is based on studies with a significant selection bias. This study aims to evaluate the external validity of a screening programme including coronary artery calcium examination, and the association between coronary artery calcium and cardiovascular events. Design Multi-centre population based study. Read More

Clin Nucl Med 2018 Jun;43(6):468-470

Extracardiac uptake on SPECT MPI, seen with physiologic radiotracer distribution, benign or malignant neoplasm, infection, inflammation, or granulomatous disease, may confound the accuracy of MPI or lead to unsuspected pathology. A 38-year-old woman with end-stage renal disease on hemodialysis had SPECT MPI for renal transplant preoperative risk stratification, showing left anterior descending artery ischemia and an intense extracardiac soft tissue focus adjacent to the diaphragmatic right ventricle concerning for focal infection related to prior coronary or gastric surgeries or tumor. CT revealed focal herniation of liver containing a flash-fill hemangioma into the left hemithorax accounting for this focal uptake. Read More

Kardiol Pol 2018 5;76(6):1002-1008. Epub 2018 Feb 5.

KARTAL KOSUYOLU RESEARCH AND TRAINING HOSPITAL, TURKEY.

Background: Epicardial adipose tissue (EAT) is thought to be associated with the extension and severity of coronary artery disease (CAD), and echocardiographic measurement of EAT thickness is considered to be a possible cardiovascular risk indica-tor. The European Society of Cardiology Task Force recommends further non-invasive testing in patients with an intermediate pre-test probability (PTP) for the diagnosis of CAD.

Aim: We sought to evaluate the clinical usefulness of performing EAT measurements in patients with a high-intermediate PTP. Read More

PLoS One 2017 7;12(12):e0189269. Epub 2017 Dec 7.

Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Objectives: With the increasing use of multi-detector CT, the number of detected cases with coronary-to-pulmonary artery fistula (CPAF) has increased. Several previous studies reported severe cases of angina, but no appropriate tests to evaluate myocardial perfusion for patients with CPAF have been established. We evaluated the hemodynamic characteristics of CPAF using thallium-201 (Tl-201) single photon emission computed tomography (SPECT). Read More

Eur J Nucl Med Mol Imaging 2018 04 27;45(4):538-548. Epub 2017 Nov 27.

Canada, Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.

Background: Prognostic value of positron emission tomography (PET) myocardial perfusion imaging (MPI) is well established. There is paucity of data on how the prognostic value of PET relates to the hemodynamic response to vasodilator stress. We hypothesize that inadequate hemodynamic response will affect the prognostic value of PET MPI. Read More

Heart 2018 06 23;104(11):888-894. Epub 2017 Nov 23.

Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.

Cardiovascular magnetic resonance (CMR) assesses cardiac function, ischaemia, viability and tissue characterisation, all within a single scan. Many studies regarding the role of CMR in stable coronary artery disease (CAD) have been published over the last decade providing important technical advances, large-scale clinical validation and prognostic data. As a result, CMR has emerged as a highly accurate technique for diagnosis and risk stratification in stable CAD and has been incorporated into national and international guidelines. Read More

Eur J Nucl Med Mol Imaging 2018 04 22;45(4):567-574. Epub 2017 Nov 22.

Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan.

Purpose: In patients with stable coronary artery disease (CAD), two main options exist to guide management: initial invasive coronary angiography (CAG), or selective CAG after risk stratification using myocardial perfusion imaging (MPI). This study compared clinical outcomes between these two strategies in a large, real-world population.

Methods: The initial cohort comprised 1,000,000 randomly selected patients who had been entered in the National Health Insurance Research Database of Taiwan between 2000 and 2011. Read More

Heart Vessels 2018 May 15;33(5):453-461. Epub 2017 Nov 15.

Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.

In patients with ST-segment elevation myocardial infarction (STEMI), it is unclear if combined assessment of left ventricular end-diastolic pressure (LVEDP) and left ventricular ejection fraction (LVEF) improves prediction of major adverse cardiac events (MACE). We analyzed data from 266 STEMI patients who underwent successful percutaneous coronary intervention and subsequent left ventriculography (LVG). Patients were divided into 4 groups, as follows: Group 1, LVEDP < 21 mmHg and LVEF ≥ 55%; Group 2, LVEDP < 21 mmHg and LVEF < 55%; Group 3, LVEDP ≥ 21 mmHg and LVEF ≥ 55%; and Group 4, LVEDP ≥ 21 mmHg and LVEF < 55%. Read More

Proc Natl Acad Sci U S A 2017 11 27;114(46):12344-12349. Epub 2017 Oct 27.

Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114;

The complete blood count (CBC) provides a high-level assessment of a patient's immunologic state and guides the diagnosis and treatment of almost all diseases. Hematology analyzers evaluate CBCs by making high-dimensional single-cell measurements of size and cytoplasmic and nuclear morphology in high throughput, but only the final cell counts are commonly used for clinical decisions. Here, we utilize the underlying single-cell measurements from conventional clinical instruments to develop a mathematical model guided by cellular mechanisms that quantifies the population dynamics of neutrophil, lymphocyte, and monocyte characteristics. Read More

Curr Cardiol Rep 2017 10 18;19(12):121. Epub 2017 Oct 18.

Department of Cardiology, Northwick Park Hospital, Harrow, UK.

Purpose Of Review: Stress echocardiography (SE) is a well-established technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). This review article summarizes the status of SE in CAD, including testing protocols, clinical efficacy and current use of newer technologies: myocardial perfusion, strain imaging, three-dimensional echocardiography and adjunctive carotid ultrasonography.

Recent Findings: Recent major findings in SE include the clinical value of myocardial perfusion imaging in multicentre studies, as well as when added to left ventricular (LV) wall motion assessment in clinical service. Read More

Eur Heart J Cardiovasc Imaging 2018 04;19(4):459-460n

Department of Cardiology, Heart Valve Clinic, CHU Sart Tilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Liège, Belgium.

Aims: To develop a document by Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI) to review and summarize the most recent evidences about the non-invasive assessment of patients with Chagas disease, with the intent to set up a framework for standardized cardiovascular imaging to assess cardiovascular morphologic and functional disturbances, as well as to guide the subsequent process of clinical decision-making.

Methods And Results: Chagas disease remains one of the most prevalent infectious diseases in Latin America, and has become a health problem in non-endemic countries. Dilated cardiomyopathy is the most severe manifestation of Chagas disease, which causes substantial disability and early mortality in the socially most productive population leading to a significant economical burden. Read More

Ann Nucl Med 2018 Jan 6;32(1):22-33. Epub 2017 Oct 6.

Department of Radiology, Graduate School of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.

Objective: To examine the additional prognostic value of coronary CT angiography (CTA) over myocardial perfusion imaging (MPI) in patients with suspected or known coronary artery disease.

Methods: A series of 157 patients (mean age 69 ± 9 years; 76% male; median follow-up 49 months; range 12-82 months) underwent stress MPI with SPECT and coronary CTA within a 6-month interval. Summed stress score (SSS) and summed difference score (SDS) of stress MPI, number of vessels with stenosis, and presence of left main trunk stenosis and high-risk plaques on coronary CTA were examined. Read More

Clin Nucl Med 2017 Dec;42(12):918-927

From the *UT Southwestern Medical Center, Dallas, TX; †Baptist Hospital of Miami, Miami, FL; ‡Mayo Clinic, Rochester, MN; §University of Washington, Seattle, WA; ∥Lenox Hill Radiology, New York, NY; ¶MD Anderson, Houston, TX; **University of Pennsylvania; and ††Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA.

This clinical practice parameter has been developed collaboratively by the American College of Radiology (ACR), the Society for Pediatric Radiology (SPR), and the Society of Thoracic Radiology (STR). This document is intended to act as a guide for physicians performing and interpreting positron emission tomography-computed tomography (PET/CT) of cardiac diseases in adults and children. The primary value of cardiac PET/CT imaging include evaluation of perfusion, function, viability, inflammation, anatomy, and risk stratification for cardiac-related events such as myocardial infarction and death. Read More

JACC Cardiovasc Imaging 2018 Jun 13;11(6):842-854. Epub 2017 Sep 13.

Department of Cardiology, Hospital Unit West, Herning, Denmark.

Objectives: This study sought to perform a prospective head-to-head comparison of the predictive value of clinical risk factors and a variety of cardiac imaging modalities including coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography (ICA) on major adverse cardiac events (MACE) and all-cause mortality in kidney transplantation candidates.

Background: Current guidelines recommend screening for coronary artery disease in kidney transplantation candidates. Furthermore, noninvasive stress imaging is recommended in current guidelines, despite its low diagnostic accuracy and uncertain prognostic value. Read More

Eur J Nucl Med Mol Imaging 2017 Dec 16;44(13):2290-2298. Epub 2017 Aug 16.

Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.

Purpose: To evaluate the prognostic value of coronary atherosclerotic burden, assessed by coronary artery calcium (CAC) score, and coronary vascular function, assessed by coronary flow reserve (CFR) in patients with suspected coronary artery disease (CAD).

Methods: We studied 436 patients undergoing hybrid Rb positron emission tomography/computed tomography imaging. CAC score was measured according to the Agatston method, and patients were categorized into three groups (0, <400, and ≥400). Read More

Am J Cardiol 2017 Oct 20;120(7):1098-1103. Epub 2017 Jul 20.

Department of Cardiology, University Hospital, Basel, Switzerland. Electronic address:

Our study aimed to assess predictors of the stress test technique used and to evaluate the impact of exercise level achieved on risk stratification in patients with asymptomatic type 2 diabetes without a previous coronary artery disease. Little is known whether co-morbidities of these patients predict the stress technique and whether physical performance provides risk stratification: 400 patients underwent clinical evaluation and myocardial perfusion scintigraphy (MPS) using physical or pharmacological stress. Physical patients were divided into 2 groups: achieving <6 and ≥6 METs, respectively. Read More

Int J Cardiol 2017 Oct;244:37-42

Department of Cardiology, University Hospital, University of Basel, Switzerland.

Aims: Evaluation of predictors of silent coronary artery disease (SCAD) in high-risk asymptomatic diabetic patients and to evaluate their two-year outcome.

Methods And Results: Four hundred diabetic patients without prior CAD but at high CAD risk underwent myocardial perfusion scintigraphy (MPS) in this prospective multicentre outcome trial. MPS were abnormal in 22% of patients. Read More

Rev Esp Med Nucl Imagen Mol 2017 Nov - Dec;36(6):377-387. Epub 2017 Jul 25.

Sección Medicina Nuclear, Departamento Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.

A discussion is presented on the current use of radioisotopes for evaluation of coronary artery disease in relation to other available techniques. The review is focused on coronary artery disease risk stratification employing single photon emission computed tomography and positron emission tomography, as well as on ischaemic cardiomyopathy and myocardial viability applications. Concepts are presented regarding coronary blood flow reserve, diagnostic and prognostic values, criteria for its appropriate use, as well as current methods to reduce unnecessary patient irradiation, in order to optimise nuclear cardiology practice. Read More

Trials 2017 07 28;18(1):358. Epub 2017 Jul 28.

Heart Clinic Ulm, Ulm, Germany.

Background: Current guidelines for the diagnosis and management of patients with stable coronary artery disease (CAD) recommend functional stress testing for risk stratification prior to revascularization procedures. Cardiac magnetic resonance imaging (CMR) is a modality of choice for stress testing because of its capability to detect myocardial ischemia sensitively and specifically. Nevertheless, evidence from randomized trials evaluating a CMR-based management of stable CAD patients in comparison to a more common angiography-based approach still is limited. Read More

G Ital Nefrol 2017 Mar;34(Suppl 69):205-222

Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.

Imaging has contributed to the successful reduction of cardiovascular morbidity and mortality in the general population and it has demonstrated excellent potential among patients with chronic kidney disease (CKD). The well-known severity of cardiovascular disease in patients suffering from CKD requires an accurate risk stratification of these patients in several clinical situations. Alterations of both structure and function of the myocardium as well as severe vasculopathy are highly prevalent in patients with advanced CKD. Read More

Isr Med Assoc J 2017 Jun;19(6):368-371

Leviev Heart Center, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: While patients presenting to emergency departments (ER) with chest pain are increasingly managed in chest pain units (CPU) that utilize accelerated diagnostic protocols for risk stratification, such as single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), data are lacking regarding the prognostic implications of mildly abnormal scans in this population.

Objectives: To evaluate the prognostic implications of mildly abnormal SPECT MPI results in patients with acute chest pain.

Methods: Of the 3753 chest pain patients admitted to the CPU at the Leviev Heart Center, Sheba Medical Center 1593 were further evaluated by SPECT MPI. Read More

Med Phys 2017 Sep 9;44(9):4536-4547. Epub 2017 Aug 9.

Department of Electrical and Computer Engineering, Oakland University, Rochester, MI, 48309, USA.

Purpose: Myocardial perfusion (MP) PET imaging is a powerful tool in risk assessment and stratification of patients with coronary artery disease. Involuntary organ motion degrades cardiac PET image resolution, while respiratory and/or cardiac gating to freeze the motion leads to noisier reconstructed images due to reduced counts in the gated frames. In this work, we propose an MRI-assisted dual motion correction method to compensate for respiratory and cardiac motion in MP PET data and study the impact of dual motion correction on MP defect detection using systematically designed experiments. Read More

Ochsner J 2017 ;17(2):208-212

Division of Cardiology, The Brooklyn Hospital Center, New York, NY.

Background: Chest pain is a common presenting symptom in the emergency department (ED). Although the diagnostic workup for chest pain is well established, the best time to perform invasive cardiac catheterization in patients with low to moderate risk of coronary artery disease is still unclear, particularly if noninvasive tests such as the electrocardiogram (ECG) and nuclear myocardial perfusion scan show nonsignificant findings.

Case Report: We present the case of a 52-year-old female who presented to the ED with acute-onset chest pain that had started early in the morning while she was sleeping. Read More

Int J Cardiovasc Imaging 2017 Dec 13;33(12):2039-2047. Epub 2017 Jun 13.

Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, No. 32, Section 2, 1st Ring Road (West), Chengdu, 610072, Sichuan Province, China.

To compare the ability of CT angiography (CTA) obstruction score and perfusion defect score on dual energy CT perfusion imaging (DEPI) for clinical risk stratification of patients with acute pulmonary embolism (PE). 55 patients diagnosed as acute PE either by CTA or DEPI were retrospectively enrolled. Patients were grouped into high-, intermediate-, and low-risk groups in accordance to the renewed guidelines of 2014. Read More

Eur J Nucl Med Mol Imaging 2017 Aug 8;44(9):1547-1558. Epub 2017 Jun 8.

Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece.

Purpose: Evaluation of the long-term prognostic value of myocardial perfusion imaging (MPI) in octogenarians.

Methods: Six hundred and twenty-nine octogenarians [51% previous myocardial infarction (MI) or revascularization] who underwent single-isotope MPI (78% Tl, 22% Tc-tetrofosmin) with exercise (38% Bruce, 2% leg ergometry) or pharmacologic (58% adenosine, 2% dobutamine) stress were studied. All patients had LVEF determined by echocardiography within 1 month from MPI. Read More

Circ Cardiovasc Imaging 2017 Jun;10(6):e005841

From the Vita-Salute University and San Raffaele Hospital, Milan, Italy (A.D., A.L., G.B., A.E., A.M., F.D., A.C., P.G.C.); CNR-IBFM, Segrate, Italy (O.R.).

Background: The incidence of angiographic no reflow (NR) and microvascular obstruction (MVO) at cardiac magnetic resonance is significantly different. The aim of this study was to investigate the occurrence of NR and MVO in a cohort of consecutive patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary interventions.

Methods And Results: In this prospective study, 88 consecutive ST-segment-elevation myocardial infarction patients were enrolled within 12 hours from symptoms onset. Read More

J Am Heart Assoc 2017 May 31;6(6). Epub 2017 May 31.

Policlinico di Bari, Bari, Italy.

Background: The assessment of myocardial perfusion (MP) and wall motion (WM) using contrast dipyridamole echocardiography (cSE-WMP) improves the sensitivity to detect coronary artery disease and the stratification of cardiac events, but its long-term value for fatal and nonfatal ischemic cardiac events, also with respect to patients undergoing revascularization or not, remains to be determined.

Methods And Results: One-thousand three-hundred and twenty-nine patients with suspect or known CAD who underwent cSE-WMP were followed for a median 5.5 years. Read More

Nucl Med Mol Imaging 2017 Jun 22;51(2):101-105. Epub 2016 Apr 22.

Department of Radiology, Incheon Saint Mary's Hospital, The Catholic University of Korea, #56 Dongsuro, Bupyeong-gu, Incheon, 403-720 South Korea.

The first step to nuclear medicine in Korea started with introduction of the gamma camera in 1969. Although planar images with the gamma camera give important functional information, they have the limitations that result from 2-dimensional images. Single-photon emission computed tomography (SPECT) due to its 3-dimensional image acquisition is superior to earlier planar gamma imaging in image resolution and diagnostic accuracy. Read More