Publications
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Mazzanti M, Shirka E, Pugliese F, et al., 2018, Underuse of non-invasive functional imaging in patients at intermediate risk of coronary artery disease. A decision support system in the clinical practice. The ARTICA database, European-Society-of-Cardiology Congress, Publisher: OXFORD UNIV PRESS, Pages: 41-41, ISSN: 0195-668X
Driessen RS, Raijmakers PG, Danad I, et al., 2018, Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease, European Journal of Nuclear Medicine and Molecular Imaging, Vol: 45, Pages: 1091-1100, ISSN: 1619-7070
PurposeTraditionally, interpretation of myocardial perfusion imaging (MPI) is based on visual assessment. Computer-based automated analysis might be a simple alternative obviating the need for extensive reading experience. Therefore, the aim of the present study was to compare the diagnostic performance of automated analysis with that of expert visual reading for the detection of obstructive coronary artery disease (CAD).Methods206 Patients (64% men, age 58.2 ± 8.7 years) with suspected CAD were included prospectively. All patients underwent 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) and invasive coronary angiography with fractional flow reserve (FFR) measurements. Non-corrected (NC) and attenuation-corrected (AC) SPECT images were analyzed both visually as well as automatically by commercially available SPECT software. Automated analysis comprised a segmental summed stress score (SSS), summed difference score (SDS), stress total perfusion deficit (S-TPD), and ischemic total perfusion deficit (I-TPD), representing the extent and severity of hypoperfused myocardium. Subsequently, software was optimized with an institutional normal database and thresholds. Diagnostic performances of automated and visual analysis were compared taking FFR as a reference.ResultsSensitivity did not differ significantly between visual reading and most automated scoring parameters, except for SDS, which was significantly higher than visual assessment (p < 0.001). Specificity, however, was significantly higher for visual reading than for any of the automated scores (p < 0.001 for all). Diagnostic accuracy was significantly higher for visual scoring (77.2%) than for all NC images scores (p < 0.05), but not compared with SSS AC and S-TPD AC (69.8% and 71.2%, p = 0.063 and p = 0.134). After optimization of the automated software, diagnostic accuracies were similar for vi
Nunes MCP, Badano LP, Antonio Marin-Neto J, et al., 2018, Multimodality imaging evaluation of Chagas disease: an expert consensus of Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI), EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol: 19, Pages: 459-+, ISSN: 2047-2404
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- Citations: 37
Thygesen K, Alpert JS, Jaffe AS, et al., 2018, [Fourth universal definition of myocardial infarction (2018)]., Kardiol Pol, Vol: 76, Pages: 1383-1415
Stirrup J, Voss U, Gregg S, et al., 2017, Inter-study reproducibility of SPECT <SUP>123</SUP>I-mIBG left atrial innervation imaging for the identification of left atrial ganglionated plexi in patients with paroxysmal atrial fibrillation, Publisher: SPRINGER, Pages: S266-S266, ISSN: 1619-7070
Danad I, Raijmakers PG, Driessen RS, et al., 2017, Comparison of Coronary CT Angiography, SPECT, PET, and Hybrid Imaging for Diagnosis of Ischemic Heart Disease Determined by Fractional Flow Reserve., JAMA Cardiol, Vol: 2, Pages: 1100-1107
Importance: At present, the choice of noninvasive testing for a diagnosis of significant coronary artery disease (CAD) is ambiguous, but nuclear myocardial perfusion imaging with single-photon emission tomography (SPECT) or positron emission tomography (PET) and coronary computed tomography angiography (CCTA) is predominantly used for this purpose. However, to date, prospective head-to-head studies are lacking regarding the diagnostic accuracy of these imaging modalities. Furthermore, the combination of anatomical and functional assessments configuring a hybrid approach may yield improved accuracy. Objectives: To establish the diagnostic accuracy of CCTA, SPECT, and PET and explore the incremental value of hybrid imaging compared with fractional flow reserve. Design, Setting, and Participants: A prospective clinical study involving 208 patients with suspected CAD who underwent CCTA, technetium 99m/tetrofosmin-labeled SPECT, and [15O]H2O PET with examination of all coronary arteries by fractional flow reserve was performed from January 23, 2012, to October 25, 2014. Scans were interpreted by core laboratories on an intention-to-diagnose basis. Hybrid images were generated in case of abnormal noninvasive anatomical or functional test results. Main Outcomes and Measures: Hemodynamically significant stenosis in at least 1 coronary artery as indicated by a fractional flow reserve of 0.80 or less and relative diagnostic accuracy of SPECT, PET, and CCTA in detecting hemodynamically significant CAD. Results: Of the 208 patients in the study (76 women and 132 men; mean [SD] age, 58 [9] years), 92 (44.2%) had significant CAD (fractional flow reserve ≤0.80). Sensitivity was 90% (95% CI, 82%-95%) for CCTA, 57% (95% CI, 46%-67%) for SPECT, and 87% (95% CI, 78%-93%) for PET, whereas specificity was 60% (95% CI, 51%-69%) for CCTA, 94% (95% CI, 88%-98%) for SPECT, and 84% (95% CI, 75%-89%) for PET. Single-photon emission tomography was found to be noninferior to PET in terms of
Stirrup JE, Underwood SR, 2017, PET should not replace routine SPECT MPS for the assessment of patients with known or suspected CAD., Journal of Nuclear Cardiology, Vol: 24, Pages: 1960-1964, ISSN: 1071-3581
Single-photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (MPS) has been widely available for decades and has been extensively validated for the diagnosis and risk assessment of patients with known or suspected coronary artery disease (CAD).1,2 It has a class I indication in both US and European guidelines.3,4 The major part of this validation has been against invasive coronary angiography, largely reflecting the anatomical thinking historically prevalent in cardiology practice. The sensitivity and normalcy of SPECT MPS for the detection of angiographically defined significant CAD is 85%-90% and 89%, respectively,2 although lower figures are not uncommon in studies subject to post-test referral bias or where the images are interpreted in the absence of the usual clinical information. When compared with invasive coronary angiography with fractional flow reserve, sensitivity is maintained but specificity is lower (61%).5 Regardless, the prognostic value of normal MPS is well recognized, with an annual coronary event rate <1%.6 Although such patients may be further stratified by anatomical tests such as invasive or CT coronary angiography, patients with a normal study can usually be reassured without the need for further testing. Those with abnormal MPS have a seven-fold higher annual risk of myocardial infarction and death compared with those with normal studies7 and the coronary event rate increases with ischemic burden.6
Tragardh E, Tan SS, Bucerius J, et al., 2017, Systematic review of cost-effectiveness of myocardial perfusion scintigraphy in patients with ischaemic heart disease, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol: 18, Pages: 825-+, ISSN: 2047-2404
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- Citations: 12
Stirrup JE, Voss U, Gregg S, et al., 2017, 123I-mIBG left atrial innervation imaging localises ganglionated plexi verified by high-frequency stimulation during AF ablation and is affected by reader confidence and uptake location, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 10-10, ISSN: 0195-668X
Stirrup JE, Voss U, Gregg S, et al., 2017, Systolic exclusion and respiratory gating of SPECT 1231-mIBG left atrial innervation imaging improves localisation of left atrial ganglionated plexi verified during AF ablation, Publisher: OXFORD UNIV PRESS, Pages: 434-435, ISSN: 0195-668X
Neglia D, Liga R, Caselli C, et al., 2017, Anatomic and functional imaging to predict long-term outcome and benefits of early revascularization in patients with suspected coronary artery disease: results from the EVINCI study, Publisher: OXFORD UNIV PRESS, Pages: 1019-1020, ISSN: 0195-668X
Voss U, Stirrup J, Gregg S, et al., 2017, Image integration of dual radio-nuclide imaging of perfusion and sympathetic activity with 3D CT for ventricular arrhythmia management in patients with ischemic and non-ischemic substrates, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 168-168, ISSN: 0195-668X
Caselli C, Liga R, Prontera C, et al., 2017, High-sensitive cardiac troponin I is associated with the extent of coronary atherosclerosis and predicts outcome in patients with suspected stable CAD, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 193-193, ISSN: 0195-668X
Mazzanti M, Pugliese F, Goda A, et al., 2017, Artificial intelligence in cardiology by clinical decision support system to predict correct diagnosis in subjects with stable chest pain from ARTICA co-operative database, Publisher: OXFORD UNIV PRESS, Pages: 655-656, ISSN: 0195-668X
Caselli C, Prontera C, Lorenzoni V, et al., 2017, Combined hs-cTnT and NT-proBNP plasma levels identify patients with high risk stable coronary artery disease and early LV dysfunction., Publisher: WILEY, Pages: 128-128, ISSN: 1388-9842
Carpeggiani C, Picano E, Brambilla M, et al., 2017, Variability of radiation doses of cardiac diagnostic imaging tests: the RADIO-EVINCI study (RADIationdOse subproject of the EVINCI study), BMC CARDIOVASCULAR DISORDERS, Vol: 17, ISSN: 1471-2261
Bouyoucef SE, Mercuri M, Pascual TN, et al., 2017, Nuclear cardiology practices and radiation exposure in Africa: results from the IAEA Nuclear Cardiology Protocols Study (INCAPS)., Cardiovasc J Afr, Vol: 28, Pages: 229-234
OBJECTIVE: While nuclear myocardial perfusion imaging (MPI) offers many benefits to patients with known or suspected cardiovascular disease, concerns exist regarding radiation-associated health effects. Little is known regarding MPI practice in Africa. We sought to characterise radiation doses and the use of MPI best practices that could minimise radiation in African nuclear cardiology laboratories, and compare these to practice worldwide. METHODS: Demographics and clinical characteristics were collected for a consecutive sample of 348 patients from 12 laboratories in six African countries over a one-week period from March to April 2013. Radiation effective dose (ED) was estimated for each patient. A quality index (QI) enumerating adherence to eight best practices, identified a priori by an IAEA expert panel, was calculated for each laboratory. We compared these metrics with those from 7 563 patients from 296 laboratories outside Africa. RESULTS: Median (interquartile range) patient ED in Africa was similar to that of the rest of the world [9.1 (5.1-15.6) vs 10.3 mSv (6.8-12.6), p = 0.14], although a larger proportion of African patients received a low ED, ≤ 9 mSv targeted in societal recommendations (49.7 vs 38.2%, p < 0.001). Bestpractice adherence was higher among African laboratories (QI score: 6.3 ± 1.2 vs 5.4 ± 1.3, p = 0.013). However, median ED varied significantly among African laboratories (range: 2.0-16.3 mSv; p < 0.0001) and QI range was 4-8. CONCLUSION: Patient radiation dose from MPI in Africa was similar to that in the rest of the world, and adherence to best practices was relatively high in African laboratories. Nevertheless there remain opportunities to further reduce radiation exposure to African patients from MPI.
Kouranos V, See JJH, Rojas B, et al., 2017, Patterns Of Cardiac Pet With Myocardial Perfusion Scan In Cardiac Sarcoidosis, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Carpeggiani C, Picano E, Brambilla M, et al., 2016, Variability of radiation doses of cardiac imaging tests: data from the RADIO-EVINCI study (RADIation dOse subproject of the EVINCI study), Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 62-63, ISSN: 0195-668X
Verbanck S, Ghorbaniasl G, Biddiscombe MF, et al., 2016, Inhaled aerosol distribution in human airways: a scintigraphy-guided study in a 3D printed model, Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol: 29, Pages: 525-533, ISSN: 1941-2711
Background: While it is generally accepted that inertial impaction will lead to particle loss as aerosol is being carried into the pulmonary airways, most predictive aerosol deposition models adopt the hypothesis that the inhaled particles that remain airborne will distribute according to the gas flow distribution between airways downstream.Methods: Using a 3D printed cast of human airways, we quantified particle deposition and distribution and visualized their inhaled trajectory in the human lung. The human airway cast was exposed to 6 μm monodisperse, radiolabeled aerosol particles at distinct inhaled flow rates and imaged by scintigraphy in two perpendicular planes. In addition, we also imaged the distribution of aerosol beyond the airways into the five lung lobes. The experimental aerosol deposition patterns could be mimicked by computational fluid dynamic (CFD) simulation in the same 3D airway geometry.Results: It was shown that for particles with a diameter of 6 μm inhaled at flows up to 60 L/min, the aerosol distribution over both lungs and the individual five lung lobes roughly followed the corresponding distributions of gas flow. While aerosol deposition was greater in the main bronchi of the left versus right lung, distribution of deposited and suspended particles toward the right lung exceeded that of the left lung. The CFD simulations also predict that for both 3 and 6 μm particles, aerosol distribution between lung units subtending from airways in generation 5 did not match gas distribution between these units and that this effect was driven by inertial impaction.Conclusions: We showed combined imaging experiments and CFD simulations to systematically study aerosol deposition patterns in human airways down to generation 5, where particle deposition could be spatially linked to the airway geometry. As particles are negotiating an increasing number of airways in subsequent branching generations, CFD predicts marked dev
Biswas S, Better N, Pascual TNB, et al., 2016, Nuclear Cardiology Practices and Radiation Exposure in the Oceania Region: Results From the IAEA Nuclear Cardiology Protocols Study (INCAPS), HEART LUNG AND CIRCULATION, Vol: 26, Pages: 25-34, ISSN: 1443-9506
Caselli C, Lorenzoni V, Lombardi M, et al., 2016, Inducible myocardial ischemia due to obstructive coronary artery disease is associated with subclinical LV dysfunction in patients with stable angina, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 18, Pages: 419-419, ISSN: 1388-9842
Caselli C, Prontera C, Lorenzoni V, et al., 2016, Bio-humoral determinants of early LV dysfunction in patients with stable angina., EUROPEAN JOURNAL OF HEART FAILURE, Vol: 18, Pages: 243-243, ISSN: 1388-9842
Underwood R, Wechalekar K, 2016, Cardiovascular disease in the literature: A selection of recent original research papers, Journal of Nuclear Cardiology, Vol: 23, Pages: 655-656, ISSN: 1532-6551
Shi L, Dorbala S, Paez D, et al., 2016, Gender Differences in Radiation Dose From Nuclear Cardiology Studies Across the World: Findings From the INCAPS Registry., JACC Cardiovasc Imaging, Vol: 9, Pages: 376-384
OBJECTIVES: The aim of this study was to investigate gender-based differences in nuclear cardiology practice globally, with a particular focus on laboratory volume, radiation dose, protocols, and best practices. BACKGROUND: It is unclear whether gender-based differences exist in radiation exposure for nuclear cardiology procedures. METHODS: In a large, multicenter, observational, cross-sectional study encompassing 7,911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was used to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. The study also included the United Nations Gender Inequality Index and Human Development Index as covariates in multivariable models. RESULTS: The proportion of myocardial perfusion imaging studies performed in women varied among countries; however, there was no significant correlation with the Gender Inequality Index. Globally, mean effective dose for nuclear cardiology procedures was only slightly lower in women (9.6 ± 4.5 mSv) than in men (10.3 ± 4.5 mSv; p < 0.001), with a difference of only 0.3 mSv in a multivariable model adjusting for patients' age and weight. Stress-only imaging was performed more frequently in women (12.5% vs. 8.4%; p < 0.001); however, camera-based dose reduction strategies were used less frequently in women (58.6% vs. 65.5%; p < 0.001). CONCLUSIONS: Despite significant worldwide variation in best practice use and radiation doses from nuclear cardiology procedures, only small differences were observed between genders worldwide. Regional variations noted in myocardial perfusion imaging
Liga R, Vontobel J, Rovai D, et al., 2016, Multicentre multi-device hybrid imaging study of coronary artery disease: results from the EValuation of INtegrated Cardiac Imaging for the Detection and Characterization of Ischaemic Heart Disease (EVINCI) hybrid imaging population, European Heart Journal - Cardiovascular Imaging, Vol: 17, Pages: 951-960, ISSN: 2047-2412
Hybrid imaging provides a non-invasive assessment of coronary anatomy and myocardial perfusion. We sought to evaluate the added clinical value of hybrid imaging in a multicentre, multivendor setting. Fourteen centres enrolled 252 patients with stable angina and intermediate (20-90%) pre-test likelihood of coronary artery disease (CAD) who underwent myocardial perfusion scintigraphy (MPS), computed tomography coronary angiography (CTCA), and quantitative coronary angiography (QCA) with fractional flow reserve (FFR). Hybrid MPS/CTCA images were obtained by 3D image fusion. Blinded core-lab analyses were performed for CTCA, MPS, QCA, and hybrid data sets. Haemodynamically significant CAD was ruled-in non-invasively in the presence of a matched finding (myocardial perfusion defect co-localized with stenosed coronary artery) and ruled-out with normal findings (both CTCA and MPS normal). Overall prevalence of significant CAD on QCA (>70% stenosis or 30-70% with FFR ≤0.80) was 37%. Of 1004 pathological myocardial segments on MPS, 246 (25%) were reclassified from their standard coronary distribution to another territory by hybrid imaging. In this respect, in 45/252 (18%) patients, hybrid imaging reassigned an entire perfusion defect to another coronary territory, changing the final diagnosis in 42% of the cases. Hybrid imaging allowed non-invasive CAD rule-out in 41%, and rule-in in 24% of patients, with a negative and positive predictive value of 88 and 87%, respectively. In patients at intermediate risk of CAD, hybrid imaging allows non-invasive co-localization of myocardial perfusion defects and subtending coronary arteries, impacting clinical decision-making in almost one every five subjects.
Patel HC, Rosen SD, Hayward C, et al., 2016, Renal denervation in heart failure with preserved ejection fraction (RDF-PEF): a randomised controlled trial, European Journal of Heart Failure, Vol: 18, Pages: 703-712, ISSN: 1879-0844
AimHeart failure with preserved ejection fraction (HFpEF) is associated with increased sympathetic nervous system (SNS) tone. Attenuating the SNS with renal denervation (RD) might be helpful and there are no data currently in humans with HFpEF.Methods and ResultsIn this single-centre, randomised, open-controlled study we included 25 patients with HFpEF (preserved left ventricular (LV) ejection fraction, left atrial (LA) dilatation or LV hypertrophy and raised B-type natriuretic peptide (BNP) or echocardiographic assessment of filling pressures). Patients were randomised (2:1) to RD with the Symplicity™ catheter or continuing medical therapy. The primary success criterion was not met in that there were no differences between groups at 12 months for Minnesota Living with Heart Failure Questionnaire score, peak oxygen uptake (VO2) on exercise, BNP, E/e’, LA volume index or LV mass index. A greater proportion of patients improved at three months in the RD group with respect to VO2 peak (56% vs 13%, P=0.025) and E/e’ (31% vs 13%, P=0.04). Change in estimated glomerular filtration rate was comparable between groups. Two patients required plain balloon angioplasty during the RD procedure to treat renal artery wall oedema.ConclusionThis study was terminated early due to difficulties in recruitment and was underpowered to detect whether RD improved the endpoints of: quality of life, exercise function, biomarkers and left heart remodelling. The procedure was safe in patients with HFpEF though two patients did require intra-procedure renal artery dilatation.
Underwood SR, 2016, A history of nuclear cardiology in the UK, A History of Radionuclide Studies in the UK: 50th Anniversary of the British Nuclear Medicine Society, Pages: 53-62, ISBN: 9783319286235
Garg P, Underwood SR, Senior R, et al., 2016, Noninvasive cardiac imaging in suspected acute coronary syndrome., Nature Reviews Cardiology, Vol: 13, Pages: 266-275, ISSN: 1759-5010
Noninvasive cardiac imaging has an important role in the assessment of patients with acute-onset chest pain. In patients with suspected acute coronary syndrome (ACS), cardiac imaging offers incremental value over routine clinical assessment, the electrocardiogram, and blood biomarkers of myocardial injury, to confirm or refute the diagnosis of coronary artery disease and to assess future cardiovascular risk. This Review covers the current guidelines and clinical use of the common noninvasive imaging techniques, including echocardiography and stress echocardiography, computed tomography coronary angiography, myocardial perfusion scintigraphy, positron emission tomography, and cardiovascular magnetic resonance imaging, in patients with suspected ACS, and provides an update on the developments in noninvasive imaging techniques in the past 5 years.
Caselli C, Prontera C, Liga R, et al., 2016, Effect of Coronary Atherosclerosis and Myocardial Ischemia on Plasma Levels of High-Sensitivity Troponin T and NT-proBNP in Patients With Stable Angina., Arteriosclerosis, Thrombosis, and Vascular Biology, Vol: 36, Pages: 757-764, ISSN: 1524-4636
OBJECTIVE: Circulating levels of high-sensitivity cardiac troponin T (hs-cTnT) and N terminal probrain natriuretic peptide (NT-proBNP) are predictors of prognosis in patients with coronary artery disease (CAD). We aimed at evaluating the effect of coronary atherosclerosis and myocardial ischemia on cardiac release of hs-cTnT and NT-proBNP in patients with suspected CAD. APPROACH AND RESULTS: Hs-cTnT and NT-proBNP were measured in 378 patients (60.1±0.5 years, 229 males) with stable angina and unknown CAD enrolled in the Evaluation of Integrated Cardiac Imaging (EVINCI) study. All patients underwent stress imaging to detect myocardial ischemia and coronary computed tomographic angiography to assess the presence and characteristics of CAD. An individual computed tomographic angiography score was calculated combining extent, severity, composition, and location of plaques. In the whole population, the median (25-75 percentiles) value of plasma hs-cTnT was 6.17 (4.2-9.1) ng/L and of NT-proBNP was 61.66 (31.2-132.6) ng/L. In a multivariate model, computed tomographic angiography score was an independent predictor of the plasma hs-cTnT (coefficient 0.06, SE 0.02; P=0.0089), whereas ischemia was a predictor of NT-proBNP (coefficient 0.38, SE 0.12; P=0.0015). Hs-cTnT concentrations were significantly increased in patients with CAD with or without myocardial ischemia (P<0.005), whereas only patients with CAD and ischemia showed significantly higher levels of NT-proBNP (P<0.001). CONCLUSIONS: In patients with stable angina, the presence and extent of coronary atherosclerosis is related with circulating levels of hs-cTnT, also in the absence of ischemia, suggesting an ischemia-independent mechanism of hs-cTnT release. Obstructive CAD causing myocardial ischemia is associated with increased levels of NT-proBNP.
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