Performance of cardiac PET/CT with and without phase analysis for detection of scar in cardiac sarcoidosis: Comparison to cardiac magnetic resonance imaging.

BACKGROUND: The presence of myocardial scar in CS patients results in poor prognosis and worse outcomes. 18F-fluorodeoxyglucose (18F-FDG) PET/CT excels at visualizing inflammation but is suboptimal at detecting scar. We evaluated PET/CT sensitivity to detect scar and investigated the incremental diagnostic value of automated PET-derived data. METHODS: 176 patients who underwent cardiac magnetic resonance (CMR) and N-13 ammonia/18F-FDG cardiac PET/CT for suspected CS within 3 months were enrolled. Scar was defined as late gadolinium enhancement (LGE) on CMR without concordant 18F-FDG uptake on 18F-FDG PET/CT. Accuracy of cardiac PET/CT at detecting scar (perfusion defect without concordant 18F-FDG uptake) was assessed before and after addition of automated PET-derived data. RESULTS: Sensitivity of PET/CT for scar detection was 45.3% (specificity 88.9%). Addition of PET-derived LV volumes and function in a logistic regression model improved sensitivity to 57.0% (specificity: 80.0%, AUC 0.72). Addition of phase analysis maximum segmental onset of myocardial contraction > 61 improved AUC to 0.75, correctly relabeling 16.3% of patients as scar (net reclassification index 8.2%). CONCLUSION: Sensitivity of gated PET MPI alone for scar detection in CS is suboptimal. Adding PET-derived volumes/function and phase analysis data results in improved detection and characterization of scar.

Thoracic fluid content: a novel parameter for predicting failed weaning from mechanical ventilation.

BACKGROUND: Weaning of patients from the mechanical ventilation remains one of the critical decisions in intensive care unit. This study aimed to evaluate the accuracy of thoracic fluid content (TFC) as a predictor of weaning outcome. METHODS: An observational cohort study included 64 critically ill surgical patients who were eligible for extubation. Before initiating the spontaneous breathing trial, the TFC was measured using the electrical cardiometry technology. Patients were followed up after extubation and divided into successful weaning group and failed weaning group. Both groups were compared according to respiratory and cardiovascular parameters. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of TFC to predict weaning outcome. RESULTS: The number of successfully weaned patients was 41/64 (64%). Twenty (31%) patients had impaired cardiac contractility, and of them, 13/20 (64%) patients were successfully extubated. Both groups, successful weaning group and failed weaning group, were comparable in most of baseline characteristics; however, the TFC was significantly higher in the failed weaning group compared to the successful weaning group. The area under the ROC curves (AUCs) showed moderate predictive ability for the TFC in predicting weaning failure (AUC [95% confidence interval] 0.69 [0.57-0.8], cutoff value > 50 kΩ-1), while the predictive ability of TFC was excellent in the subgroup of patients with ejection fraction < 40% (AUC [95% confidence interval 0.93 [0.72-1], cutoff value > 50 kΩ-1). CONCLUSIONS: Thoracic fluid content showed moderate ability for predicting weaning outcome in surgical critically ill patients. However, in the subgroup of patients with ejection fraction less than 40%, TFC above 50 kΩ-1 has an excellent ability to predict weaning failure.

Comparison of in-stent neoatherosclerosis and tissue characteristics between early and late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study.

Optical frequency domain imaging (OFDI) was utilized to compare the prevalence of neoatherosclerosis (NA) and morphological characteristics of the neointimal tissue in second generation drug eluting stent (G2-DES)-treated lesions between early (<1 year, E-ISR) and late (>1 year, L-ISR) in-stent restenotic phases. Data comparing NA and in vivo tissue characteristics between early and late in-stent restenosis (ISR) after implantation of G2-DES is limited. An OFDI analysis was performed in 50 G2-DESs {35 everolimus-eluting stent [22 cobalt-chromium (CoCr), 13 platinum-chromium (PtCr)], and 15 biolimus-eluting stent [BES]} ISR lesions (46 consecutive patients) undergoing target lesion revascularization, classified as E-ISR (n = 22 lesion) and L-ISR (n = 28 lesion). NA, defined as a neointima formation containing lipids or calcification was observed in fewer than half (24/50) of all ISR lesions with no significant difference between E-ISR and L-ISR lesions (50 vs. 46.4%, p = 0.8). There were also no significant differences in the morphological appearance and tissue characteristics between E-ISR and L-ISR lesions. ISR was more likely to occur earlier [median 8.6 (8.3-8.9) months] after PtCr-EES implantations (12 lesions vs. 1, p < 0.001), while 3/4 of the BES ISR lesions and more than 2/3 of the CoCr-EES ISR lesions were observed after 1 year of implantation [median 21.3 (20.7-27.5) months, p < 0.001]. Acknowledging some limitations, our observations may suggest that the prevalence of neoatherosclerosis and the morphological appearance, and tissue characteristics of G2-DESs restenotic lesions are similar between the early and late restenotic phases. Certain platforms (PtCr-EESs) may have preferentially presented with early ISR.

In-stent neoatherosclerosis and tissue characteristics of restenotic lesions following implantation of second generation drug-eluting stents in unrestricted coronary lesions: Optical frequency domain imaging study.

BACKGROUND: Differences in stent platform, polymer coatings, and antirestenotic drugs among the current in use second-generation drug-eluting stents (G2-DESs) may induce significant variations in neointimal response and vascular healing, which may impact the prevalence of neoatherosclerosis (NA) and morphological appearance of the restenotic tissue. METHODS AND RESULTS: Utilizing Optical frequency domain imaging, two independent reviewers, retrospectively compared the prevalence of neoatherosclerosis (NA), and the morphological differences, and tissue characteristics of 50 G2-DESs in-stent restenosis (ISR) lesions (35 everolimus-eluting stent [22 cobalt-chromium (CoCr), 13 platinum-chromium (PtCr)], and 15 biolimus-eluting stent [BES]) implanted liberally in unrestricted coronary lesions. More than half of the stents were implanted in type C lesions, while 40% of the stents were implanted primarily in lesions with recanalized chronic total occlusion. NA, defined as a neointima formation with the presence of lipids or calcification, was observed in fewer than half (24/50) of all ISR lesions with no significant in-between group differences (41%, 69%, and 40% in CoCr, PtCr, and BES respectively, P = 0.22), nor were there any significant differences in the morphological appearance or tissue characteristics between all G2-DESs subtypes. CONCLUSIONS: Acknowledging some limitations, our results may suggest that the prevalence of NA and the morphological appearance of restenotic lesions might not differ when G2-DESs are implanted in unrestricted, rather complex, coronary lesions.

Prediction of left ventricular contractile recovery using tissue Doppler strain and strain rate measurements at rest in patients undergoing percutaneous coronary intervention.

The aim of the study was to assess the ability of tissue Doppler (TD) deformation analysis at rest to predict left ventricular contractile recovery in patients undergoing percutaneous coronary intervention (PCI). This prospective cohort enrolled 67 patients with segmental wall motion abnormality. Assessment of each segment was performed at rest and during low dose Dobutamine stress echocardiography (DSE) using a 4 point scoring system, TD peak systolic strain (PSS) and peak systolic strain rate (PSSR). The study followed up the patients for contractile improvement after 6 months of successful PCI by echocardiography. Of a 319 dysfunctional segments, 155 (49%) showed contractile recovery and 164 (51%) did not. PSS and PSSR at rest were significantly higher in recovered segments compared to segments without recovery (PSS: -7.27 ± 0.8 Vs. -6.14 ± 0.7%, PSSR: -0.34 ± 0.13 Vs. -0.24 ± 0.1/s. p < 0.0001 both). Similarly, both parameters were significantly higher in the contractile recovery group at follow up (p 0.001). Resting PSSR as well as PSS and PSSR during DSE were significant independent predictors of contractile recovery (p < 0.001 each). For predicting segmental contractile recovery, resting PSSR with a -0.31/s cut-off point had 76% sensitivity and 59% specificity (AUC 0.74), DSE qualitative viability assessment had a sensitivity of 75% and specificity of 77%, DSE PSS with a cut-off point of -9.1% had 74% sensitivity and 63% specificity (AUC 0.77) and DSE PSSR with a cut-off point of -0.72/s had 78% sensitivity and 77% specificity (AUC 0.81). Resting PSSR is a modest predictor of segmental contractile recovery after PCI while PSSR during DSE has a comparable diagnostic performance to subjective wall motion scoring. Recovered segments show improvement of deformation parameters after PCI.

Echocardiographic evaluation of cardiac structure and function in obese Egyptian adolescents.

OBJECTIVE: The objective of this study was to detect structural and functional changes in the left and right ventricles in obese Egyptian adolescents. Methods and results Anthropometric and echocardiographic parameters, including tissue Doppler imaging, were obtained from 70 obese adolescents with average body mass index of 34 plus or minus 3.8 and compared with 50 age- and sex-matched controls, with a body mass index of 21.6 plus or minus 1.9. Cardiac dimensions, stroke volume, left ventricular and right ventricular systolic and diastolic functions were evaluated. The obese group had a higher end-diastolic septal and posterior wall thickness and left ventricular mass index than the non-obese group. Body mass index, mid-arm and hip circumference values showed significant correlations with these echocardiographic variables. Systolic and diastolic functions of the left ventricle were normal in both groups, although stroke volume was high in the obese group. The right ventricle tissue Doppler parameters were similar in both groups. However, the S wave of the septal/lateral tricuspid valve annulus was reduced in the obese group, but not to the level reflecting systolic dysfunction. This was inversely correlated with hip, waist, and mid-arm circumference. Stepwise multiple regression analysis showed that the mid-arm and hip circumference followed by the body mass index are significant predictors of these early cardiac abnormalities. CONCLUSION: Left ventricular hypertrophy is present in obese children, although both systolic and diastolic functions are normal. Tissue Doppler imaging revealed a minor, but still significant, reduction in the right ventricular systolic function. Mid-arm and hip circumference are predictors of left ventricular hypertrophy.

Plasma thrombin-activatable fibrinolysis inhibitor levels and Thr325Ile polymorphism as a risk marker of myocardial infarction in Egyptian patients.

OBJECTIVE: The objective of this study was to investigate whether thrombin activatable fibrinolytic inhibitor (TAFI) Thr325Ile polymorphism and TAFI antigen (Ag) levels could constitute a risk marker of myocardial infarction (MI) in Egyptian patients. STUDY POPULATION AND RESULTS: The study included forty-six patients with acute MI (mean age 55.7 +/- 8.1 years, 33 men, 13 women) compared with age and sex-matched healthy volunteers (n = 54) as a control group. Clinical examination, laboratory investigations, electrocardiography (ECG) and/or echocardiography were done. TAFI Thr325Ile (reference sequence: rs1926447) polymorphism was genotyped in both studied groups using TaqMan SNP (single nucleotide polymorphism) genotyping assay. The genotypes of the high-risk allele [Thr/Ile (CT) and Ile/Ile (TT)] were significantly more frequent in patients compared with the control group (54.4% and 32.6% vs. 51.8% and 5.6%, respectively) and were also associated with an increased risk of MI [OR = 4.95, (95% CI: 1.80 - 13.63); P = 0.0001]. Ile325 allele carriers were more frequent in cases than in control subjects (60.0% vs. 31.5%) [OR = 3.26, (95% CI = 1.82 - 5.83), P = 0.001]. The Thr325Ile SNP significantly correlated with TAFI antigen levels with the C/C genotype corresponding with the highest and the T/T genotype with the lowest TAFI antigen levels (P < 0.001). No statistically significant relation was found between TAFI Thr325Ile polymorphism and either the type or the site of MI. CONCLUSIONS: TAFI Thr325Ile and its respective plasma protein level could have a contribution to MI risk in the Egyptian population.This could be helpful in refining a risk profile for coronary heart disease (CHD) patients.