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- Baron, Tomasz, et al.
(författare)
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Cardiac Imaging in Carcinoid Heart Disease
- 2021
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Ingår i: JACC Cardiovascular Imaging. - : American College of Cardiology. - 1936-878X .- 1876-7591. ; 14:11, s. 2240-2253
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Tidskriftsartikel (refereegranskat)abstract
- Carcinoid disease is caused by neuroendocrine tumors, most often located in the gut, and leads in approximately 20% of cases to specific, severe heart disease, most prominently affecting right-sided valves. If cardiac disease occurs, it determines the patient's prognosis more than local growth of the tumor. Surgical treatment of carcinoid-induced valve disease has been found to improve survival in observational studies. Cardiac imaging is crucial for both diagnosis and management of carcinoid heart disease; in the past, imaging was accomplished largely by echocardiography, but more recently, imaging for carcinoid heart disease has increasingly become multimodal and warrants awareness of the particular diagnostic challenges of this disease. This paper reviews the pathophysiology and manifestations of carcinoid heart disease in light of the different imaging modalities.
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| 4. |
- Harms, Hendrik J, et al.
(författare)
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Automatic calculation of myocardial external efficiency using a single 11C-acetate PET scan.
- 2018
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Ingår i: Journal of Nuclear Cardiology. - : Springer Science and Business Media LLC. - 1071-3581 .- 1532-6551. ; 25:6, s. 1937-1944
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Myocardial external efficiency (MEE) is defined as the ratio of kinetic energy associated with cardiac work [forward cardiac output (FCO)*mean systemic pressure] and the chemical energy from oxygen consumed (MVO2) by the left ventricular mass (LVM). We developed a fully automated method for estimating MEE based on a single 11C-acetate PET scan without ECG-gating.METHODS AND RESULTS: Ten healthy controls, 34 patients with aortic valve stenosis (AVS), and 20 patients with mitral valve regurgitation (MVR) were recruited in a dual-center study. MVO2 was calculated using washout of 11C -acetate activity. FCO and LVM were calculated automatically using dynamic PET and parametric image formation. FCO and LVM were also obtained using cardiac magnetic resonance (CMR) in all subjects. The correlation between MEEPET-CMR and MEEPET was high (r = 0.85, P < 0.001) without significant bias. MEEPET was 23.6 ± 4.2% for controls and was lowered in AVS (17.2 ± 4.3%, P < 0.001) and in MVR (18.0 ± 5.2%, P = 0.004). MEEPET was strongly associated with both NYHA class (P < 0.001) and the magnitude of valvular dysfunction (mean aortic gradient: P < 0.001, regurgitant fraction: P = 0.009).CONCLUSION: A single 11C-acetate PET yields accurate and automated MEE results on different scanners. MEE might provide an unbiased measurement of the phenotypic response to valvular disease.
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| 6. |
- Rosengren, Sara, et al.
(författare)
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Diagnostic Accuracy of [11C]PIB Positron Emission Tomography for Detection of Cardiac Amyloidosis
- 2020
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Ingår i: JACC Cardiovascular Imaging. - : Elsevier BV. - 1936-878X .- 1876-7591. ; 13:6, s. 1337-1347
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This dual-site study evaluated the diagnostic accuracy of the method.BACKGROUND: Pittsburgh compound ([11C]PIB) positron emission tomography (PIB-PET) has shown promise as a specific and noninvasive method for the diagnosis of cardiac amyloidosis (CA).METHODS: The study had 2 parts. In the initial study, 51 subjects were included, 36 patients with known CA and increased wall thickness (15 immunoglobulin light chain [AL] and 21 transthyretin [ATTR] amyloidosis) and 15 control patients (7 were nonamyloid hypertrophic and 8 healthy volunteers). Subjects underwent PIB-PET and echocardiography. Sensitivity and specificity of PIB-PET were established for 2 simple semiquantitative approaches, standardized uptake value ratio (SUVR) and retention index (RI). The second part of the study included 11 amyloidosis patients (5 AL and 6 hereditary ATTR) without increased wall thickness to which the optimal cutoff values of SUVR (>1.09) and RI (>0.037 min-1) were applied prospectively.RESULTS: The diagnostic accuracy of visual inspection of [11C]PIB uptake was 100% in discriminating CA patients with increased wall thickness from controls. Semiquantitative [11C]PIB uptake discriminated CA from controls with a 94% (95% confidence interval [CI]: 80% to 99%) sensitivity for both SUVR and RI and specificity of 93% (95% CI: 66% to 100%) for SUVR and 100% (95% CI: 75% to 100%) for RI. [11C]PIB uptake was significantly higher in AL-CA than in ATTR-CA patients (p < 0.001) and discriminated AL-CA from controls with 100% (95% CI: 88% to 100%) accuracy for both the semiquantitative measures. In the prospective group without increased wall thickness, RI was elevated compared to controls (p = 0.001) and 5 of 11 subjects were evaluated as [11C]PIB PET positive.CONCLUSIONS: In a dual-center setting, [11C]PIB PET was highly accurate in detecting cardiac involvement in the main amyloid subtypes, with 100% accuracy in AL amyloidosis. A proportion of amyloidosis patients without known cardiac involvement were [11C]PIB PET positive, indicating that the method may detect early stages of CA.
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| 7. |
- Sörensen, Jens, et al.
(författare)
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Diagnosis of left ventricular hypertrophy using non-ECG-gated 15O-water PET
- 2022
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Ingår i: Journal of Nuclear Cardiology. - : Springer. - 1071-3581 .- 1532-6551. ; , s. 2361-2373
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To develop a method for diagnosing left ventricular (LV) hypertrophy from cardiac perfusion 15O-water positron emission tomography (PET).Methods: We retrospectively pooled data from 139 subjects in four research cohorts. LV remodeling patterns ranged from normal to severe eccentric and concentric hypertrophy. 15O-water PET scans (n = 197) were performed with three different PET devices. A low-end scanner (66 scans) was used for method development, and remaining scans with newer devices for a blinded evaluation. Dynamic data were converted into parametric images of perfusable tissue fraction for semi-automatic delineation of the LV wall and calculation of LV mass (LVM) and septal wall thickness (WT). LVM and WT from PET were compared to cardiac magnetic resonance (CMR, n = 47) and WT to 2D-echocardiography (2DE, n = 36). PET accuracy was tested using linear regression, Bland–Altman plots, and ROC curves. Observer reproducibility were evaluated using intraclass correlation coefficients.Results: High correlations were found in the blinded analyses (r ≥ 0.87, P < 0.0001 for all). AUC for detecting increased LVM and WT (> 12 mm and > 15 mm) was ≥ 0.95 (P < 0.0001 for all). Reproducibility was excellent (ICC ≥ 0.93, P < 0.0001).Conclusion: 15O-water PET might detect LV hypertrophy with high accuracy and precision.
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| 8. |
- Sörensen, Jens, et al.
(författare)
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Diagnostic accuracy of 15O-water PET for left-ventricular hypertrophy
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To develop and validate a method for diagnosing left ventricular (LV) hypertrophy from cardiac perfusion 15O-water positron emission tomography (PET).Methods:This was a retrospective study with pooled data from 139 subjects in four research cohorts. LV remodeling patterns ranged from normal to severe eccentric and concentric hypertrophy. 15O-water PET scans (n=197) were performed with three different PET devices. Data from a low-end scanner (66 scans) were used for method development, remaining scans were used for a blinded evaluation. Dynamic data were converted into parametric images of perfusable tissue fraction for semi-automatic delineation of the LV wall in the short axis view. The enclosed region was used to calculate LV mass (LVM) and septal wall thickness (WT). LVM and WT from PET were compared to cardiac magnetic resonance (CMR, n=47) and WT to 2D-echocardiography (2DE, n=36). PET accuracy was tested using linear regression, Bland-Altman plots, and ROC curves. Observer reproducibility were evaluated using intraclass correlation coefficients. Results: Correlations (PET-LVM and PET-WT towards CMR; PET-WT towards 2DE) were high (r≥0.87, P<0.0001 for all) with high-end scanners, and slightly lower for LVM (r=0.84) and WT (r=0.76, both P<0.0001) with a low-end scanner. There was no significant bias for WT, but a proportional bias for LVM was found. The area-under-the-curve for blinded detection of increased LVM and WT (>12 mm and >15 mm) diagnosed by conventional imaging was ≥0.95 (P<0.0001 for all). Reproducibility was excellent (ICC ≥ 0.93, P<0.0001). Conclusion: 15O-water PET might detect LV hypertrophy with high accuracy and precision.
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| 9. |
- Sörensen, Jens, et al.
(författare)
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Myocardial Efficiency : A Fundamental Physiological Concept on the Verge of Clinical Impact
- 2020
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Ingår i: JACC Cardiovascular Imaging. - : Elsevier BV. - 1936-878X .- 1876-7591. ; 13:7, s. 1564-1576
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Tidskriftsartikel (refereegranskat)abstract
- Myocardial external efficiency is the relation of mechanical energy generated by the left (or right) ventricle to the consumed chemical energy from aerobic metabolism. Efficiency can be calculated invasively, and, more importantly, noninvasively by using positron emission tomography, providing a single parameter by which to judge the adequacy of myocardial metabolism to generated mechanical output. This parameter has been found to be impaired in heart failure of myocardial or valvular etiology, and it changes in a characteristic manner with medical or interventional cardiac therapy. The authors discuss the concept, strengths, and limitations, known applications, and future perspectives of the use of myocardial efficiency.
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| 10. |
- Sörensen, Jens, et al.
(författare)
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Myocardial External Efficiency in Asymptomatic Severe Primary Mitral Regurgitation Using 11C-Acetate PET
- 2023
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Ingår i: Journal of Nuclear Medicine. - : Society of Nuclear Medicine. - 0161-5505 .- 1535-5667 .- 2159-662X. ; 64:4, s. 645-651
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Tidskriftsartikel (refereegranskat)abstract
- Subjects with asymptomatic moderate-severe or severe primary mitral regurgitation (MR) are closely observed for signs of progression or symptoms requiring surgical intervention. The role of myocardial metabolic function in progression of MR is poorly understood. We used 11C-acetate positron emission tomography (PET) to non-invasively measure myocardial external efficiency (MEE), which is the energetic ratio of external cardiac work and left ventricular oxygen consumption.Methods and Results: 47 patients in surveillance with MR and no or minimal symptoms prospectively underwent PET, echocardiography and cardiac magnetic resonance imaging (CMR) on the same day. PET was used to simultaneously measure cardiac output, LV mass and oxygen consumption to establish MEE. PET in patients were compared to healthy volunteers (n = 9). MEE and standard imaging indicators of regurgitation severity, LV volumes and function were studied as predictors of time to surgical intervention. Patients were followed median 3.0 years (interquartile range 2.0-3.8) and the endpoint was reached in 22 subjects (47%). MEE in patients reaching the endpoint (23.8±5.0%) was lower than in censored patients (28.5±4.5%, P = 0.002) and in healthy volunteers (30.1±4.9%, 0.001). MEE with a cut-off lower than 25.7% was significantly associated with the outcome (hazard ratio of 7.5 (95%CI: 2.7-20.6, p<0.0001) and retained independent significance when compared to standard imaging parameters.Conclusion: MEE independently predicted time to progression requiring valve surgery in patients with asymptomatic moderate-severe or severe primary MR. The study suggests that inefficient myocardial oxidative metabolism precedes clinically observed progression in MR.
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