| 1. |
- Ahmeti, Artan, et al.
(författare)
-
Prognostic value of left atrial volume index in acute coronary syndrome : A systematic review and meta-analysis
- 2021
-
Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; , s. 128-135
-
Tidskriftsartikel (refereegranskat)abstract
- Background: In the absence of mitral valve disease, increased left atrial volume (LAV) is a marker of diastolic dysfunction and long-standing elevated left ventricle (LV) pressure. The aim of this study was to assess the role of increased baseline LAV in predicting clinical outcome of patients presenting with acute coronary syndrome (ACS).Methods: We systematically searched all electronic databases up to September 2020 in order to select clinical trials and observational studies, which assessed the predictive role of LAV indexed (LAVI) on clinical outcome in patients with ACS. Primary clinical endpoints were as follows: major adverse cardiac events (MACE), all-cause mortality and hospitalization. Secondary endpoints were in-hospital complications.Results: A total of 2,705 patients from 11 cohort studies with a mean follow-up 18.7 +/- 9.8 months were included in the meta-analysis. Patients with low LAVI had low risk for MACE (15.9% vs. 33.7%; p < .01), long-term all-cause mortality (9.14% vs. 18.1%; p < .01), short-term mortality (3.31% vs. 9.38%; p = .02) and lower hospitalization rate (11.6% vs. 25.5%; p < .01) compared to patients with increased LAVI. Atrial fibrillation and cardiogenic shock as in-hospital events were lower (p < .05 for all) in patients with low LAVI but ventricular fibrillation/tachycardia was not different between groups (p = .14).Conclusion: Increased LAVI is an independent predictor of outcome in patients with ACS. Thus, assessment of LA index in these patients is important for better risk stratification and guidance towards optimum clinical management.
|
|
| 2. |
- Asp, A. M., et al.
(författare)
-
Cardiovascular changes in patients with mild-to-moderate chronic kidney disease compared with healthy subjects: a 5-year follow-up study
- 2020
-
Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 40:2, s. 91-98
-
Tidskriftsartikel (refereegranskat)abstract
- Background There is limited knowledge about how cardiovascular parameters change over time in patients with mild-to-moderate chronic kidney disease (CKD). We studied several cardiovascular biomarkers over a 5-year period in patients with mild-to-moderate CKD and in healthy controls. Methods Fifty-four patients with CKD stages 2-3 and 54 controls were included. The CKD patients were closely monitored and well controlled for hypertension and other cardiovascular risk factors. Ambulatory blood pressure (BP) monitoring, ankle-brachial index (ABI), carotid and cardiac ultrasound (including measurement of the left ventricular mass index (LVMI)), and biochemical analyses were evaluated. Results Renal function decreased in both groups, with no significant difference in the change over time. In the CKD patients, none of the BP variables increased over time, but in the controls, average 24-h and daytime systolic BP increased significantly. ABI increased slightly in the CKD patients (P<0 center dot 001), but not in the controls (P = 0 center dot 963), and phosphate had a significant positive effect on ABI. Although in the CKD patients, there was no significant increase over time in common carotid artery diameter (P = 0 center dot 274), there was a small but significant increase in the controls (P = 0 center dot 001). LVMI increased significantly over time in both groups. Conclusions In our study of patients with mild-to-moderate CKD, the progression of cardiovascular changes over time was relatively slow. Good BP control and treatment of other risk factors may have contributed to slow the progress of cardiovascular involvement, which emphasizes the importance of dedicated care in this population.
|
|
| 3. |
|
|
| 4. |
- Bajraktari, Gani, et al.
(författare)
-
Left atrial structure and function predictors of recurrent fibrillation after catheter ablation : a systematic review and meta-analysis
- 2020
-
Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 40:1, s. 1-13
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Catheter ablation (CA) has become a conventional treatment for atrial fibrillation (AF), but remains with high recurrence rate. The aim of this meta-analysis was to determine left atrial (LA) structure and function indices that predict recurrence of AF.Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to September 2017 in order to select clinical trials and observational studies which reported echocardiographic predictors of AF recurrence after CA. Eighty-five articles with a total of 16 126 patients were finally included.Results: The pooled analysis showed that after a follow-up period of 21 +/- 12 months, patients with AF recurrence had larger LA diameter with weighted mean difference (WMD: 2 center dot 99 ([95% CI 2 center dot 50-3 center dot 47], P<0 center dot 001), larger LA volume index (LAVI) maximal and LAVI minimal (P<0 center dot 0001 for both), larger LA area (P<0 center dot 0001), lower LA strain (P<0 center dot 0001) and lower LA total emptying fraction (LA EF) (P<0 center dot 0001) compared with those without AF recurrence. The most powerful LA predictors (in accuracy order) of AF recurrence were as follows: LA strain <19% (OR: 3 center dot 1[95% CI, -1.3-10 center dot 4], P<0 center dot 0001), followed by LA diameter >= 50 mm (OR: 2 center dot 75, [95% CI 1 center dot 66-4 center dot 56,] P<0 center dot 0001), and LAVmax >150 ml (OR: 2 center dot 25, [95% CI, 1.1-5 center dot 6], P = 0 center dot 0002).Conclusions: Based on this meta-analysis results, a dilated left atrium with diameter more than 50 mm and volume above 150 ml or myocardial strain below 19% reflect an unstable LA that is unlikely to hold sinus rhythm after catheter ablation for atrial fibrillation.
|
|
| 5. |
- Berg, Hans E., et al.
(författare)
-
Threshold-automated CT measurements of muscle size and radiological attenuation in multiple lower-extremity muscles of older individuals
- 2020
-
Ingår i: Clinical Physiology and Functional Imaging. - : WILEY. - 1475-0961 .- 1475-097X. ; 40:3, s. 165-172
-
Tidskriftsartikel (refereegranskat)abstract
- Muscle atrophy and fat infiltration, two indicators of deconditioning and weakness in elderly frail patients, are typically assessed by means of manual image analysis from computed tomography (CT) scans. As this time-consuming image analysis limits its wider use in clinical studies, the use of tissue thresholds to semi-automatically assess muscle composition has been suggested. Here, we aimed to investigate the relationship between manual and semi-automated analysis of both cross-sectional area (CSA) and radiological attenuation (RA), in multiple muscles of the lower extremities in aged (77 +/- 6 years) sedentary individuals (n = 40). The participants underwent CT scans of their lower limbs, including hip, thigh and calf muscles. The subsequent analysis of CSA and RA was conducted using both manual segmentation and semi-automatic thresholds (-30 to +150 Hounsfield units). Automated measurements were generally strongly correlated with manually encircled CSA in all muscle groups (R = 0.79-0.99, p < .05) and shortened the analysis time by 70% (p < .05). In m. iliopsoas, however, the CSA became overestimated (15%, p < .05) with thresholded measurements, while the assessment of both CSA and RA was underestimated in muscles with high-fat content (i.e., the gluteal muscles) and in individuals with high-fat infiltration. In conclusion, using the semi-automated technique with conventional thresholds is a time-saving method that delivers accurate gross size of the muscle groups, particularly in the thigh. However, caution should be exercised when using semi-automated techniques for assessing CSA and fat infiltration in muscles with high-fat content.
|
|
| 6. |
- Bjöersdorff, Mimmi, et al.
(författare)
-
Detection of lymph node metastases in patients with prostate cancer: Comparing conventional and digital F-18 -fluorocholine PET-CT using histopathology as a reference
- 2022
-
Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X.
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Positron emission tomography-computed tomography (PET-CD with [F-18]-fluorocholine (FCH) is used to detect and stage metastatic lymph nodes in patients with prostate cancer. Improvements to hardware and software have recently been made. We compared the capability of detecting regional lymph node metastases using conventional and digital silicon photomultiplier (SiPM)-based PET-CT technology for FCH. Extended pelvic lymph node dissection (ePLND) histopathology was used as a reference method. Methods: The study retrospectively examined 177 patients with intermediate or high-risk prostate cancer who had undergone staging with FCH PET-CT before ePLND. Images were obtained with either the conventional Philips Gemini PET-CT (n = 93) or the digital SiPM-based GE Discovery MI PET-CT (n = 84) and compared. Results: Images that were obtained using the Philips Gemini PET-CT system showed 19 patients (20%) with suspected lymph node metastases, whereas the GE Discovery MI PET-CT revealed 36 such patients (43%). The sensitivity, specificity, and positive and negative predictive values were 0.3, 0.84, 0.47, and 0.72 for the Philips Gemini, while they were 0.58, 0.62, 0.31, and 0.83 for the GE Discovery MI, respectively. The areas under the curves in a receiver operating characteristic curve analysis were similar between the two PET-CT systems (0.57 for Philips Gemini and 0.58 for GE Discovery MI, p = 0.89). Conclusions: Marked differences in sensitivity and specificity were found for the different PET-CT systems, although the overall diagnostic performance was similar. These differences are probably due to differences in both hardware and software, including reconstruction algorithms, and should be considered when new technology is introduced.
|
|
| 7. |
- Boano, Gabriella, et al.
(författare)
-
Effect of cryothermic and radiofrequency Cox-Maze IV ablation on atrial size and function assessed by 2D and 3D echocardiography, a randomized trial. To freeze or to burn
- 2023
-
Ingår i: Clinical Physiology and Functional Imaging. - : WILEY. - 1475-0961 .- 1475-097X. ; 43:6, s. 431-440
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundAtrial linear scars in Cox-Maze IV procedures are achieved using Cryothermy (Cryo) or radiofrequency (RF) techniques. The subsequent postoperative left atrial (LA) reverse remodelling is unclear. We used 2- and 3-dimensional echocardiography (2-3DE) to compare the impact of Cryo and RF procedures on LA size and function 1 year after Cox-maze IV ablation concomitant with Mitral valve (MV) surgery. MethodsSeventy-two patients with MV disease and AF were randomized to Cryo (n = 35) or RF (n = 37) ablation. Another 33 patients were enroled without ablation (NoMaze). All patients underwent an echocardiogram the day before and 1 year after surgery. The LA function was assessed on 2D strain by speckle tracking and 3DE. ResultsForty-two ablated patients recovered sinus rhythm (SR) 1 year after surgery. They had comparable left and right systolic ventricular function, LA volume index (LAVI), and 2D reservoir strain before surgery. At follow-up, the 3DE extracted reservoir and booster function were higher after RF (37 & PLUSMN; 10% vs. 26 & PLUSMN; 6%; p < 0.001) than Cryo ablation (18 & PLUSMN; 9 vs. 7 & PLUSMN; 4%; p < 0.001), while passive conduit function was comparable between groups (24 & PLUSMN; 11 vs. 20 & PLUSMN; 8%; p = 0.17). The extent of LAVI reduction depended on the duration of AF preoperatively. ConclusionsSR restoration after MV surgery and maze results in LA size reduction irrespective of the energy source used. Compared to RF, the extension of ablation area produced by Cryo implies a structural LA remodelling affecting LA systolic function.
|
|
| 8. |
- Borrelli, Pablo, et al.
(författare)
-
Artificial intelligence-based detection of lymph node metastases by PET/CT predicts prostate cancer-specific survival
- 2021
-
Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 41:1, s. 62-67
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction Lymph node metastases are a key prognostic factor in prostate cancer (PCa), but detecting lymph node lesions from PET/CT images is a subjective process resulting in inter-reader variability. Artificial intelligence (AI)-based methods can provide an objective image analysis. We aimed at developing and validating an AI-based tool for detection of lymph node lesions. Methods A group of 399 patients with biopsy-proven PCa who had undergone(18)F-choline PET/CT for staging prior to treatment were used to train (n = 319) and test (n = 80) the AI-based tool. The tool consisted of convolutional neural networks using complete PET/CT scans as inputs. In the test set, the AI-based lymph node detections were compared to those of two independent readers. The association with PCa-specific survival was investigated. Results The AI-based tool detected more lymph node lesions than Reader B (98 vs. 87/117;p = .045) using Reader A as reference. AI-based tool and Reader A showed similar performance (90 vs. 87/111;p = .63) using Reader B as reference. The number of lymph node lesions detected by the AI-based tool, PSA, and curative treatment was significantly associated with PCa-specific survival. Conclusion This study shows the feasibility of using an AI-based tool for automated and objective interpretation of PET/CT images that can provide assessments of lymph node lesions comparable with that of experienced readers and prognostic information in PCa patients.
|
|
| 9. |
- Borrelli, P., et al.
(författare)
-
Automated classification of PET-CT lesions in lung cancer: An independent validation study
- 2022
-
Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 42:5, s. 327-332
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction Recently, a tool called the positron emission tomography (PET)-assisted reporting system (PARS) was developed and presented to classify lesions in PET/computed tomography (CT) studies in patients with lung cancer or lymphoma. The aim of this study was to validate PARS with an independent group of lung-cancer patients using manual lesion segmentations as a reference standard, as well as to evaluate the association between PARS-based measurements and overall survival (OS). Methods This study retrospectively included 115 patients who had undergone clinically indicated (18F)-fluorodeoxyglucose (FDG) PET/CT due to suspected or known lung cancer. The patients had a median age of 66 years (interquartile range [IQR]: 61-72 years). Segmentations were made manually by visual inspection in a consensus reading by two nuclear medicine specialists and used as a reference. The research prototype PARS was used to automatically analyse all the PET/CT studies. The PET foci classified as suspicious by PARS were compared with the manual segmentations. No manual corrections were applied. Total lesion glycolysis (TLG) was calculated based on the manual and PARS-based lung-tumour segmentations. Associations between TLG and OS were investigated using Cox analysis. Results PARS showed sensitivities for lung tumours of 55.6% per lesion and 80.2% per patient. Both manual and PARS TLG were significantly associated with OS. Conclusion Automatically calculated TLG by PARS contains prognostic information comparable to manually measured TLG in patients with known or suspected lung cancer. The low sensitivity at both the lesion and patient levels makes the present version of PARS less useful to support clinical reading, reporting and staging.
|
|
| 10. |
- Bytyci, Ibadete, et al.
(författare)
-
Left atrial stiffness predicts cardiac events in patients with heart failure and reduced ejection fraction : The impact of diabetes
- 2021
-
Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 41:2, s. 208-216
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to investigate the relationship between diabetes mellitus (DM) and left atrial (LA) remodelling in a group of patients with heart failure and reduced ejection fraction (HFrEF), and their combined impact on cardiac events (CE).Methods: This study included 136 consecutive HFrEF patients (65 +/- 11 years), 36 had DM, and 86 had increased LA stiffness (LASt). All patients underwent complete conventional and tissue Doppler echocardiographic measurements were made including LA volumes and function. LASt was calculated using the formula: LASt = E/e' ratio / PALS.Results: At 55 +/- 37 months follow-up, free survival from CE was 69% in patients without DM and 44.4% in those with DM (p < .0001). The CE free survival was lower in patients with increased LASt compared to normal LASt, (50 versus. 80%, p < .001), irrespective of the presence of DM (27 versus. 71%, p < .001).The best cut-off value of LASt for predicting CE in the group as a whole was >= 0.82% [81% sensitivity, 72% specificity and AUC 0.82 (p < .001)]. LASt >= 0.82% also predicted CE in no DM patients [78% sensitivity, 71% specificity and AUC 0.80 (p < .001)] and was a stronger predictor in DM patients [85% sensitivity, 71% specificity and AUC = 0.847 (p < .001)].Conclusion: High LA stiffness is associated with poor clinical outcome in patients with HFrEF. Diabetes has an additional incremental value in determining clinical outcome in those patients.
|
|
