Poor nutrition is the leading cause of poor health, health care spending, and lost productivity in the United States and globally, which acts through cardiometabolic diseases as precursors to ...cardiovascular disease, cancer, and other conditions. There is great interest in how the social determinants of health (the conditions in which people are born, live, work, develop, and age) impact cardiometabolic disease. Food insecurity is an example of a powerful social determinant of health that impacts health outcomes. Nutrition insecurity, a distinct but related concept to food insecurity, is a direct determinant of health. In this article, we provide an overview of how diet in early life relates to cardiometabolic disease and then continue to focus on the concepts of food insecurity and nutrition insecurity. In the discussions herein we make important distinctions between the concepts of food insecurity and nutrition insecurity and provide a review of their concepts, histories, measurement and assessment devices, trends and prevalence, and links to health and health disparities. The discussions here set the stage for future research and practice to directly address the negative consequences of food and nutrition insecurity.
Impaired vasodilator function is an early manifestation of coronary artery disease and may precede angiographic stenosis. It is unknown whether noninvasive assessment of coronary vasodilator function ...in patients with suspected or known coronary artery disease carries incremental prognostic significance.
A total of 2783 consecutive patients referred for rest/stress positron emission tomography were followed up for a median of 1.4 years (interquartile range, 0.7-3.2 years). The extent and severity of perfusion abnormalities were quantified by visual evaluation of myocardial perfusion images. Rest and stress myocardial blood flows were calculated with factor analysis and a 2-compartment kinetic model and were used to compute coronary flow reserve (coronary flow reserve equals stress divided by rest myocardial blood flow). The primary end point was cardiac death. Overall 3-year cardiac mortality was 8.0%. The lowest tertile of coronary flow reserve (<1.5) was associated with a 5.6-fold increase in the risk of cardiac death (95% confidence interval, 2.5-12.4; P<0.0001) compared with the highest tertile. Incorporation of coronary flow reserve into cardiac death risk assessment models resulted in an increase in the c index from 0.82 (95% confidence interval, 0.78-0.86) to 0.84 (95% confidence interval, 0.80-0.87; P=0.02) and in a net reclassification improvement of 0.098 (95% confidence interval, 0.025-0.180). Addition of coronary flow reserve resulted in correct reclassification of 34.8% of intermediate-risk patients (net reclassification improvement=0.487; 95% confidence interval, 0.262-0.731). Corresponding improvements in risk assessment for mortality from any cause were also demonstrated.
Noninvasive quantitative assessment of coronary vasodilator function with positron emission tomography is a powerful, independent predictor of cardiac mortality in patients with known or suspected coronary artery disease and provides meaningful incremental risk stratification over clinical and gated myocardial perfusion imaging variables.
BACKGROUND:It is suggested that the integration of maximal myocardial blood flow (MBF) and coronary flow reserve (CFR), termed coronary flow capacity, allows for comprehensive evaluation of patients ...with known or suspected stable coronary artery disease. Because management decisions are predicated on clinical risk, we sought to determine the independent and integrated value of maximal MBF and CFR for predicting cardiovascular death.
METHODS:MBF and CFR were quantified in 4029 consecutive patients (median age 66 years, 50.5% women) referred for rest/stress myocardial perfusion positron emission tomography scans from January 2006 to December 2013. The primary outcome was cardiovascular mortality. Maximal MBF <1.8 mL·g·min and CFR<2 were considered impaired. Four patient groups were identified based on the concordant or discordant impairment of maximal MBF or CFR. Association of maximal MBF and CFR with cardiovascular death was assessed using Cox and Poisson regression analyses.
RESULTS:A total of 392 (9.7%) cardiovascular deaths occurred over a median follow-up of 5.6 years. CFR was a stronger predictor of cardiovascular mortality than maximal MBF beyond traditional cardiovascular risk factors, left ventricular ejection fraction, myocardial scar and ischemia, rate-pressure product, type of radiotracer or stress agent used, and revascularization after scan (adjusted hazard ratio, 1.79; 95% confidence interval CI, 1.38–2.31; P<0.001 per unit decrease in CFR after adjustment for maximal MBF and clinical covariates; and adjusted hazard ratio, 1.03; 95% CI, 0.84–1.27; P=0.8 per unit decrease in maximal MBF after adjustment for CFR and clinical covariates). In univariable analyses, patients with concordant impairment of CFR and maximal MBF had high cardiovascular mortality of 3.3% (95% CI, 2.9–3.7) per year. Patients with impaired CFR but preserved maximal MBF had an intermediate cardiovascular mortality of 1.7% (95% CI, 1.3–2.1) per year. These patients were predominantly women (70%). Patients with preserved CFR but impaired maximal MBF had low cardiovascular mortality of 0.9% (95% CI, 0.6–1.6) per year. Patients with concordantly preserved CFR and maximal MBF had the lowest cardiovascular mortality of 0.4% (95 CI, 0.3–0.6) per year. In multivariable analysis, the cardiovascular mortality risk gradient across the 4 concordant or discordant categories was independently driven by impaired CFR irrespective of impairment in maximal MBF.
CONCLUSIONS:CFR is a stronger predictor of cardiovascular mortality than maximal MBF. Concordant and discordant categories based on integrating CFR and maximal MBF identify unique prognostic phenotypes of patients with known or suspected coronary artery disease.
18F-FDG PET/CT is used to diagnose cardiac sarcoidosis and endocarditis. It requires myocardial glucose utilization (MGU) suppression to avoid false positives, which occur in up to 20% of patients. ...Serum beta-hydroxybutyrate (BHB) levels may help identify incomplete suppression of MGU. We determined the optimal timing and diagnostic thresholds to identify incomplete suppression of MGU.
We retrospectively identified 114 patients referred for 18F-FDG PET/CT for endocarditis, wherein myocardial uptake outside of paravalvular regions is not related to pathology and can be confidently ascribed as being due to inadequate suppression of MGU. Patients followed a high-fat, low-carbohydrate diet and received heparin. Serum BHB, insulin, glucose and hemoglobin A1c were measured. Maximum standardized uptake value (SUVmax) of left ventricle (LV) and mean SUV (SUVmean) in LV blood pool (LVBP) was measured. Logistic regression and area under the receiver-operating characteristic analyses were used to quantify the relationship between biomarkers and MGU suppression. A threshold of BHB ≥ 0.35 mmol·L−1 to detect suppression resulted in sensitivity of 88% and specificity of 61%. A threshold of BHB ≥ 0.95 mmol·L−1 resulted in sensitivity of 45% and specificity of 100%. AUC was 0.87. BHB measured ~ 4 hours prior to 18F-FDG injection performed similarly to or better than later timepoints.
Serum BHB levels are useful for assessing suppression of MGU and could simplify interpretation of 18F-FDG PET/CT inflammation studies.
el PET/TC con 18F-FDG es utilizado para diagnosticar sarcoidosis cardíaca y endocarditis. Requiere la supresión de la utilización de glucosa miocárdica (MGU) para evitar falsos positivos, que pueden ocurrir hasta en el 20% de los pacientes. Los niveles séricos de beta-hidroxibutirato (BHB) pueden ayudar a identificar la supresión incompleta de MGU. Determinamos el momento óptimo y los umbrales de diagnóstico para identificar la supresión incompleta de MGU.
Identificamos retrospectivamente a 114 pacientes referidos para PET/TC con 18F-FDG por endocarditis, en los que la captación miocárdica fuera de las regiones paravalvulares no está relacionada con la patología y puede atribuirse con seguridad a que se debe a una supresión inadecuada de la MGU. Los pacientes siguieron una dieta alta en grasas, baja en carbohidratos y recibieron heparina. Se midieron en suero BHB, insulina, glucosa y hemoglobina A1c. Se midió el valor máximo de captación estandarizado (SUVmax) del ventrículo izquierdo (LV) y el SUV medio (SUVmean) del pool sanguíneo del LV (LVBP). La regresión logística y el área bajo los análisis de características operativas del receptor fueron utilizados para cuantificar la relación entre los biomarcadores y la supresión de MGU. Un umbral de BHB ≥ 0.35 mmol/L para detectar la supresión resultó en una sensibilidad del 88% y una especificidad del 61%. Un umbral de BHB ≥ 0.95 mmol/L dio como resultado una sensibilidad del 45% y una especificidad del 100%. El AUC fue de 0.87. BHB medido ~ 4 horas antes de la inyección de 18F-FDG funciona de manera similar o mejor que los puntos de tiempo posteriores.
Los niveles séricos de BHB son útiles para evaluar la supresión de la MGU y podrían simplificar la interpretación de los estudios de inflamación de PET/TC con 18F-FDG.
18F-FDG PET/CT可用于诊断心脏结节病和心内膜炎。它需要抑制心肌葡萄糖摄取(MGU)以避免高达20%的假阳性。血清β-羟丁酸(BHB)水平可能有助于识别MGU的不完全抑制。我们确定了MGU不完全抑制的最佳时机和诊断阈值。
我们回顾性纳入114例因心内膜炎需行18F-FDG PET/CT检查的患者, 当瓣周区以外出现非病理性心肌摄取时, 可以明确归因于MGU不完全抑制。患者遵循高脂肪、低碳水化合物饮食并接受肝素治疗。研究测定患者的血清BHB、胰岛素、血糖、糖化血红蛋白, 左心室(LV)的最大标准化摄取值(SUVmax)和左室血池(LVBP)的平均摄取值(SUVmean)。逻辑回归和接收者操作特征曲线下面积分析用于量化生物标志物与MGU抑制之间的关系。当BHB阈值 ≥ 0.35 mmol/L时, 诊断敏感性为88%, 特异性为61%。当BHB阈值 ≥ 0.95 mmol/L时, 敏感性为45%, 特异性为100%, AUC为0.87。在18F-FDG注射前约4小时测量的BHB与后续时间点测量的BHB结果相当或更好。
血清BHB水平可用于评估MGU的抑制情况, 并可简化18F-FDG PET/CT炎症病变判读。
Les protocoles de préparation des diètes sont une méthode efficace dans le but de supprimer la captation myocardique physiologique du 18F-fluorodéoxyglucose (FDG). Cette étude a pour but d’investiguer l’efficacité de différentes diètes restreintes en glucide en utilisant des repas en boite préalablement préparés.
Les patients ont été divisés en 4 groupes recevant des protocoles préparatoires différents comme suit: uniquement un minimum de jeûne de 15 heures, deux repas avec une diète riche en gras et faible en glucides (HFLCD), deux repas avec une diète riche en protéines animales et a faible teneur en glucides (HAPLCD) et deux repas avec une diète riche en protéines végétales et a faible teneur en glucides (HPPLCD). Les boites de repas ont été préparées selon les restrictions en glucides requises. Les indices de captation myocardique normalisés SUV max et SUV moyen ont été mesurés et le taux de suppression a été analysé.
Le SUV max myocardique moyen du jeûne seul, HFLCD, HAPLCD et HPPLCD étaient respectivement de 8.26 + 5.85, 2.21 + 1.50, 2.34 + 1.88 et 4.10 + 3.61 et le taux de suppression était respectivement de 36.6%, 93.3%, 93.3% et 70%. L’efficacité de HFLCD, HAPLCD et HPPLCD était supérieure a celle du jeûne de 15 heures seul. Les SUV max de HFLCD et HAPLCD ne démontraient aucune différence significative (p = 1), tandis que ceux de HFLCD et HPPLCD démontraient des différences significatives (p = 0.046).
En utilisant des boîtes de repas préalablement préparées basées sur des restrictions en glucides, HFLCD, HAPLCD et HPPLCD peuvent être administrés aux patients avec des besoins en diète différents, tout en fournissant une diminution substantielle de la captation myocardique physiologique du FDG.
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EMUNI, FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Individuals with cardiac sarcoidosis have an increased risk of ventricular arrhythmia and death. Several small cohort studies have evaluated the ability of late gadolinium enhancement (LGE) by ...cardiac magnetic resonance imaging (MRI) to predict adverse cardiovascular events. However, studies have yielded inconsistent results, and some analyses were underpowered. Therefore, we sought to systematically review and perform meta-analysis of the prognostic value of cardiac MRI for patients with known or suspected cardiac sarcoidosis.
We systematically searched for cohort studies of patients with known sarcoidosis with suspected cardiac involvement who underwent cardiac MRI with LGE with at least 12 months of either prospective or retrospective follow-up data regarding post-MRI adverse cardiovascular outcomes. We identified 7 studies of 694 subjects (mean age 53; 42% men).One hundred and ninety-nine patients (29%) were LGE positive. All-cause mortality occurred in 19 LGE-positive versus 17 LGE-negative subjects (annualized incidence, 3.1% versus 0.6%). The pooled relative risk was 3.38 (95% confidence interval, 1.07-10.7; P=0.04). Cardiovascular mortality occurred in 10 LGE-positive versus 2 LGE-negative subjects (annualized incidence, 1.9% versus 0.3%; relative risk 10.7 95% confidence interval, 1.34-86.3; P=0.03). Ventricular arrhythmia occurred in 41 LGE-positive versus 0 LGE-negative subjects (annualized incidence, 5.9% versus 0%; relative risk 19.5 95% confidence interval, 2.68-143; P=0.003). A combined end point of death or ventricular arrhythmia occurred in 64 LGE-positive versus 18 LGE-negative subjects (annualized incidence, 8.8% versus 0.6%; relative risk 6.20 95% confidence interval, 2.47-15.6; P<0.001). There was no significant heterogeneity for any outcomes.
LGE is associated with future cardiovascular death and ventricular arrhythmia among patients referred to MRI for known or suspected cardiac sarcoidosis.
With appropriate protocols, F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can visualize myocardial inflammation. Optimal protocols and normative myocardial ...FDG uptake values are not well-established.
We evaluated 111 patients referred for inflammation cardiac FDG PET/CT. Patients followed a low-carbohydrate, high-fat diet for 36 hours before imaging and received unfractionated heparin. Glucose and fatty acid metabolism biomarkers were obtained. Mean blood pool and maximum myocardial uptake (SUVmean, SUVmax) were measured, avoiding areas of abnormal FDG uptake or spillover.
Adequate suppression of myocardial FDG uptake occurred in 95% of patients (n = 106). Myocardial SUVmax was significantly below background blood pool SUVmean: septal myocardial to blood pool ratio 0.75 (95% CI 0.73-0.77; P < 0.001); lateral myocardial to blood pool ratio 0.70 (95% CI 0.68-0.72; P < 0.001). Glucose, insulin, and C-peptide correlated to blood pool SUVmean (Spearman rs = 0.39, P < 0.01; rs = 0.40, P < 0.01; rs = 0.35, P < 0.01) and myocardial SUVmax (Spearman rs = 0.31, P < 0.01; rs = 0.31, P < 0.01; rs = 0.26, P < 0.01). Fatty acid metabolism biomarkers did not correlate to myocardial SUVmax.
Patients following intensive metabolic preparation have myocardial FDG SUVmax below background SUVmean. Biomarkers of glucose metabolism modestly correlate to FDG uptake.
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EMUNI, FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
This study sought to evaluate differential effects of visceral fat (VF) and subcutaneous fat and their effects on metabolic syndrome (MetS) risk across body mass index (BMI) categories.
The regional ...distribution of adipose tissue is an emerging risk factor for cardiometabolic disease, although serial changes in fat distribution have not been extensively investigated. VF and its alterations over time may be a better marker for risk than BMI in normal weight and overweight or obese individuals.
We studied 1,511 individuals in the MESA (Multi-Ethnic Study of Atherosclerosis) with adiposity assessment by computed tomography (CT). A total of 253 participants without MetS at initial scan underwent repeat CT (median interval 3.3 years). We used discrete Cox regression with net reclassification to investigate whether baseline and changes in VF area are associated with MetS.
Higher VF was associated with cardiometabolic risk and coronary artery calcification, regardless of BMI. After adjustment, VF was more strongly associated with incident MetS than subcutaneous fat regardless of weight, with a 28% greater MetS hazard per 100 cm(2)/m VF area and significant net reclassification (net reclassification index: 0.44, 95% confidence interval CI: 0.29 to 0.60) over clinical risk. In individuals with serial imaging, initial VF (hazard ratio: 1.24 per 100 cm(2)/m, 95% CI: 1.08 to 1.44 per 100 cm(2)/m, p = 0.003) and change in VF (hazard ratio: 1.05 per 5% change, 95% CI: 1.01 to 1.08 per 5% change, p = 0.02) were associated with MetS after adjustment. Changes in subcutaneous fat were not associated with incident MetS after adjustment for clinical risk and VF area.
VF is modestly associated with BMI. However, across BMI, a single measure of and longitudinal change in VF predict MetS, even accounting for weight changes. Visceral adiposity is essential to assessing cardiometabolic risk, regardless of age, race, or BMI, and may serve as a marker and target of therapy in cardiometabolic disease.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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