Abstract Hypoalbuminemia, a frailty criterion, belongs to a group of comorbidities not captured as a traditional risk factor. We assessed its prognostic value in patients who underwent transcatheter ...aortic valve implantation (TAVI). The study included 1215 consecutive patients from the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI Japanese multicenter registry. Hypoalbuminemia was defined as serum albumin level<3.5 g/dL. Baseline characteristics, procedural outcomes, and all-cause, cardiovascular, and non-cardiovascular mortality rates after TAVI were compared between patients with albumin level<3.5 g/dL (hypoh-ALB group, n=284) and those with albumin level>3.5 g/dL (nonhyponh-ALB group, n=931). Several baseline characteristics differed significantly between both groups, including age (85.1±5.1 years vs. 84.2±4.9 years, p=0.012), ejection fraction (58.5±14.3% vs. 62.9±12.4%, p<0.001), baseline kidney function, or liver disease. The 30-day mortality rate in all patients showed significant differences between the 2 groups (3.9% vs. 1.3%, p=0.005). During a mean follow-up of 330 days, cumulative all-cause, cardiovascular, and non-cardiovascular mortality rates were significantly higher in the hALB group than in the nhALB group (log-rank test, p<0.001, p=0.0021, and p<0.001, respectively). The groups were also analysed using a propensity-matching model for adjusting the baseline differences. The analysis revealed that the poorer prognosis of the hALB group in terms of cumulative all-cause and non-cardiovascular mortality was retained (p=0.038, and p=0.0068, respectively); however, differences in cardiovascular mortality rates in the two groups were attenuated (p=0.93). In conclusion, hypoalbuminemia was associated with poor prognosis, highlighted by the increase in non-cardiovascular mortality. Baseline albumin level could be a useful marker for risk stratification before TAVI.
Objectives This study evaluated the usefulness of fasting18 F-fluorodeoxyglucose (FDG)–positron emission tomography (PET) in the diagnosis and management of cardiac sarcoidosis (CS) and compared it ...with FDG uptake in dilated cardiomyopathy (DCM). Background Cardiac sarcoidosis may clinically present as DCM but is amenable to systemic corticosteroid therapy if disease activity is high. Although alterations of FDG uptake have been reported in CS, limited information is available on the quantitative estimates of FDG uptake. Methods Fasting FDG–PET was performed in 24 systemic sarcoidosis patients and was compared with 8 age-matched DCM patients. FDG–PET was also performed in 15 age-matched healthy control subjects. Twelve of the 24 sarcoidosis patients had cardiac involvement based on criteria established by the Japanese Ministry of Health and Welfare; the remaining 12 of 24 patients revealed no evidence of cardiac involvement. The myocardial FDG uptake was quantified by measuring the standardized uptake value in 17 myocardial segments in each subject. Coefficient of variation (COV), which equals the standard deviation of uptake divided by the average uptake of 17 segments, was calculated as an index of heterogeneity in the heart. Results The FDG uptake was distinctly heterogeneous in CS patients. The COV value was significantly greater in CS patients (0.25 ± 0.05) than control subjects (0.14 ± 0.03, p < 0.01), sarcoidosis patients without cardiac involvement (0.14 ± 0.03, p < 0.01), or DCM patients (0.15 ± 0.02, p < 0.01). The COV value in DCM patients was similar to control subjects or sarcoidosis patients without cardiac involvement. The cutoff COV value for the diagnosis of CS was 0.18 (sensitivity: 100%; specificity: 97%). After corticosteroid therapy in CS patients, the COV value was decreased to 0.14 ± 0.06 (p < 0.05) and became essentially similar to the other groups. Conclusions Heterogeneous myocardial FDG uptake may be a useful diagnostic marker of disease activity for CS.
Objectives The aim of this study was to compare the effect of pioglitazone with glimepiride on coronary arterial inflammation with serial18 F-fluorodeoxyglucose (FDG)–positron emission tomography ...(PET) combined with computed tomography (CT) angiography. Background Recent studies have shown that FDG-PET combined with CT is a reliable tool to visualize and quantify vascular inflammation. Although pioglitazone significantly prevented the progression of coronary atherosclerosis and reduced the recurrence of myocardial infarction in patients with type 2 diabetes mellitus (DM), it remains unclear whether pioglitazone could attenuate coronary artery inflammation. Methods Fifty atherosclerotic patients with impaired glucose tolerance or type 2 DM underwent determination of blood chemistries, anthropometric and inflammatory variables, and FDG-PET/CT angiography, and then were randomized to receive either pioglitazone or glimepiride for 16 weeks. Effects of the treatments on vascular inflammation of the left main trunk were evaluated by FDG-PET/CT angiography at baseline and end of the study. Vascular inflammation of the left main trunk was measured by blood-normalized standardized uptake value, known as a target-to-background ratio. Results Three patients dropped out of the study during the assessment or treatment. Finally, 25 pioglitazone-treated patients and 22 glimepiride-treated patients (37 men; mean age: 68.1 ± 8.3 years; glycosylated hemoglobin: 6.72 ± 0.70%) completed the study. After 16-week treatments, fasting plasma glucose and glycosylated hemoglobin values were comparably reduced in both groups. Changes in target-to-background ratio values from baseline were significantly greater in the pioglitazone group than in the glimepiride group (–0.12 ± 0.06 vs. 0.09 ± 0.07, p = 0.032), as well as changes in high-sensitivity C-reactive protein (pioglitazone vs. glimepiride group: median: –0.24 interquartile range (IQR): –1.58 to –0.04 mg/l vs. 0.08 IQR: –0.07 to 0.79 mg/l, p = 0.031). Conclusions Our study indicated that pioglitazone attenuated left main trunk inflammation in patients with impaired glucose tolerance or DM in a glucose-lowering independent manner, suggesting that pioglitazone may protect against cardiac events in patients with impaired glucose tolerance or DM by suppressing coronary inflammation. (Anti-Inflammatory Effects of Pioglitazone; NCT00722631 )
Abstract Background Controlling intracoronary computed tomography (CT) number for coronary CT angiography (CCTA) has been difficult. Objective The study assessed whether intracoronary CT number of ...CCTA could be estimated. Methods One hundred twenty six patients were randomly assigned to either CCTA with 30 mL of contrast media (CM) following 5 mL of CM at timing bolus or CCTA with 50 mL of CM following 10 mL of CM at timing bolus. The relationships between intracoronary CT number and patients’ characteristics and peak time and peak CT number at timing bolus in patients who showed valid time–density curve were analyzed in both groups. Then, the multiple regression equation best described was made. The prediction system was validated by 112 patients randomly targeted between 250 HU and 430 HU of CT number. Results In group 5/30, intracoronary CT number was positively correlated with peak CT number at timing bolus (correlation coefficient, 1.42, p < 0.001), negatively correlated with body surface area (−109.19, p < 0.001) and peak time (−6.93, p < 0.001). Whereas, intracoronary CT number was positively correlated with only peak CT number at timing bolus (1.33, p < 0.001) in group 10/50. Then, CT number-controlling system using the simple equation best described CT number was established for CCTA following 5 mL of CM at timing bolus. Of 112 patients, there was good correlation between target CT number and measured CT number ( r = 0.85, p < 0.0001) in 96 patients (85.7%), having valid time–density curve at timing bolus. Conclusions Controlling CT number may be enabled by CT number-controlling system following 5 mL of CM at timing bolus.
Abstract Background Coronary computed tomography angiography (CCTA) may be useful for noninvasive follow-up; however, evaluation of coronary stenosis and CT number of plaque may be inaccurate under ...different vessel enhancement of contrast media. We examined the reproducibility of the CT number of repeat CCTA using our original CT number-controlling system (CTN-CS), which selects contrast level by a multiple regression equation using body surface area and peak CT number and peak time on timing bolus and during CCTA. Methods and results One hundred seventy-two patients who underwent serial CCTA were prospectively and randomly assigned to 3 groups. In the first group, Group A, the amount of contrast for the second CCTA was determined by CTN-CS to match the intracoronary CT number of the first CCTA. In Group B, each patient received the same amount of intravenous contrast in both CCTA examinations. In Group C, 0.7 mL/mg body weight (BW) of contrast medium (350 mgI/mL) was used for baseline and follow-up CCTAs. The regression of repeated CCTAs was the best in Group A ( r = 0.85, p < 0.001) vs. Group B ( r = 0.52, p < 0.001), and Group C ( r = 0.61, p < 0.001). The absolute difference between intracoronary CT numbers of the second and first CCTA was the lowest in Group A (24.8 ± 21.8 HU), followed by Group B (37.6 ± 26.2 HU; p < 0.05) and Group C (46.5 ± 34.4 HU; p < 0.001). Conclusions Using CTN-CS, the difference of intracoronary CT numbers of the second and first CCTA was the smallest when compared to CCTAs using the same contrast volumes or constant volumes per body weight.
Objectives The aim of this study was to compare the effect of pioglitazone, an insulin sensitizer, with glimepiride, an insulin secretagogue, on atherosclerotic plaque inflammation by using serial18 ...F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging. Background Atherosclerosis is intrinsically an inflammatory disease. Although hyperglycemia is associated with an increased risk of atherosclerotic cardiovascular disease, there are no clinical data to show the preference of any specific oral hypoglycemic agents to prevent atherosclerotic plaque inflammation. Methods A total of 56 impaired glucose tolerant or diabetic patients with carotid atherosclerosis underwent a complete history, determinations of blood chemistries, anthropometric variables, and FDG-PET. They were randomly assigned to receive either pioglitazone (15 to 30 mg) or glimepiride (0.5 to 4.0 mg) for 4 months with titration to optimal dosage. Effects of the drugs on atherosclerotic plaque inflammation were evaluated by FDG-PET at study completion. Plaque inflammation was measured by blood-normalized standardized uptake value, known as a target-to-background ratio. Results The study was completed in 31 pioglitazone-treated patients and 21 glimepiride-treated patients. Although both treatments reduced fasting plasma glucose and hemoglobin A1c values comparably, pioglitazone, but not glimepiride, decreased atherosclerotic plaque inflammation. Compared with glimepiride, pioglitazone significantly increased high-density lipoprotein cholesterol level. High-sensitivity C-reactive protein was decreased by pioglitazone, whereas it was increased by glimepiride. Multiple stepwise regression analysis revealed that the increase in high-density lipoprotein cholesterol level was independently associated with the attenuation of plaque inflammation. Conclusions Our present study suggests that pioglitazone could attenuate atherosclerotic plaque inflammation in patients with impaired glucose tolerance or in diabetic patients independent of glucose lowering effect. Pioglitazone may be a promising strategy for the treatment of atherosclerotic plaque inflammation in impaired glucose tolerance or diabetic patients. (Detection of Plaque Inflammation and Visualization of Anti-Inflammatory Effects of Pioglitazone on Plaque Inflammation in Subjects With Impaired Glucose Tolerance and Type 2 Diabetes Mellitus by FDG-PET/CT; NCT00722631 )
Diagnostic Accuracy of Coronary In-Stent Restenosis Using 64-Slice Computed Tomography: Comparison With Invasive Coronary Angiography Mariko Ehara, Masato Kawai, Jean-François Surmely, Tetsuo ...Matsubara, Mitsuyasu Terashima, Etsuo Tsuchikane, Yoshihisa Kinoshita, Tatsuya Ito, Yoshihiro Takeda, Kenya Nasu, Nobuyoshi Tanaka, Akira Murata, Hiroshi Fujita, Koyo Sato, Atsuko Kodama, Osamu Katoh, Takahiko Suzuki To evaluate the diagnostic accuracy of coronary in-stent restenosis with 64-slice multislice computed tomography coronary angiography (CTCA), we scanned 125 stented segments and compared with invasive coronary angiography (ICA). Overall sensitivity, specificity, positive predictive values, and negative predictive values by CTCA were 92%, 81%, 54%, and 98%, respectively. Grading of neointimal proliferation with visual estimation by CTCA showed a correlation with the percent diameter stenosis by ICA, and as the grade increases, the median value of percent diameter stenosis increased linearly. Our results show that binary restenosis can be excluded with high probability by CTCA, with a moderate rate of false-positive results.
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