Abstract Smoking is a central factor in many pathological conditions. Its role in neoplasm, lung and cardiovascular diseases has been well established for years. However it is less acknowledged the ...cigarette smoking affects both the innate and adoptive immune arms. Cigarette smoke was shown to augment the production of numerous pro-inflammatory cytokines such as TNF-α, IL-1, IL-6, IL-8 GM-CSF and to decrease the levels of anti-inflammatory cytokines such as IL-10. Tobacco smoke via multiple mechanisms leads to elevated IgE concentrations and to the subsequent development of atopic diseases and asthma. Cigarette smoke has also been shown activate in many ways macrophage and dendritic cell activity. While it is better evident how cigarette smoke evokes airway diseases more mechanisms are being revealed linking this social hazard to autoimmune disorders, for instance via the production of antibodies recognizing citrullinated proteins in rheumatoid arthritis or by the elevation of anti-dsDNA titers in systemic lupus erythematosus. The current review underlines the importance of smoking prevention and eradication not only in respiratory disorders but also in autoimmune conditions as well.
Abstract Objectives This study aims to assess the correlations among coronary artery calcium (CAC), self-reported exercise, and mortality in asymptomatic patients. Background The interaction between ...reported exercise habits and CAC scores for predicting clinical risk is not yet well known. Methods We followed 10,690 asymptomatic patients who underwent CAC scanning. Patients were divided into 4 groups based on a single-item self-reported exercise. Mean follow-up was 8.9 ± 3.5 years for the occurrence of all-cause mortality (ACM). Results Annualized ACM progressively increased with increasing CAC score (p < 0.001) and decreasing exercise (p < 0.001). Among patients with CAC scores of 0, ACM was low regardless of the amount of exercise. Among patients with CAC scores from 1 to 399, there was a stepwise increase in ACM for each reported decrement in exercise, and this difference was markedly more pronounced among patients with CAC scores ≥400. Compared with highly active patients with a CAC score of 0, highly sedentary patients with CAC scores ≥400 had a 3.1-fold increase (95% confidence interval: 1.35 to 7.11) in adjusted ACM risk. Our single-item physical activity questionnaire was also predictive of risk factors and clinical and lipid profile measurements. Conclusions In asymptomatic patients, self-reported exercise is a significant predictor of long-term outcomes. Prognostic value of the reported exercise is additive to the increasing degree of underlying atherosclerosis. Among patients with high CAC scores, exercise may play a protective role, whereas reported minimal or no exercise substantially increases clinical risk. Our results suggest there is clinical utility for the use of a simple single-item exercise questionnaire for such assessments.
Precise definition of the mitral valve plane (VP) during segmentation of the left ventricle for SPECT myocardial perfusion imaging (MPI) quantification often requires manual adjustment, which affects ...the quantification of perfusion. We developed a machine learning approach using support vector machines (SVM) for automatic VP placement.
A total of 392 consecutive patients undergoing
Tc-tetrofosmin stress (5 min; mean ± SD, 350 ± 54 MBq) and rest (5 min; 1,024 ± 153 MBq) fast SPECT MPI attenuation corrected (AC) by CT and same-day coronary CT angiography were studied; included in the 392 patients were 48 patients who underwent invasive coronary angiography and had no known coronary artery disease. The left ventricle was segmented with standard clinical software (quantitative perfusion SPECT) by 2 experts, adjusting the VP if needed. Two-class SVM models were computed from the expert placements with 10-fold cross validation to separate the patients used for training and those used for validation. SVM probability estimates were used to compute the best VP position. Automatic VP localizations on AC and non-AC images were compared with expert placement on coronary CT angiography. Stress and rest total perfusion deficits and detection of per-vessel obstructive stenosis by invasive coronary angiography were also compared.
Bland-Altman 95% confidence intervals (CIs) for VP localization by SVM and experts for AC stress images (bias, 1; 95% CI, -5 to 7 mm) and AC rest images (bias, 1; 95% CI, -7 to 10 mm) were narrower than interexpert 95% CIs for AC stress images (bias, 0; 95% CI, -8 to 8 mm) and AC rest images (bias, 0; 95% CI, -10 to 10 mm) (
< 0.01). Bland-Altman 95% CIs for VP localization by SVM and experts for non-AC stress images (bias, 1; 95% CI, -4 to 6 mm) and non-AC rest images (bias, 2; 95% CI, -7 to 10 mm) were similar to interexpert 95% CIs for non-AC stress images (bias, 0; 95% CI, -6 to 5 mm) and non-AC rest images (bias, -1; 95% CI, -9 to 7 mm) (
was not significant NS). For regional detection of obstructive stenosis, ischemic total perfusion deficit areas under the receiver operating characteristic curve for the 2 experts (AUC, 0.79 95% CI, 0.7-0.87; AUC, 0.81 95% CI, 0.73-0.89) and the SVM (0.82 0.74-0.9) for AC data were the same (
= NS) and were higher than those for the unadjusted VP (0.63 0.53-0.73) (
< 0.01). Similarly, for non-AC data, areas under the receiver operating characteristic curve for the experts (AUC, 0.77 95% CI, 0.69-0.89; AUC, 0.8 95% CI, 0.72-0.88) and the SVM (0.79 0.71-0.87) were the same (
= NS) and were higher than those for the unadjusted VP (0.65 0.56-0.75) (
< 0.01).
Machine learning with SVM allows automatic and accurate VP localization, decreasing user dependence in SPECT MPI quantification.
Assessment of myocardial uptake of Tc-99m-pyrophosphate (Tc-99m PYP) is pivotal in distinguishing transthyretin-associated cardiac amyloidosis (ATTR) from light chain amyloid (AL). It is often ...difficult to differentiate myocardial uptake from blood pool radioactivity with planar imaging or SPECT. We studied whether simultaneous dual-isotope Tc-99m PYP/Tl-201 SPECT improves assessment of Tc-99m PYP uptake compared to single-isotope SPECT.
Simultaneous Tc-99m PYP/Tl-201 dual-isotope SPECT was acquired in 112 patients studied for possible cardiac amyloidosis. Visual interpretation was performed by two observers on single-isotope followed by dual-isotope SPECT. Heart-to-contralateral lung ratio (H/CL) of myocardial counts quantified by single-isotope and dual-isotope SPECT was compared between ATTR, AL, and no amyloidosis groups.
In 112 patients (39 ATTR and 26 AL patients, and 47 no amyloidosis), a lower proportion of no amyloidosis and AL patients were classified visually as equivocal with dual-isotope SPECT compared to single-isotope SPECT (2% vs 19%, P = 0.02 and 8% vs 35%, P = 0.04, respectively). H/CL measurements with single-isotope and dual-isotope were lower in AL and no amyloidosis patients vs ATTR patients (P < 0.05). Interobserver agreement of visual assessment was improved with dual-isotope SPECT (P = 0.03). AUCs for detection of ATTR by visual assessment and H/CL quantification were higher with dual-isotope (0.94 and 0.95, respectively) compared to single-isotope SPECT (0.84, P = 0.001 and 0.92, P = 0.02).
Tc-99m PYP/Tl-201 SPECT improves visual differentiation of ATTR and AL amyloidosis compared to single-isotope SPECT. Visual assessment and H/CL quantitation with dual-isotope SPECT provide similar discrimination between patients with ATTR and AL amyloidosis.
La evaluación de la captación miocárdica de Tc-99m-pirofosfato (Tc-99m PYP) es fundamental para distinguir la amiloidosis cardíaca asociada a transtiretina (ATTR) del amiloide de cadena ligera (AL). A menudo es difícil diferenciar la captación miocárdica de la radioactividad del pool sanguíneo con imágenes planares o SPECT. Nosotros estudiamos si el SPECT dual simultáneo con isótopos Tc-99m PYP/Tl 201 mejora la evaluación de la captación de Tc-99m PYP comparado con el SPECT con isótopo simple.
El SPECT simultáneo con isotopo dual Tc-99m PYP / Tl-201 se adquirió en 112 pacientes estudiados para una posible amiloidosis cardíaca. La reconstrucción de la imagen y la interpretación visual se realizaron en el isótopo único seguido del SPECT de isótopo dual. Se comparó la relación entre corazón y el pulmón contralateral (H/CL) de la cuantificación de cuentas miocárdicas por isotipo simple y SPECT de isótopo dual entre los grupos de ATTR, AL y el grupo sin amiloidosis.
en 112 pacientes (39 pacientes con ATTR, 26 pacientes con AL y 47 sin amiloidosis), una menor proporción de pacientes sin amiloidosis y con AL, se clasificaron visualmente como equívocos con SPECT de isótopo dual en comparación con SPECT de isótopo único (4% vs 16% P = 0.04 y 8% vs 34%, P = 0.03 respectivamente). Las mediciones de H/CL con isótopo simple e isótopo dual fueron más bajas en pacientes con AL y sin amiloidosis en comparación a los pacientes con ATTR (P < 0.05). La concordancia intra/interobservador de la cuantificación de H/CL fue mejorada con SPECT de isótopo dual (P = 0.04 y 0.02, respectivamente). El AUC para la detección de ATTR por evaluación visual y la cuantificación de la relación H/CL fueron mayores en el grupo de isótopo dual (0.94 y 0.95, respectivamente) en comparación con SPECT de isótopo único (0.84, P = 0.001 y 0.92, P = 0.02).
el SPECT Tc-99m PYP/Tl-201 mejora la diferenciación visual de la amiloidosis ATTR y AL en comparación con el SPECT de isótopo único. La evaluación visual y la cuantificación de la relación H/CL con SPECT de isótopo dual proporcionan una discriminación similar entre los pacientes con amiloidosis asociada a ATTR y AL.
评估Tc-99m-pyrophosphate(Tc-99m PYP)的心肌摄取是鉴别甲状腺素转运蛋白相关型(ATTR)和轻链型(AL)心脏淀粉样变的关键。然而,平面或SPECT断层显像难以从血池放射性摄取中辨识心肌摄取情况。本研究通过与单核素SPECT Tc-99m PYP比较,探讨同步双核素Tc-99m PYP/TI-201 SPECT能否提高 Tc-99m PYP心肌摄取的评价能力。
对112名疑似心脏淀粉样变的患者进行同步Tc-99m PYP/TI-201 双核素SPECT显像。分别采用单核素与双核素SPECT数据进行重建和视觉评估。比较ATTR, AL和无心脏淀粉样变三组之间单、双核素SPECT心/对侧肺放射性计数比值(H/CL)的差异。
在112名患者(39名ATTR, 26名AL,以及47名无淀粉样变患者)中,采用双同位素SPECT视觉评估对无心脏淀粉样变和AL判断不确定的比率要低于单核素SPECT的比率(分别为4% vs 16%, P = 0.04 和8% vs 34%, P = 0.03)。不论单/双核素SPECT计算的H/CL比值,在AL和无淀粉样变患者中均低于ATTR患者(P < 0.05)。使用双核素SPECT提高了观察者自身和观察者间的一致性(分别为p = 0.04 和0.02)。采用双核素SPECT视觉评估和和H/CL比值检测ATTR的AUC值(分别为0.94和0.95)要高于使用单核素SPECT的结果(0.84, P = 0.001 和0.92, P = 0.02)。
Tc-99m PYP/Tl-201 SPECT提高了单核素SPECT视觉分析鉴别ATTR和AL的能力。双同位素SPECT的视觉评估和H/CL定量分析对鉴别ATTR和AL效能相当。
L’amyloïdose cardiaque à la transthyrétine (ATTR) est une cardiomyopathie rare mais sous-diagnostiquée. Son diagnostic histologique invasif, peut être avantageusement remplacé par la scintigraphie planaire au pyrophosphate de technetium (99mTc-PYP). Malheureusement, les cameras a detecteurs de cadmium zinc telluride ne peuvent pas generer des images planaires. A ce jour aucune validation du diagnostic de l’ATTR par imagerie non planaire n’a été proposée et validée. Nous avons développé et validé un protocole utilisant la caméra cardiaque CZT de GE pour le diagnostic de l’ATTR.
43 sujets (24 ATTR, 19 non-ATTR) ont été étudiés avec une camera double tête Philips en imagerie planaire et la caméra cardiaque CZT de General Electric. L’absorption myocardique du 99mTc-PYP a été quantifiée en utilisant le rapport classique entre les activités cardiaque et thoracique droite controlaterale (H / CL). Les acquisitions CZT ont été quantifiées par 2 lecteurs indépendamment des données planaires. La sensibilité et la spécificité de la scintigraphie au CZT ont été analysées sur base du seuil diagnostique (H/CL) de 1.5. L’analyse statistique de McNemar’s et le coefficient de corrélation de Pearson ont été calculés.
nous n’avons pas observé de différence significative pour l’identification positive de l’ATTR parmi les sujets étudiés (76,7% d’hommes, âgés de 77 ± 9 ans) entre les deux modalités scintigraphiques. De plus nous avons observé une forte corrélation entre les rapports par imagerie CZT et planaire (r = 0,92, P < 0,0001), avec faible variabilité intra- (ICC = 0,89 (0,80-0,94)) et inter-observateur (ICC = 0,80 (0,65-0,89)). La scintigraphie au CZT a montré une sensibilité et spécificité de 100% pour le diagnostic de l’ATTR.
L’imagerie CZT au 99mTc-PYP est aussi sensible et spécifique que l’imagerie planaire pour le diagnostic de l’ATTR. Ces résultats sont cliniquement importants compte tenu de la prévalence des caméras CZT dans les centres de médecine nucléaire, de l’émergence de thérapies ATTR modificatrices de la maladie, et de l’addition de cette nouvelle modalité diagnostique.
Atherothrombotic events in coronary arteries are most often due to rupture of unstable plaque resulting in myocardial infarction. Radiolabeled molecular imaging tracers directed toward cellular ...targets that are unique to unstable plaque can serve as a powerful tool for identifying high-risk patients and for assessing the potential of new therapeutic approaches. Two commonly available radiopharmaceuticals-
F-FDG and
F-NaF-have been used in clinical research for imaging coronary artery plaque, and ongoing clinical studies are testing whether there is an association between
F-NaF uptake and future atherothrombotic events. Other, less available, tracers that target macrophages, endothelial cells, and apoptotic cells have also been tested in small groups of patients. Adoption of molecular imaging of coronary plaque into clinical practice will depend on overcoming major hurdles, ultimately including evidence that the detection of unstable plaque can change patient management and improve outcomes.
•Medical records of ambulatory patients with heart failure were reviewed.•Among 814 patients, 464 (57%) had non-coronary cardiac calcifications.•Patients with calcifications had more hospitalizations ...for heart failure.•The OR for all-cause death, HF hospitalizations, and the composite endpoint were greater in patients with calcifications.•Calcifications should be included in risk stratification for heart failure.
Calcium deposits on heart valves are considered a local manifestation of atherosclerosis and are associated with poor cardiovascular outcomes. The clinical significance of cardiac calcifications among heart failure (HF) patients, as assessed by echocardiography, is unknown. This study evaluated associations of cardiac calcifications with mortality and hospital admissions in this specific population.
Medical records of all patients who initiated ambulatory surveillance at our HF clinic during 2011–2018 were reviewed. Calcifications in the aortic valve, aortic root, or the mitral valve were evaluated. Patients with moderate to severe regurgitation or stenosis of the aortic or mitral valves were excluded. The primary endpoint was the composite of long-term all-cause mortality and HF hospitalizations. Secondary endpoints were long-term all-cause mortality and more than one hospitalization due to HF.
This retrospective study included 814 patients (mean age 70.9 ± 13 years, 63.2% male). Of the total cohort, 350 (43%) had no cardiac calcifications and 464 (57%) had at least 1 calcified site. Considering the patients with no calcification as the reference group yielded a higher adjusted odds ratios for the composite endpoint, all-cause death, and recurrent HF hospitalizations, among patients with any cardiac calcification (OR = 1.68, 95%CI = 1.1–2.5, p = 0.01, OR=1.61, 95%CI = 1.1–2.3, p < 0.01, and OR = 1.50, 95%CI = 1.1–2.2, p < 0.01, respectively).
We found an independent association between cardiac calcifications and the risk of death and HF hospitalizations among ambulatory HF patients. Cardiac calcifications evaluated during routine echocardiography may contribute to the risk stratification of patients with HF.
(1) Background: left atrial appendage occlusion (LAAO) is considered an effective and relatively safe treatment for the prevention of thromboembolic events in patients with atrial fibrillation and a ...contra-indication for anticoagulation. We present a large multicenter real-world experience of transcatheter LAAO implementation in patients with atrial fibrillation who cannot be treated with chronic anti-coagulation; (2) Methods: included were atrial fibrillation patients who underwent transcatheter LAAO between 1 January 2016 and 30 June 2021. The study was conducted using the electronic health record database of Clalit Health Services (CHS). The primary outcomes included hemorrhagic and ischemic stroke following LAAO; (3) Results: included were 389 atrial fibrillation patients. During a median follow-up of 2.1 years, 13% patients had ischemic cerebrovascular accident (CVA), and 4.4% patients had hemorrhagic CVA. While the risk of ischemic stroke increased gradually over time, the risk of hemorrhagic CVA was highest during the first 3 months following the procedure. Moreover, previous ischemic stroke was the only significant predictor for both hemorrhagic and ischemic stroke following LAAO; (4) Conclusions: while the annual performance rate of transcatheter LAAO has increased significantly over the past years, post procedural long-term prognosis remains poor with a substantial risk of both thrombotic and bleeding events.
Objectives To examine currently known and additional potential neurological manifestations of the antiphospholipid syndrome (APS) and to discuss current and experimental therapeutic options in light ...of the present knowledge of the disease mechanism. Methods The PubMed database was searched for articles published between the years 1980 and 2008 for keywords referring to APS and several neurological conditions. Relevant English language articles were reviewed. Results APS is characterized by diverse neurological manifestations. These include cerebral ischemic events, epilepsy, dementia, cognitive deficits, headaches, psychiatric disorders, chorea, multiple sclerosis-like, transverse myelitis, and ocular symptoms. Some of the symptoms can be associated with ischemia; however, other mechanisms that could lead to similar outcomes have been described, such as direct binding of antiphospholipid antibodies to neural tissue. Current treatment guidelines concern cerebrovascular events only. We propose several different therapeutic options related to the autoimmune nature of the syndrome. Conclusion Neurological manifestations in APS are diverse and may be confused with other neurologic syndromes. This information is important for the proper diagnosis and management of patients. Experimental therapeutic alternatives expand the treatment options for patients and physicians.
Objectives To review the clinical aspects of cardiac arrhythmias and conduction disturbances in several common and less encountered adult rheumatic diseases and to underline the importance of prompt ...diagnosis and management in these patients. Methods The PubMed database was searched for articles published between the years 1960 and 2008 for keywords referring to autoimmune diseases. All relevant English-written articles were reviewed. Most were uncontrolled series and case reports, due to the lack of prospective studies and randomized trials. Results Rheumatologic conditions may affect the cardiovascular system and increase morbidity and mortality. Rhythm and conduction defects are usually mild but may be life-threatening; in certain diseases, such as in systemic lupus erythematosus they may resolve following therapy with corticosteroids. Conduction defects occur frequently in patients with spondyloarthropathies and in those with various forms of vasculitis. Enhanced variation of the QT interval may be a sensitive marker of a higher arrythmogenic tendency in patients with autoimmune conditions. Conclusions It is important to identify patients at high risk for cardiac arrhythmias. Treating such patients with arrhythmias should not differ fundamentally from other patients. Nevertheless, appropriate clinical attention and judgment should be applied to exclude the possibility that arrhythmias reflect uncontrolled myocardial inflammation.
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