Left ventricular myocardial cellular perfusion against the background of cardiac contractility modulation in patients with heart failure and atrial fibrillation

Aim. To assess the effect of cardiac contractility modulation (CCM) in patients with heart failure (HF) and atrial fibrillation (AF) on left ventricular (LV) myocardial cellular perfusion using perfusion single photon emission computed tomography (SPECT).Material and methods. 99mTc-MIBI SPECT gated myocardial perfusion imaging was performed in 60 patients with HF and AF before implantation of CCM device and after 6-months follow-up. All patients received long-term optimal medication therapy for HF. Results. The results obtained indicate a significant positive effect of CCM use in patients with HF and AF on LV ejection fraction (increase from 22 [18;30] to 25,5 [19;38] (p=0,002)), LV volume (decrease in LV end-systolic volume from 187 [114;238] to 154 [100;201] (p=0,001), end-diastolic volume from 229 [174;290] to 209 [159;259] (p=0,007)), as well as myocardial perfusion values. There is a favorable myocardial perfusion dynamics, which was more pronounced in nonischemic HF: increase in SRS from 6 [5;9] to 8,0 [6;11] after 6 months (p=0,01)). The extent of impaired perfusion significantly decreases from 12 [9;17] to 9 [6;16] (p=0,04). An indicator reflecting the total impairment of LV myocardial perfusion significantly decreases: total perfusion deficit decreased from 10 [8;14] to 7 [6;14] after 6 months (p=0,02), compared with ischemia-related HF.Conclusion. Perfusion SPECT makes it possible to assess the myocardial cellular perfusion during CCM therapy in patients with HF of various origin and AF. CCM therapy improves myocardial contractility and perfusion in patients with HF and AF

ПЕРФУЗИОННАЯ ОЭКТ МИОКАРДА С КТ-КОРРЕКЦИЕЙ ПОГЛОЩЕНИЯ: ПРИНЦИПЫ ПОЛУЧЕНИЯ И ИНТЕРПРЕТАЦИИ ДАННЫХ (МЕТОДИЧЕСКИЕ РЕКОМЕНДАЦИИ)

Guidelines for the implementation and interpretation of myocardial perfusion single-photon emission computed tomography (SPECT) with CT-based attenuation correction (AC) are compiled on the basis of long-term (since 1978) experience of the group of authors regarding the research of myocardial perfusion in various cardiovascular diseases, and aligned with the current EANM guidelines.Методические рекомендации по выполнению и интерпретации данных перфузионной однофотонной эмиссионной компьютерной томографии (ОЭКТ) миокарда с КТ-коррекцией поглощения излучения составлены на основании многолетнего (с 1978 г.) опыта авторского коллектива по исследованию перфузии миокарда при различных заболеваниях сердечно-сосудистой системы и приведены в соответствие с текущими рекомендациями EANM

Expert Center for cardiac amyloidosis: reality and perspectives

Aim. To evaluate the features of diagnosis of amyloid cardiomyopathy (ACMP), differential diagnosis of different types of amyloidosis and its clinical manifestations. Materials and methods. Were analyzed 150 cases of patients who consulted at the Expert Center for Amyloidosis with suspicion of the presence of ACMP. 63 patients were diagnosed with ACMP: 25 (39.7%) – women, 38 (60.3%) – men, with an average age of 64.1±1.5. 36 (57.1%) patients had AL-amyloidosis (immunoglobulin amyloid light-chain amyloidosis), 25 (39.7%) – ATTR-amyloidosis (transthyretin amyloidosis), 2 (3.2%) – AA-amyloidosis with heart failure (reactive systemic amyloidosis caused by hypersecretion of á-globulin). The analysis of clinical manifestations depending on the type of amyloidosis, data of laboratory and instrumental methods of diagnosis is carried out. Results. In most cases, 53 (84.1%) patients, amyloidosis manifested as signs of heart failure. Among cardiac manifestations, shortness of breath (95.2%), general weakness (93.7%), lower limb edema (76.2%) were the most common. To confirm the diagnosis, despite the high accuracy of the speckle-tracking echocardiography and magnetic resonance imaging of the heart with gadolinium, in rare cases a biopsy is required (e.g. there is a combination of clinical signs of several types of amyloidosis). Biopsy of the affected organ was performed in 31 (49.2%) patients. The strategy for further pathogenetic treatment depends on the determination of the type of amyloidosis. Free light chains of immunoglobulins were detected in 57.1% of cases, which allowed diagnosis of AL-amyloidosis. In 17 (38.6%) patients myocardial scintigraphy with 99mTc-pyrophosphate showed signs of ATTR-amyloidosis, which with a negative result of immunochemical studies allows non-invasive diagnosis of it. Conclusion. ACMP is a disease with an extremely adverse prognosis. Raising the awareness of specialists about ACMP is an important goal. With timely diagnosis, pathogenetic therapy can be started early, which will improve the quality of life and prognosis of patients with ACMP

Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

FUNDING SUPPORT AND AUTHOR DISCLOSURES Dr Williams is supported by the British Heart Foundation (FS/ICRF/ 20/26002). Dr Einstein has received speaker fees from Ionetix; has received consulting fees from W. L. Gore & Associates; has received authorship fees from Wolters Kluwer Healthcare – UpToDate; and has received grants or grants pending to his institution from Attralus, Canon Medical Systems, Eidos Therapeutics, GE Healthcare, Pfizer, Roche Medical Systems, W. L. Gore & Associates, and XyloCor Ther- apeutics. Dr Williams has received speaker fees from Canon Medical Systems. Dr Dorbala has received honoraria from Pfizer and GE Healthcare; and has received grants to her institution from Pfizer and GE Healthcare. Dr Sinitsyn has received congress speaker honoraria from Bayer, GE Healthcare, Siemens, and Philips. Dr Kudo has received research grants from Nihon Medi-physics and FUJIFILM Toyama Chemical. Dr Bucciarelli-Ducci is CEO (part-time) of the So- ciety for Cardiovascular Magnetic Resonance; and has received speaker fees from Circle Cardiovascular Imaging, Bayer, and Siemens Healthineers. All other authors have reported that they have no re- lationships relevant to the contents of this paper to disclose.Peer reviewedPublisher PD

Current status of nuclear cardiology in the Russian Federation

The article is devoted to the analysis of the current status of nuclear cardiology in the Russian Federation. The data on the number of facilities performing radionuclide investigations for the diagnosis and monitoring of the treatment of cardiovascular diseases, their staffing and equipment are given. The statistics of the conducted nuclear cardiology tests for 2018-2020 are given, as well as their methods, features and diagnostic significance are described

Analysis of the restoration of cardiology diagnostics scope in the Russian Federation during the COVID-19 pandemic: results of the Russian segment of the INCAPS COVID 2 study under the auspices of the International Atomic Energy Agency

Aim. To assess the changes in cardiology diagnostics scope in the Russian Federation during the coronavirus disease 2019 (COVID-19) pandemic.Material and methods. In an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), including questions about changes in the workflow of diagnostic laboratories and the scope of cardiac diagnostics from March 2019 (pre-pandemic) to April 2020 (first wave of the pandemic) and April 2021 (recovery stage), 15 Russian medical centers from 5 cities took part.Results. The decrease in the diagnostics scope by April 2020 by 59,3% compared to March 2019, by April 2021, stopped and was replaced by growth (+7,1%, the recovery rate, 112,1%). The greatest increase was in routine examinations, such as echocardiography (+11,6%), stress echocardiography (+18,7%), stress single photon emission computed tomography (+9,7%), and to a lesser extent resting computed tomography angiography (+7,0%) and magnetic resonance imaging (+6,6%). The performance of stress electrocardiography, stress magnetic resonance imaging and positron emission tomography for the diagnosis of endocarditis in April 2021 compared to March 2019 decreased by 10,3%, 63,2% and 62,5%, respectively.Conclusion. Due to the resumption of patient admissions for cardiac examinations during the ongoing COVID-19 pandemic, with the anti-epidemic measures taken and certain changes in the workflow, there has been a recovery in the diagnostics scope in most of the included centers

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

SPECIFIC FEATURES OF INTERPRETATION OF MYOCARDIAL PERFUSION SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY WITH COMPUTED TOMOGRAPHIC ABSORPTION CORRECTION

Objective: to study the capabilities of a hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) system during myocardial perfusion imaging study, to evaluate the impact of absorption correction (AC), and to reveal factors influencing the contribution of AC to the diagnostic result of the study.Material and methods. The study included 167 patients who underwent myocardial perfusion SPECT with and without CT AC. Differences between AC and non-AC studies were visually analyzed; the results of the analysis were used to form groups of visual differences. The supposed factors influencing the contribution of AC were studied, by assigning visual differences to a particular group.Results. The possible variants of the impact of AC were described in the baseline scintigrams. AC made a significant contribution in 68% of cases. With AC, the perfusion defects visible during non-AC study recovered in 80% of these cases. The factors predicting substantial differences between the AC and non-AC studies included weight, end diastolic volume, male sex, patients with small focal perfusion defects and transient ischemia, and inadequate injected activity. Factors, such as body mass index, large perfusion defects, CT subsystem and orbit settings, and time from the injection of a radiotracer to the initiation of a study, had no substantial impact on the contribution of AC. During AC studies, SRS and transient ischemic dilatation were significantly higher than during non-AC studies, requiring a shift of standard criteria. There were some methodical features of interpretation of myocardial perfusion SPECT using CT correction.Conclusion. Myocardial SPECT with AC enhances the diagnostic value of the technique, simplifies the interpretation of myocardial perfusion SPECT, and reduces the number of falsepositive and questionable results

Interpretation of myocardial perfusion SPECT with attenuation correction. Part 2

Objective: to investigate the possibilities of a combined single photon emission computed tomography/computed tomography (SPECT/CT) system during myocardial perfusion studies and to examine the features of their interpretation.Subjects and methods. In April 2013 to April 2019, the Department of Radionuclide Diagnosis, National Medical Research Center of Cardiology, performed myocardial perfusion SPECT with attenuation correction (AC) in 3144 patients with various cardiovascular diseases. Based on the experience gained, the authors expanded and adjusted the principles of processing and interpreting the results of this study, which they had first set forth in 2014. Special emphasis is placed on the interpretation of apical and septal perfusion defects and diffuse perfusion irregularity, on the demonstration of the role of current reconstruction algorithms in obtaining highest-quality myocardial images, and on the assessment of self-potentialities of lowdose CT findings at myocardial SPECT/CT, as well as on proposals to standardize quantitative parameters for perfusion assessment at myocardial SPECT/CT.Results. AC affected in large measure the interpretation of myocardial perfusion SPECT in most cases. Apical perfusion defect appeared on AC images was observed in 50% of patients without established coronary heart disease and could be interpreted as a normal variant (apical thinning). The diffuse irregularity of perfusion radiopharmaceutical tracer accumulation in the application of the current reconstruction algorithms stood out in a separate pattern as a sign of microcirculatory disturbances. Low-dose CT data allow visualization of a severe thoracic abnormality at imaging and should be reflected in the conclusion. The perfusion study descriptions based on an analysis of AC and nAC images had a greater interoperator consistency than those based on an analysis of only nAC images (w = 0.915 and 0.809, respectively; p = 0.027). At the same time, the use of arithmetic means of the extent of transient ischemia (Reversibility Extent) is better consistent with visual analysis (= 0.08Ѓ}1.46%, p = 0.49).Conclusion. The use of AC and current iterative algorithms at myocardial perfusion SPECT should be part of a mandatory study protocol, since this affects to a large extent the diagnostic value of the technique. The borderline values of disturbed perfusion parameters at AC should be reconsidered