Sydämen rasituskaikukuvaus

Vertaisarvioitu.Sydämen rasituskaikukuvaus on pitkään käytössä ollut, monipuolinen sydänsairauksien tutkimusmenetelmä. Rintakipupotilaan hemodynaamisesti merkittävä, ahtauttava sepelvaltimotauti on mahdollista todeta seinämäliikehäiriönä, joka kehittyy rasituksen aiheuttaman sydänlihasiskemian seurauksena. Kaikukuvauksen avulla on mahdollista arvioida sydänlihasiskemian sijaintia ja laajuutta sekä sen yhteyttä potilaan kuormitukseen ja oireisiin. Rasituskaikukuvaus mahdollistaa sydämen rakenteen ja toiminnan monipuolisen tutkimisen, kuten vasemman kammion systolisen ja diastolisen toimintahäiriön toteamisen. Tutkimuksen käyttöaiheet ovat laajentuneet, ja sitä käytetään aiempaa enemmän muun muassa läppävikojen vaikeuden, sydänlihassairauksien ja epäselvän hengenahdistuksen selvittelyssä.Peer reviewe

Prognostic Value of Tc-99m-HMDP Scintigraphy in Elderly Patients With Chronic Heart Failure

Background This study evaluated the prevalence and prognostic significance of cardiac transthyretin amyloidosis (ATTR) diagnosed using Tc-99m- hydroxymethylene-diphosphonate (Tc-99m-HMDP) scintigraphy in an elderly heart failure population. Methods This retrospective study included 335 patients aged >70 years with heart failure and who underwent Tc-99m-HMDP scintigraphy due to non-cardiac reasons in three imaging centres in Finland (Kymenlaakso Central Hospital, Jorvi Central Hospital, and Meilahti University Hospital). A Perugini grade >= 2 and heart-to-contralateral ratio (H/CL) of >= 1.30 were considered positive for cardiac ATTR. The overall and cardiovascular mortality were obtained from the national statistical service (Statistics Finland). Results There were 234 deaths, of which 70 were classified as being due to cardiovascular causes during a median follow-up of 1 (1-3) year. Transthyretin amyloidosis was diagnosed in 22 patients (6.6%) using visual analysis and 17 patients using the H/CL ratio (5.1%). Patients with ATTR were older (85 +/- 5 vs 80 +/- 5 yrs; p=0.002) and had higher N-terminal pro-brain natriuretic peptide (NT-ProBNP) levels (1,451 [813-3,799] vs 6,192 [2,030-8,833] ng/L; p=0.02). Age, bone metastases, and glomerular filtration rate were independent predictors of overall mortality in multivariable analysis. Age, glomerular filtration rate, >= grade 2 visual cardiac uptake, and H/CL ratio were independent predictors of cardiovascular mortality. Conclusions Cardiac uptake suggestive of ATTR was found in 5% of elderly patients with chronic heart failure. The presence of cardiac uptake on bone scintigraphy did not convey independent prognostic value on overall mortality but was independently associated with cardiovascular mortality.Peer reviewe

Prognostic significance of incidental suspected transthyretin amyloidosis on routine bone scintigraphy

Background Transthyretin amyloidosis (ATTR) is an occasional incidental finding on bone scintigraphy. We studied its prognostic impact in elderly patients. Methods The study population consisted of 2000 patients aged over 70 years who underwent bone scintigraphies with clinical indications in three nuclear medicine departments (Kymenlaakso, Jorvi and Meilahti hospitals) in Finland. All studies were performed using (99m)Technetium labeled hydroxymethylene diphosphonate (HMDP). ATTR was suspected in patients with >= grade 2 Perugini grade uptake (grade 0-3). Heart-to-contralateral ratio (H/CL) of >= 1.30 was considered positive for ATTR. The overall and cardiovascular mortality were obtained from the Finnish National Statistical Service. Results There were a total of 1014 deaths (51%) and 177 cardiovascular deaths (9%) during median follow-up of 4 +/- 2 years. ATTR was suspected in 69 patients (3.6%) of which 54 (2.7%) had grade 2 and 15 (.8%) had grade 3 uptake and in 47 patients (2.4%) by H/CL ratio. In multivariate analyses age, bone metastasis, H/CL ratio and grade 3 uptake were independent predictors of overall and cardiovascular mortality. Grade 2 uptake was a predictor of cardiovascular mortality. Conclusions A suspected ATTR as an incidental finding on bone scintigraphy predicts elevated overall and cardiovascular mortality in elderly patients.Peer reviewe

Bile Reflux Scintigraphy After Mini-Gastric Bypass

Significant weight-loss and diabetes remission have been reported after mini-gastric bypass (MGB). Concern has been raised regarding postoperative bile reflux (BR), but it has not been demonstrated in previous studies. We set out to find out if BR is evident in hepatobiliary scintigraphy after MGB. Nine consecutive patients, seven with type 2 diabetes, underwent MGB (15 cm gastric tube, 250-275 cm biliary limb) at our institution with a 12-month follow-up, with none lost to follow-up. Then, 10.7 months (8.6-13.0) after MGB, all patients underwent hepatobiliary scintigraphy and a reflux symptom questionnaire (GerdQ) was filled out. A gastroscopy with biopsies was done for all patients with a bile-reflux-positive scintigraphy. Mean age at operation was 56 years (41-65) and preoperative BMI 43.1 kg/m(2) (34.2-54.6). Mean %EWL was 83.9 (49.5-128.3) at 12 months. Four patients reached diabetes remission and two became insulin-independent. Hepatobiliary scintigraphy showed a transient BR into the gastric tube for five patients. Bile tracer was found in the gastric tube at 23-58 min after the tracer injection and highest activity was 8% (1-8%) at 58 min. Bile tracer was not found in the esophagus of any of the patients. One patient with a positive scintigraphy in the gastric tube required re-operation. Two patients with reflux symptoms had a negative scintigraphy. Our results indicate that transient bile reflux is common after MGB in the gastric tube, but not in the esophagus. The clinical relevance of bile reflux needs further studies.Peer reviewe

Bile Reflux is a Common Finding in the Gastric Pouch After One Anastomosis Gastric Bypass

INTRODUCTION: Data on postoperative bile reflux after one anastomosis gastric bypass (OAGB) is lacking. Bile reflux scintigraphy (BRS) has been shown to be a reliable non-invasive tool to assess bile reflux after OAGB. We set out to study bile reflux after OAGB with BRS and endoscopy in a prospective series (RYSA Trial). METHODS: Forty patients (29 women) underwent OAGB between November 2016 and December 2018. Symptoms were reported and upper gastrointestinal endoscopy (UGE) was done preoperatively. Six months after OAGB, bile reflux was assessed in UGE findings and as tracer activity found in gastric tube and esophagus in BRS (follow-up rate 95%). RESULTS: Twenty-six patients (68.4%) had no bile reflux in BRS. Twelve patients (31.6%) had bile reflux in the gastric pouch in BRS and one of them (2.6%) had bile reflux also in the esophagus 6 months postoperatively. Mean bile reflux activity in the gastric pouch was 5.2% (1-21%) of total activity. De novo findings suggestive of bile reflux (esophagitis, stomal ulcer, foveolar inflammation of gastric pouch) were found for 15 patients (39.5%) in postoperative UGE. BRS and UGE findings were significantly associated (P = 0.022). Eight patients experienced de novo reflux symptoms at 6 months, that were significantly associated with BRS and de novo UGE findings postoperatively (P = 0.033 and 0.0005, respectively). CONCLUSION: Postoperative bile reflux in the gastric pouch after OAGB is a common finding in scintigraphy and endoscopy. The long-term effects of bile exposure will be analyzed in future reports after a longer follow-up. TRIAL REGISTRATION: Clinical Trials Identifier NCT02882685.Peer reviewe

Seasonal Temperature Changes Do Not Affect Cardiac Glucose Metabolism

Peer reviewe

Convolutional neural networks for detection of transthyretin amyloidosis in 2D scintigraphy images

Background Transthyretin amyloidosis (ATTR) is a progressive disease which can be diagnosed non-invasively using bone avid [Tc-99m]-labeled radiotracers. Thus, ATTR is also an occasional incidental finding on bone scintigraphy. In this study, we trained convolutional neural networks (CNN) to automatically detect and classify ATTR from scintigraphy images. The study population consisted of 1334 patients who underwent [Tc-99m]-labeled hydroxymethylene diphosphonate (HMDP) scintigraphy and were visually graded using Perugini grades (grades 0-3). A total of 47 patients had visual grade >= 2 which was considered positive for ATTR. Two custom-made CNN architectures were trained to discriminate between the four Perugini grades of cardiac uptake. The classification performance was compared to four state-of-the-art CNN models. Results Our CNN models performed better than, or equally well as, the state-of-the-art models in detection and classification of cardiac uptake. Both models achieved area under the curve (AUC) >= 0.85 in the four-class Perugini grade classification. Accuracy was good in detection of negative vs. positive ATTR patients (grade = 2, AUC > 0.88) and high-grade cardiac uptake vs. other patients (grade < 3 vs. grade 3, AUC = 0.94). Maximum activation maps demonstrated that the automated deep learning models were focused on detecting the myocardium and not extracardiac features. Conclusion Automated convolutional neural networks can accurately detect and classify different grades of cardiac uptake on bone scintigraphy. The CNN models are focused on clinically relevant image features. Automated screening of bone scintigraphy images using CNN could improve the early diagnosis of ATTR.Peer reviewe

Adalimumab and sulfasalazine in alleviating sacroiliac and aortic inflammation detected in PET/CT in patients with axial spondyloarthritis : PETSPA

Publisher Copyright: © 2021 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.Aim: Inflammatory signals in the sacroiliac (SI) joints and the aorta of patients with axial spondyloarthritis (axSpA) were graded by positron emission tomography/computed tomography (PET/CT) imaging before and after treatment with sulfasalazine (SSZ) or adalimumab (ADA). Methods: Patients with axSpA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4, were recruited. Disease-modifying antirheumatic drug-naïve patients started SSZ for 12 weeks, whereas those with prestudy treatment with or contraindication to SSZ commenced ADA for 16 weeks. In addition, those patients in the SSZ group with insufficient response commenced ADA for 16 weeks. 18F-fluorodeoxyglucose PET/CT was performed after inclusion and after treatment with SSZ and ADA. Maximum standardized uptake value (SUVmax) was assessed for the aorta and the SI joints, and maximal target-to-blood-pool ratio (TBRmax) only for the aorta. Results: Among five SSZ patients, mean ± SD BASDAI was 4.7 ± 1.6 before and 3.5 ± 1.4 after treatment (p =.101). In 13 ADA patients, the BASDAI decreased from 5.4 ± 1.6 to 2.8 ± 2.2 (p <.001). Among the SSZ patients, SUVmax in SI joints decreased from 2.35 ± 0.55 to 1.51 ± 0.22 (−35.8%, p =.029). Aortic TBRmax decreased from 1.59 ± 0.43 to 1.26 ± 0.26 (−33.2%, p =.087). In the ADA patients, SUVmax in the SI joints was 1.92 ± 0.65 before and 1.88 ± 0.54 after treatment (−1.8%, p =.808) and TBRmax in the aorta 1.50 ± 0.60 before and 1.40 ± 0.26 after treatment (−6.7%, p =.485). Conclusions: Our small open-label study showed that SSZ may reduce PET-CT-detectable inflammation in the SI joints, with a trend towards a reduction in the aorta.Peer reviewe

Exercise training does not improve myocardial diastolic tissue velocities in Type 2 diabetes

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Sydämen rasituskaikukuvaus

Sydämen rasituskaikukuvaus on pitkään käytössä ollut, monipuolinen sydänsairauksien tutkimusmenetelmä. Rintakipupotilaan hemodynaamisesti merkittävä, ahtauttava sepelvaltimotauti on mahdollista todeta seinämäliikehäiriönä, joka kehittyy rasituksen aiheuttaman sydänlihasiskemian seurauksena. Kaikukuvauksen avulla on mahdollista arvioida sydänlihasiskemian sijaintia ja laajuutta sekä sen yhteyttä potilaan kuormitukseen ja oireisiin. Rasituskaikukuvaus mahdollistaa sydämen rakenteen ja toiminnan monipuolisen tutkimisen, kuten vasemman kammion systolisen ja diastolisen toimintahäiriön toteamisen. Tutkimuksen käyttöaiheet ovat laajentuneet, ja sitä käytetään aiempaa enemmän muun muassa läppävikojen vaikeuden, sydänlihassairauksien ja epäselvän hengenahdistuksen selvittelyssä.             </p