Stress Myocardial Perfusion Imaging for Assessing Prognosis: An Update

A strength of nuclear myocardial perfusion imaging (MPI) is the wealth of prognostic data accumulated over 30 years of experience with this technique. Nuclear MPI can predict outcomes and guide revascularization decisions in symptomatic patients and is well validated in special populations such as patients with diabetes and chronic renal disease. Known limitations, such as underestimation of ischemia and radiation burden, are being progressively reduced through advances such as positron emission tomography absolute flow quantification and fusion with computed tomography, new camera hardware and software, and stress-only protocols. Advanced statistical techniques and increasing focus on comparative effectiveness and appropriateness will continue to optimize nuclear cardiology going forward

Coronary Microvascular Dysfunction, Microvascular Angina, and Treatment Strategies

AbstractAngina without coronary artery disease (CAD) has substantial morbidity and is present in 10% to 30% of patients undergoing angiography. Coronary microvascular dysfunction (CMD) is present in 50% to 65% of these patients. The optimal treatment of this cohort is undefined. We performed a systematic review to evaluate treatment strategies for objectively-defined CMD in the absence of CAD. We included studies assessing therapy in human subjects with angina and coronary flow reserve or myocardial perfusion reserve <2.5 by positron emission tomography, cardiac magnetic resonance imaging, dilution methods, or intracoronary Doppler in the absence of coronary artery stenosis ≥50% or structural heart disease. Only 8 papers met the strict inclusion criteria. The papers were heterogeneous, using different treatments, endpoints, and definitions of CMD. The small sample sizes severely limit the power of these studies, with an average of 11 patients per analysis. Studies evaluating sildenafil, quinapril, estrogen, and transcutaneous electrical nerve stimulation application demonstrated benefits in their respective endpoints. No benefit was found with L-arginine, doxazosin, pravastatin, and diltiazem. Our systematic review highlights that there is little data to support therapies for CMD. We assess the data meeting rigorous inclusion criteria and review the related but excluded published data. We additionally describe the next steps needed to address this research gap, including a standardized definition of CMD, routine assessment of CMD in studies of chest pain without obstructive CAD, and specific therapy assessment in the population with confirmed CMD

Addendum to ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis:Part 1 of 2-evidence base and standardized methods of imaging

There are 2 primary reasons for an addendum. The first is that the document reviewer list is being updated to include Dr Richard Cheng and Dr Roy John, who have critically reviewed the document, but were inadvertently not listed as reviewers. In addition, since the publication of this document and the introduction of approved therapies for transthyretin cardiac amyloidosis, the clinical use of bone tracer cardiac scintigraphy has been extended to populations with a lower prevalence of transthyretin cardiac amyloidosis. Numerous observations have raised concerns about (1) incorrect diagnosis of transthyretin cardiac amyloidosis based on 99mTc-pyrophosphate (PYP) planar imaging and heart-to-contralateral lung (H/CL) ratio without confirmation of diffuse myocardial uptake on single photon emission computed tomography (SPECT) imaging at some sites; (2) excess blood pool activity on the 1-hour planar and SPECT images being interpreted as positive scans; and (3) missed diagnosis of light chain amyloidosis, as serum-free light chain studies and serum and urine immunofixation electrophoresis studies may not be recommended in the 99mTc-PY P/-3,3-diphosphono-1,2-propanodicarboxylic acid/hydroxymethylene diphosphonate (99mTc-PYP/DPD/HMDP) report. Incorrect diagnosis leads to inappropriate therapy and worse patient outcomes. SPECT and planar imaging performed at 3-hour maximize specificity. 1 , 2 , 3 Additionally, technical parameters have been updated

ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis:Part 1 of 2-Evidence Base and Standardized Methods of Imaging

In the Introduction SCMR was listed incorrectly. SCMR is the Society for Cardiovascular Magnetic Resonance. • Figure 1 erroneously printed without Yen sign (¥) in ‘Final Diagnosis.’ Please see revised Figure 1. • Acknowledgments erroneously printed without reviewers Richard Cheng, MD and Roy John, MD