Pericardial Fat Thickness Increases with Greater Burden of Adverse Metabolic Factors Among Adults with Normal-Range Body Mass Index: The Framingham Heart Study

Introduction: Greater burden of pericardial fat is associated with increased body mass index (BMI). Obesity is associated with unfavorable metabolic characteristics such as hypertension, dyslipidemia, and glucose intolerance. We sought to determine whether unfavorable metabolic profile alone, in the absence of excess BMI, was itself associated with increased pericardial fat thickness (PFT). Methods:From the 1,794 Framingham Offspring cohort adults who underwent cardiac magnetic resonance (CMR), we identified 446 free of non-skin cancer and prevalent clinical cardiovascular disease (CVD) who had 18.5≤BMI2and complete covariates. We calculated a metabolic score (MS) based on ATPIII criteria where 1 point was assigned for each of: a) fasting glucose≥100 mg/dL or diabetes; b) SBP≥130 or DBP≥85 mmHg or antihypertensive treatment; c) triglycerides≥150 mg/dL; d) HDL cholesterol \u3c40(M)/ Results: PFT increased with worsening metabolic score at the fixed locations of the apical and mid-level RV, as well as at maximal PFT. On pairwise comparisons, only the MS3+ group had PFT that was consistently significantly greater than that of MS0. Conclusions: In a community-dwelling cohort, among participants who were free of cancer and clinical CVD and had normal-range or BMI, worsening metabolic profile was associated with increased pericardial fat thickness

Advances in Diagnostic Imaging for Cardiac Sarcoidosis

Sarcoidosis is a systemic granulomatous disease of unknown etiology, and its clinical presentation depends on the affected organ. Cardiac sarcoidosis (CS) is one of the leading causes of death among patients with sarcoidosis. The clinical manifestations of CS are heterogeneous, and range from asymptomatic to life-threatening arrhythmias and progressive heart failure due to the extent and location of granulomatous inflammation in the myocardium. Advances in imaging techniques have played a pivotal role in the evaluation of CS because histological diagnoses obtained by myocardial biopsy tend to have lower sensitivity. The diagnosis of CS is challenging, and several approaches, notably those using positron emission tomography and cardiac magnetic resonance imaging (MRI), have been reported. Delayed-enhanced computed tomography (CT) may also be used for diagnosing CS in patients with MRI-incompatible devices and allows acceptable evaluation of myocardial hyperenhancement in such patients. This article reviews the advances in imaging techniques for the evaluation of CS

Successful embolization for a traumatic pseudoaneurysm concomitant with a massive back hematoma by a prone transradial catheterization technique

A 25-year-old man with a massive traumatic subcutaneous hematoma in his back was transferred to our emergency department. Contrast-enhanced computed tomography revealed a pseudoaneurysm with extravasation within the hematoma. The patient was unable to take a supine position due to the massive back hematoma. We thus performed a transcatheter embolization of bilateral cervical branches with the patient in the prone position, via a radial artery. After two embolizations, successful hemostasis was achieved. The prone transradial catheterization technique is useful for embolization in patients who cannot be in the supine position

Qualitative and Quantitative Assessments of Cardiac Sarcoidosis using 18F-FDG PET

Sarcoidosis is a multisystem disease pathologically characterized by non-caseating granuloma. Cardiac sarcoidosis (CS) remains an important prognostic factor of sarcoidosis patients. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) has been applied as a noninvasive tool not only for CS diagnoses but also for the evaluation of therapeutic effects and prognoses. Visual assessment is a standard method to evaluate whether the 18F-FDG uptake is physiological or active inflammation due to the CS. A semi-quantitative assessment using the standardized uptake value (SUV) is a simple method for achieving a more accurate diagnosis. A volume-based analysis has been proposed as a new marker that can provide information about the improvement or prevention of heart failure and can be used to predict a further clinical event in CS patients. This is a brief review of the objective and quantitative assessments of the magnitude and extent of CS activity with the use of 18F-FDG PET

The usefulness of 18F-FDG PET/CT for assessing methotrexate-associated lymphoproliferative disorder (MTX-LPD)

Background: Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a benign lymphoid proliferation or malignant lymphoma in patients who have been treated with MTX. MTX withdrawal and observation for a short period should be considered in the initial management of patients who develop LPD while on MTX therapy. Here we evaluated the diagnostic accuracy and predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for MTX-LPD. Methods: We retrospectively investigated the cases of 15 patients clinically suspected of having MTX-LPD. A total of 324 anatomic regions (207 nodal and 117 extranodal regions) were assessed by 18F-FDG PET/CT and by multi-detector row CT (MDCT). Each anatomic region was classified as either malignant or benign. The uptake of 18F-FDG was assessed semi-quantitatively with the standardized uptake value maximum (SUVmax), the whole-body metabolic tumor volume (WBMTV), and the whole-body total lesion glycolysis (WBTLG) in order to investigate predictive factors of spontaneous regression after the withdrawal of MTX. Results: MTX-LPD lesions were observed in 92/324 (28.4 %) regions. 18F-FDG PET/CT showed 90.2 % sensitivity, 97.4 % specificity, and 95.4 % accuracy, values which were significantly higher than those of MDCT (59.8, 94.8, and 84.9 %, respectively. p < 0.002). After the withdrawal of MTX, 9/15 patients (60.0 %) achieved complete response (CR). The SUVmax, WBMTV and WBTLG values of the CR patients were 9.2 (range 2.8-47.1), 44.3 (range 0-362.6) ml, 181.8 (range 0-2180.9) ml, respectively, which were not significantly different from those of the non-CR patients: 10.6 (range 0-24.9), 15.7 (range 0-250.1) ml, and 97.4 (range 0-1052.1) ml. Conclusions: Although 18F-FDG PET/CT was a useful tool to detect MTX-LPD lesions, none of the 18F-FDG PET parameters before the withdrawal of MTX could be used to predict CR after the withdrawal of MTX

Improved regionalmyocardial blood flow and flow reserve after coronary revascularization as assessed by serial O-15-water positron emission tomography/computed tomography

Aims Myocardial perfusion imaging without and with quantitative myocardial blood flow (MBF) and myocardial flow reserve (MFR) plays an important role in the diagnosis and risk stratification of patients with stable coronary artery disease (CAD). We aimed to quantify the effects of coronary revascularization on regional stress MBF and MFR and to determine whether the presence of subendocardial infarction was associated with these changes. Methods and results Forty-seven patients with stable CAD were prospectively enrolled. They underwent 15O-water positron emission tomography at baseline and 6 months after optimal medical therapy alone (n = 16), percutaneous coronary intervention (PCI) (n = 18), or coronary artery bypass grafting (CABG) (n = 13). Stenosis of >= 50% diameter was detected in 98/141 vessels (70%). The regional MFR was significantly increased from baseline to follow-up [1.84 (interquartile range, IQR 1.28-2.17) vs. 2.12 (IQR 1.69-2.63), P < 0.001] in vessel territories following PCI or CABG due to an increase in the stress MBF [1.33 (IQR 0.97-1.67) mL/g/min vs. 1.64 (IQR 1.38-2.17) mL/g/min, P < 0.001], whereas there was no significant change in the regional stress MBF or MFR in vessel territories without revascularization. A multilevel mixed-effects models adjusted for baseline characteristics, subendocardial infarction assessed by cardiovascular magnetic resonance imaging, and intra-patient correlation showed that the degree of angiographic improvement after coronary revascularization was significantly associated with increased regional stress MBF and MFR (P < 0.05 for all). Conclusion Coronary revascularization improved the regional stress MBF and MFR in patients with stable CAD. The magnitude of these changes was associated with the extent of revascularization independent of subendocardial infarction

Regional interaction between myocardial sympathetic denervation, contractile dysfunction, and fibrosis in heart failure with preserved ejection fraction : 11C-hydroxyephedrine PET study

Purpose: This investigation aimed to identify significant predictors of regional sympathetic denervation quantified by 11C-hydroxyephedrine (HED) positron emission tomography (PET) in patients with heart failure with preserved left ventricular ejection fraction (HFpEF). Methods: Thirty-four patients (63 ± 15 years, 23 male) with HFpEF (left ventricular ejection fraction ≥ 40%) and 11 age-matched volunteers without heart failure were included. Cardiac magnetic resonance imaging was performed to measure left ventricular size, function, and the extent of myocardial late gadolinium enhancement (LGE). 11C-HED PET was performed to quantify myocardial sympathetic innervation expressed as 11C-HED retention index (RI [%/min]). To identify predictors of regional 11C-HED RI in HFpEF patients, we proposed a multivariate mixed-effects model for repeated measures over segments with an unstructured covariance matrix. Results: Global 11C-HED RI was significantly lower and more heterogeneous in HFpEF patients versus volunteers (P < 0.01 for all). Regional 11C-HED RI correlated positively with systolic wall thickening (r = 0.42, P < 0.001) and negatively with the extent of LGE (r = -0.43, P < 0.001). Segments with large extent of LGE in HFpEF patients had the lowest regional 11C-HED RI among all segments (P < 0.001 for post hoc tests). Multivariate analysis demonstrated that systolic wall thickening and the extent of LGE were significant predictors of regional 11C-HED RI in HFpEF patients (both P ≤ 0.001). Conclusion: Regional sympathetic denervation was associated with contractile dysfunction and fibrotic burden in HFpEF patients, suggesting that regional sympathetic denervation may provide an integrated measure of myocardial damage in HFpEF