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A Quick Glance at Selected Topics in This Issue

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A Quick Glance at Selected Topics in This Issue REVIEW ARTICLE A quick glance at selected topics in this issue Pradeep Bhambhvani, MD,a Fadi G. Hage, MD, FASNC,b,c and Ami E. Iskandrian, MD, MASNCb a Division of Molecular Imaging and Therapeutics, Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL b Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL c Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL Received Feb 1, 2019; accepted Feb 4, 2019 doi:10.1007/s12350-019-01652-9 ‘‘A quick glance at selected topics in this issue’’ aims to highlight contents of the Journal and provide a quick review to the readers. (J Nucl Cardiol 2019;26:355–8.) Key Words: CAD Æ sarcoi Æ PET Æ SPECT Æ viability Æ myocardial blood flow Abbreviations LV Left Ventricle CAD Coronary Artery Disease FDG 18F-fluorodeoxyglucose MPI Myocardial Perfusion Imaging CZT Cadmium Zinc Telluride SPECT Single Photon Emission Computed CAC Coronary Artery Calcium Tomography PET Positron Emission Tomography ‘‘A quick glance at selected topics in this issue’’ activity in blood and tissue samples and the gamma aims to highlight contents of the Journal and provide a camera. These manuscripts are complimented by a great quick review to the readers. We realize that many of you selection of original articles with accompanying edito- do not have time to read all journals or attend all rials, brief reports, ‘What is this image’ and ‘Images that national meetings. For that reason, every issue of the Teach,’ and a CME review paper by Henry Gewirtz JNC includes 2 types of literature reviews. One sum- (https://doi.org/10.1007/s12350-018-1270-3) that dis- marizing recent key nuclear cardiology articles that have cusses the ‘Coronary circulation: Pressure/flow been published in journals other than ours (https://doi. parameters for assessment of ischemic heart disease.’ org/10.1007/s12350-019-01610-5) while the second Reviewed is the physiology of the coronary circulation outlines select publications in the general cardiovascular and the available invasive (e.g., fractional flow reserve, disease literature that have relevance to our field (http etc.) and non-invasive (e.g., PET-derived myocardial s://doi.org/10.1007/s12350-019-01611-4). blood blow and coronary flow reserve, etc.) metrics of Another entry is the historical corner that looks at the physiological status of the coronary circulation with the career and scientific contributions of a pioneer in potential strengths and weaknesses. Many of the original Nuclear Medicine instrumentation, Dr. Hal O. Anger articles also have PowerPoint slides. The abstract of the (https://doi.org/10.1007/s12350-018-1384-7). He inven- lead original article ‘The utility of 82Rb PET for ted the scintillation well counter to measure radiotracer myocardial viability assessment: comparison with per- fusion-metabolism 82Rb-18F-FDG PET’ by Moody and colleagues from Ann Arbor, Michigan, has also been Reprint requests: Pradeep Bhambhvani, MD, Division of Molecular translated into Spanish, Chinese, and French in response Imaging and Therapeutics, Department of Radiology, The Uni- to requests from the international readership. Pow- versity of Alabama at Birmingham, 619 19th Street South, JT 777, erPoint slides from this paper can be found by https:// Birmingham, AL 35249; [email protected] doi.org/10.1007/s12350-019-01615-0. The review arti- 1071-3581/$34.00 cle by Lee and colleagues on ‘Advances in imaging Copyright Ó 2019 American Society of Nuclear Cardiology. 355 356 Bhambhvani et al Journal of Nuclear CardiologyÒ JNC Quick Glance March 2019 March/April 2019 instrumentation for nuclear cardiology’ (https://doi.org/ AV-block and cardiac arrhythmias (ventricular tachy- 10.1007/s12350-017-0979-8) includes discussions on cardia and atrial fibrillation). SPECT, SPECT/CT, CZT scanners, PET/CT, PET/MRI, Myocardial ischemia is known to contribute to motion correction in cardiac PET etc. Also included in arrhythmogenesis and present-day clinical risk stratifi- the issue by Al-Mallah and colleagues (https://doi.org/ cation for ventricular arrhythmias is far from perfect. 10.1007/s12350-019-01603-4) is a summary of key Ghannam et al. (https://doi.org/10.1007/s12350-017-09 imaging studies that were presented at the American 75-z) studied the relationship of rubidium-82 PET MPI- Heart Association Scientific Sessions 2018 in Chicago derived quantification of myocardial blood flow to related to the fields of nuclear cardiology (planar, arrhythmic events in 159 patients with implantable car- SPECT and PET), cardiac computed tomography, car- diac defibrillators. They noted that after adjustment for diac magnetic resonance, and echocardiography. LV ejection fraction, age, and sex, impaired stress Our comments on a few selected papers noted myocardial blood flow was associated with an increased below are therefore only the tip of the iceberg. These risk of ventricular arrhythmias in this high-risk popula- manuscripts were selected randomly and we sincerely tion, whereas residual EF, summed rest, and summed believe all original articles serve a purpose, provide stress scores were not. The authors make a case for great value, and have undergone an intense peer review. incorporation of stress myocardial blood flow in future FDG PET is the most sensitive non-invasive test for models of ventricular arrhythmia risk assessment. distinguishing scar from hibernating myocardium in The size of myocardial infarction is predictive of patients with severe coronary artery disease and subsequent morphological changes and clinical out- impaired left ventricular function. However, FDG PET come. Ghotbi and colleagues from the University of is time consuming and resource intensive. 82Rb, a Copenhagen, Denmark (https://doi.org/10.1007/s12350- potassium analog has been studied as a marker of 017-0993-x) investigated whether Rubidium-82 PET myocardial tissue integrity but with equivocal results. MPI-derived measurements of resting blood flow and Moody et al. from Ann Arbor, Michigan (https://doi.org/ extent of severe hypoperfusion in the subacute phase of 10.1007/s12350-019-01615-0), attempt to define the STEMI can predict final infarct size, LVEF, and regio- relationship between 82Rb kinetics and myocardial via- nal wall motion as measured by cardiac magnetic bility compared with conventional 82Rb and FDG resonance (CMR) at 3-month follow-up. 35 STEMI perfusion-metabolism PET imaging in a pilot study with patients undergoing primary percutaneous coronary 120 patients referred for evaluation of myocardial via- intervention (PCI) were included prospectively. Rest bility prior to revascularization and 37 normal PET MPI was performed the day after PCI (median 36 volunteers. Dynamic 82Rb 3D PET data were acquired at hours) when patients were clinically stable. The authors rest, whereas FDG 3D PET data were acquired after report that PET MPI seems to forecast the degree of wall metabolic preparation using a standardized hyperinsu- motion impairment (LVEF) and amount of scar. Resting linemic-euglycemic clamp. The authors noted that the blood flow measurements by PET were significantly 82Rb kinetic parameters k2 and partition coefficient lower in patients with reduced LVEF at 3-month follow- (KP), reliably differentiated hibernating myocardium up compared to those with preserved LVEF. The from scar. The 82Rb partition coefficient is readily investigators make the case for a single rest PET MPI estimated using the same protocol and kinetic model that would take less than 15 minutes to perform the day commonly used for myocardial blood flow, and can be after a STEMI which could add useful prognostic obtained at no additional cost, imaging time, or radiation information. exposure. The results demonstrate the feasibility of MPI is a useful CAD risk stratification tool in using 82Rb kinetics to differentiate scar from hibernating chronic kidney disease (CKD) patients. Nakamura and myocardium. colleagues from Japan (https://doi.org/10.1007/s12350- FDG PET/CT has been used to identify active car- 017-0880-5) report results of a Japanese multicenter, diac inflammation from sarcoidosis. Tuominen and prospective cohort study investigating the ability of MPI colleagues from Tampere, Finland (https://doi.org/10.1 to predict cardiac events in 529 advanced CKD patients 007/s12350-017-0940-x), retrospectively attempt to without definitive CAD. The mean estimated GFR was identify patients with suspected cardiac sarcoidosis, who 29.0 ± 12.8 (mL/minute/1.73 m2). Major cardiac events are most likely to benefit from PET imaging. The were analyzed for 3 years after registration. A total of 60 investigators found that in a cohort of 137 patients with cardiac events (3 cardiac deaths, 6 sudden deaths, 5 non- suspected cardiac sarcoidosis, the highest frequency of fatal myocardial infarctions, 46 heart failure hospital- pathologic cardiac PET findings (RV and/or LV uptake) ization cases) occurred. They found that the event-free was seen in female patients with a history of advanced survival rate was lower among patients with kidney dysfunction, higher summed stress score, and higher C- Journal of Nuclear CardiologyÒ Bhambhvani et al 357 Volume 26, Number 2;355–8 JNC Quick Glance March 2019 reactive protein (CRP) values. Thus, from a practical with biopsy-proven cardiac amyloidosis. All patients point of view, the authors suggest that CKD patients with transthyretin cardiac amyloidosis had cardiac with eGFR\15 mL/minute/1.73 m2 or CRP C0.3 mg/dL uptake of Tc-HMDP based on visual/qualitative evalu- should be assessed with MPI. In these patients, if the ation. Quantitative assessment using the heart retention- summed stress score is C8, their cardiac prognosis may to-whole body retention ratio (HR:WBR) showed that be worse. Thus, advanced renal dysfunction combined patients with transthyretin cardiac amyloidosis had a with MPI abnormalities provided additional prognostic significantly higher HR:WBR ratio compared to patients information that is superior to either marker alone. with light-chain cardiac amyloidosis. A positive 99mTc- Wu et al.
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