Editor-in-Chief: A. Giustina ▶ Covers leading topics in endocrinology ▶ Includes Hormones of reproduction, metabolism, growth, and ion balance ▶ Offers the latest on insulin and diabetes ▶ Presents newly-emerging endocrine-related topics ▶ 94% of authors who answered a survey reported that they would definitely publish or probably publish in the journal againWell-established as a major journal in today's rapidly advancing experimental and clinical research, Endocrine publishes full-length original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical (including proof of concept studies and clinical trials) research in all the different fields of endocrinology and metabolism. Endocrine covers the following leading topics in Endocrinology such as: Neuroendocrinology, Pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, type 1 and type 2 diabetes, hormones of male and female reproduction, and of HPA axis, pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
Cardiac sarcoidosis (CS) is a rare and potentially fatal condition, characterized by the presence of non-necrotizing granulomatous inflammation and concomitant fibrosis. A variety of clinical manifestation has been described, such as conduction disorders, ventricular arrythmias, congestive heart failure and sudden cardiac death, making a prompt diagnosis and early treatment desirable. Endomyocardial biopsy is the gold-standard diagnostic test, but has a low sensitivity due to the multifocal aspect of the disease. Advanced imaging modalities, such as cardiac magnetic resonance and positron emission tomography (PET) with 18F-fluorodeoxyglucose are now part of the diagnostic criteria and also assist in determining treatment response. However, the interpretation of those studies can be challenging and needs to be made by specialists, as the misdiagnosis could be harmful for the patient. This article describes the pathophysiology of CS and advanced imaging modalities (with a major focus on PET) that should be considered for diagnostic approach and therapy monitoring. Also, newer clinical trials evaluating treatment strategies are described.
This review describes the current evidence and controversies for viability imaging to direct revascularization decisions and the impact on patient outcomes. Balancing procedural risks and possible benefit from revascularization is a key question in patients with heart failure of ischemic origin (IHF). Different stages of ischemia induce adaptive changes in myocardial metabolism and function. Viable but dysfunctional myocardium has the potential to recover after restoring blood flow. Modern imaging techniques demonstrate different aspects of viable myocardium; perfusion (SPECT, PET, CMR), cell metabolism (PET), cell membrane integrity and mitochondrial function (201Tl and 99mTc-based SPECT), contractile reserve (stress echocardiography, CMR) and scar (CMR). Observational studies suggest that IHF patients with significant viable myocardium may benefit from revascularization compared to medical treatment alone but that in patients without significant viability, revascularization appears to offer no survival benefit or could even worsen the outcome. This was not supported by 2 randomized trials (STICH and PARR-2) although post-hoc analyses suggest that benefit can be achieved if decisions had been strictly based on viability imaging recommendations. Based on current evidence, viability testing should not be the routine for all patients with IHF considered for revascularization but rather integrated with clinical data to guide decisions on revascularization of high-risk patients with comorbidities. Fundamental concepts regarding viability imagingIn patients with IHF, left ventricle (LV) dysfunction can result from scar, stressinduced ischemia, resting ischemia, remodelling, stunning, hibernation or a combination of these processes. To understand the potential benefits of revascularization, knowledge of the different myocardial states in IHF is essential.(2-7) Myocardial ischemia refers to a state of inadequate oxygen delivery that cannot meet the myocardium´s metabolic demand.(8) The severity of inadequate flow will determine the intrinsic molecular adaptations of the myocardium and High Optimal medical therapy
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