Aims To define characteristic PET/CTA patterns of FDG uptake and anatomic changes following prosthetic heart valves (PVs) implantation over time, to help not to misdiagnose post-operative inflammation and avoid false-positive cases. Methods and results Prospective evaluation of 37 post-operative patients without suspected infection that underwent serial cardiac PET/CTA examinations at 1, 6, and 12 months after surgery, in which metabolic features (FDG uptake distribution pattern and intensity) and anatomic changes were evaluated. Standardized uptake values (SUVs) were obtained and a new measure, the valve uptake index (VUI), (SUVmax–SUVmean)/SUVmax, was tested to homogenize SUV results. In total, 111 PET/CTA scans were performed in 37 patients (19 aortic and 18 mitral valves). FDG uptake was visually detectable in 79.3% of patients and showed a diffuse, homogeneous distribution pattern in 93%. Quantitative analysis yielded a mean maximum standardized uptake value (SUVmax) of 4.46 ± 1.50 and VUI of 0.35 ± 0.10. There were no significant differences in FDG distribution or uptake values between 1, 6, or 12 months. No abnormal anatomic changes or endocarditis lesions were detected in any patient during follow-up. Conclusions FDG uptake, often seen in recently implanted PVs, shows a characteristic pattern of post-operative inflammation and, in the absence of associated anatomic lesions, could be considered a normal finding. These features remain stable for at least 1 year after surgery, so questioning the recommended 3-month safety period. A new measure, the VUI, can be useful for evaluating the FDG distribution pattern.

Background and Purpose-Optimization of coronary risk evaluation in stroke patients has been encouraged. The relationship between symptomatic intracranial atherosclerosis and occult coronary artery disease (CAD) has not been evaluated sufficiently. We aimed to investigate the prevalence of silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis and to identify factors associated with its presence. Methods-From 186 first-ever transient ischemic attack or ischemic stroke patients with intracranial stenoses, 65 fulfilled selection criteria, including angiographic confirmation of a symptomatic atherosclerotic stenosis and absence of known CAD. All patients underwent a maximal-stress myocardial perfusion single-photon emission computed tomography (SPECT

In this pilot study, different CO values of phase histogram parameters were observed between normal subjects and patients with conduction and MCD, and between patients with and without criteria of cardiac resynchronization therapy.

Background-The incremental prognostic value of myocardial perfusion-gated single photon emission computed tomography (MPGS) compared with exercise test has not yet been properly evaluated. Methods and Results-Five thousand six hundred seventy-two consecutive patients with known or suspected coronary disease undergoing exercise MPGS between 1997 and 2007 were included. Three-year predictive models for total death and death from cardiovascular causes or acute myocardial infarction (ie, major cardiovascular events [MCE]) were built using Cox-regression modeling, including only the clinical information. Then the exercise and MPGS information was sequentially added. The added discriminative ability of exercise test information and MPGS was assessed by net reclassification improvement and integrated discrimination improvement. The increase in predictive ability of exercise information for death and MCE was high as assessed by net reclassification improvement (0.199 and 0.263) and integrated discrimination improvement (0.042 and 0.021). The only variable of MPGS associated with total death was ejection fraction (hazard ratio, 0.84; 95% confidence interval, 0.79-0.89; P<0.001). Global stress ischemic score emerged as an additional variable associated with MCE (hazard ratio, 1.07; 95% confidence interval, 1.02-1.12; P=0.007). Adding MPGS information barely improved the prognostic value for total death (net reclassification improvement, 0.017; integrated discrimination improvement, 0.013), but it increased for MCE (net reclassification improvement, 0.122; integrated discrimination improvement, 0.033). Conclusions-Adding

The warranty period for a normal stress-rest SPECT is highly variable since it is primarily determined by the type of stress, the patient's clinical characteristics and LVEF.

Prognostic information from myocardial perfusion SPECT and radionuclide angiography has limited clinical significance with regard to cardiac death in adult patients with HC. However, the presence of fixed defects and lower ejection fraction in these patients has an adverse prognostic meaning for severe complications.

Objectives: To assess the long-term effectiveness of stapedotomies performed on patients with otosclerosis and preoperative small air-bone gaps (ABGs). Methods: Retrospective study comparing the 10-year postoperative hearing outcomes after primary stapedotomies in patients with small (≤20 dB) and large ABGs (> 20 dB). Ninety out of 175 stapedotomies (22 and 68 in the small and large ABG groups, respectively) were monitored with long-term follow-ups. Results: Ten years after the operation, hearing measurements were similar for both groups, although a significant decline of bone conduction thresholds was evident (p = 0.007 and p < 0.001, respectively). An improvement of ≥10 dB in the postoperative ABG (clinical improvement) was achieved only in the large ABG group. Conclusions: Even though long-term hearing levels will evolve similarly in patients with ≤20 and > 20 dB preoperative ABGs, the lack of clinical improvement found in the small ABG group is not in favor of an early surgery.

This editorial refers to the article published by Sachpekidis et al 1 titled 'Equilibrium radionuclide angiography (ERNA): intra-and interobserver repeatability and reproducibility in the assessment of cardiac systolic and diastolic function' on the Journal of Nuclear Cardiology. The objective of this study was to assess the intra-and interobserver agreement in assessing the systolic and diastolic function with ERNA. The authors analyzed thirty-two adults underwent baseline and repeat ERNA. An experienced and a trainee operator analyzed the data by assigning regions of interest manually, fully automatically, and semi-automatically. The Bland-Altman statistic was used to assess the repeatability (two different assessments of a single acquisition) and reproducibility (assessments of two different acquisitions). According to the obtained results, the Authors concluded that: 'A good repeatability but a moderate reproducibility was found in the assessment of the left ventricular ejection fraction (LVEF). Less good were the findings in the assessment of diastolic function. The results also depended on the software tool'.This article provides interesting information about the intra-and interobserver repeatability and reproducibility in the assessment of cardiac systolic and diastolic function. Despite the fact that in the conclusions of this study the authors say that ERNA has a moderate reproducibility in the assessment of the LVEF; ERNA continues to be one of the best imaging techniques for the analysis of ventricular function. The analysis of the variability in the measurements of a technique is complex and not only depends on of the intra-and interobserver variability, but of other variabilities that are not generally taken into account, such as the day-to-day variability of the phenomenon studied, the variability of the pathology, age, gender, etc. In addition to this research study, it has a very heterogeneous population (men = 20, women = 12, heart failure = 13, cardiotoxic chemotherapy = 12, different degree of systolic dysfunction) in a small (n = 31) number of patients. Table 1 shows the reproducibility, and inter-and intra-observer variations of ERNA according to different acquisition methodology to evaluate left and right ventricular function. 1-7 ERNA has a high reproducibility, very low inter-or intra-observer variability, and high precision; it has been shown to be accurate when compared to other modalities and has strong early data that demonstrated efficacy in guiding the safety of treatment regimens, and it continues to be widely used for routine clinical monitoring. 8 This information is consistent with the comments of Sachpekidis et al. 9 in a previous review. Haarmark et al 10 evaluated 463 subjects without diabetes, previous potentially cardiotoxic chemotherapy, known cardiovascular or pulmonary disease, by means of Cadmium Zinc Telluride (CZT) SPECT camera. They conclude that there are age-related changes in cardiac dimensions with age depending on gender, although with only