Highlights of the Year in JACC 2008

Abstract

Because a high cardiac death rate is observed in hemodialysis patients, Nishimura et al. (1) evaluated 375 asymptomatic hemodialysis patients with single-photon emission computed tomography (SPECT) imaging and beta-methylp-[123I]-iodophenyl-pentadecanoic acid (BMIPP), reflecting myocardial fatty acid metabolism. Severely reduced BMIPP uptake might be related to repetitive ischemia and thus be predictive for cardiac death. Patients with severely abnormal BMIPP SPECT images had a significantly higher mortality rate at 3 years than those without (39% vs. 2%).The volume of diagnostic imaging has increased exponentially over the recent years, and the appropriateness of these tests has been questioned (2). As a first step in evaluating the appropriateness, Gibbons et al. (3) applied recommended criteria to 284 patients who underwent SPECT myocardial perfusion imaging and found 64% of studies were classified appropriate, 11% were uncertain, 14% were inappropriate, and 11% were unclassifiable; similar numbers were reported for stress echocardiography. Application of these criteria will require refinement.It remains uncertain whether cardiac medications need to be withdrawn before SPECT myocardial perfusion imaging. In a dedicated review, Zoghbi et al. (4) addressed this topic. They emphasized that, when detection of coronary artery disease (CAD) is the question, withdrawal of cardiac medication (e.g., beta-blockers) is appropriate to increase sensitivity of the technique. If the question is whether ischemia remains despite medical therapy, then medication should be continued.The use of nuclear techniques in the field of molecular imaging is increasing. Terrovitis et al. (5) demonstrated in an elegant animal model that ectopic expression of the sodiumiodide symporter enables imaging of transplanted cardiac stem cells with either positron emission tomography or SPECT imaging. Thus far, these techniques are used in animal models but should eventually be suitable for patients (6). Cardiac Computed Tomography (CT)CT calcium scoring and angiography is being increasingly used. In 2008, the feasibility and excellent accuracy for detection of CAD of 256-row detector CT was first reported (7). However, Meijboom et al. (8) have demonstrated that 50% of the atherosclerotic lesions detected on CT angiography do not result in ischemia as demonstrated by normal intracoronary fractional flow reserve. More recently, the focus of CT angiography is shifting toward prognosis (9). Raggi et al. (10) assessed all-cause mortality in 35,388 patients after a mean follow-up of 5.8 Ϯ 3 years. Increasing calcium scores were related to decreasing survival. Importantly, even in patients Ն70 years of age, calcium scoring contributed significantly to risk stratification. Ostrom et al. (11) evaluated 2,538 patients (suspected for CAD) with electron beam CT and demonstrated that CT angiography was an independent predictor of mortality.Choi et al. (12) reported on the potential use of multislice CT for screening asymptomatic individuals for CAD. A total o...

Diagnostic value of PET-measured heterogeneity in myocardial blood flows during cold pressor testing for the identification of coronary vasomotor dysfunction

“…1,[3][4][5][20][21][22][23]44 Furthermore, there is also an intrinsic variability of the severity of endothelium-dependent vasomotor dysfunction in the individual, despite the presence of a similar risk profile, which has to be taken into consideration. 11,37 Another explanation is that the extent of a diminished global MBF response to CPT, as indicative for coronary endothelial dysfunction, 45 is also determined by an ␣-adrenergically mediated constriction of the vascular smooth muscle cells, which is closely related to the degree of sympathetic stimulation during CPT, as reported recently. 27 Thus interindividual differences in sympathetic stimulation of the vascular smooth muscle cells are likely to add some variability to the abnormal global MBF responses during CPT.…”

Fetal magnetocardiogram waveform characteristics

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Fetal magnetocardiography (fMCG), the magnetic analog of fetal electrocardiography (ECG), is the most direct and precise method of assessing fetal rhythm and conduction. In recent years, the efficacy of fMCG for diagnosis and prognosis of serious fetal arrhythmia has become widely recognized (Donofrio et al 2014, DeMaria et al 2009.A critical capability of fMCG is measurement of waveform intervals, which are fundamental parameters of cardiac rhythm. While echocardiography can also infer cardiac time intervals from the mechanical activity of the heart (Pasquini et al 2007), the corresponding intervals are imprecise and do not always accurately reflect the underlying electrical activity (Van Hare 2013).

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“…Fetal magnetocardiography (fMCG), the magnetic analog of fetal electrocardiography (ECG), is the most direct and precise method of assessing fetal rhythm and conduction. In recent years, the efficacy of fMCG for diagnosis and prognosis of serious fetal arrhythmia has become widely recognized (Donofrio et al 2014, DeMaria et al 2009.…”