Cardiac transthyretin amyloidosis treatment improves outcomes after aortic valve replacement for severe stenosis.

Background And Aims: Concomitant aortic stenosis (AS) and transthyretin-associated cardiac amyloidosis (ATTR-CA) is an increasingly recognized cause of structural heart failure. Aortic valve replacement (AVR) improves prognosis in this population, but the efficacy of ATTR-specific medication remains unclear. This study aimed to investigate the prognostic implications of ATTR-specific medication in patients with dual AS-CA.

The Use and Efficacy of FFR-CT: Real-World Multicenter Audit of Clinical Data With Cost Analysis.

Background: Fractional flow reserve-computed tomography (FFR-CT) is endorsed by UK and U.S. chest pain guidelines, but its clinical effectiveness and cost benefit in real-world practice are unknown.

Prevalence and Outcomes of Concomitant Aortic Stenosis and Cardiac Amyloidosis.

Background: Older patients with severe aortic stenosis (AS) are increasingly identified as having cardiac amyloidosis (CA). It is unknown whether concomitant AS-CA has worse outcomes or results in futility of transcatheter aortic valve replacement (TAVR).

Objectives: This study identified clinical characteristics and outcomes of AS-CA compared with lone AS.

The rationale for the primacy of coronary CT angiography in the National Institute for Health and Care Excellence (NICE) guideline (CG95) for the investigation of chest pain of recent onset.

The National Institute for Health and Care Excellence (NICE) provides independent evidence-based guidance for England's National Health Service. Its 2010 guideline for the "assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin" (CG95) recommended a variety of first-line investigations in stable patients, depending on the pre-test probability (PTP) of obstructive coronary artery disease (CAD). Following a limited review, NICE produced an updated version of CG95 in 2016.

How variable are the volumetric measurements from gated perfusion SPECT when a one-day stress-rest protocol is used?

Background: Using myocardial perfusion scintigraphy (MPS), an increase in left ventricular (LV) volumes or a decrease in ejection fraction (EF) from rest to stress may be clinically important. The variation in these measures between the low-dose stress acquisition and high-dose rest acquisition in a one-day stress-rest protocol has not been established. We assessed the reproducibility of gated volumetric indices between stress and rest and the normal variation in ungated TID ratio for a one-day stress-rest Tc-tetrofosmin protocol.

Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial.

Background: The optimal management of patients found to have multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction is uncertain.

Objectives: CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a U.K.

Advances in SPECT in evaluating coronary disease.

Myocardial perfusion scintigraphy is the longest established of the functional imaging investigations for patients with known or suspected coronary artery disease. This article describes recent technical and clinical advances that are ensuring that the technique remains relevant some 40 years after its first introduction.

Cardiac iodine-123 metaiodobenzylguanidine imaging predicts ventricular arrhythmia in heart failure patients receiving an implantable cardioverter-defibrillator for primary prevention.

Objective: To assess the prognostic value of cardiac iodine-123 metaiodobenzylguanidine ((123)I-MIBG) scintigraphy to predict ventricular arrhythmias in patients with heart failure (HF) listed for implantable cardioverter-defibrillator (ICD) devices as primary prevention.

Design, Setting And Patients: A prospective cohort study in 27 patients with HF referred for ICD implantation (alone or in combination with cardiac resynchronisation therapy) at a tertiary cardiac centre.

Methods: Cardiac (123)I-MIBG scintigraphy was performed with calculation of early and late heart-to-mediastinum (H:M) ratios, washout rate, and summed defect score from single photon emission computed tomography (SPECT) acquisition.

Prognostic value of a nine-minute treadmill test in patients undergoing myocardial perfusion scintigraphy.

Exercise capacity is an important predictor of risk in known or suspected coronary disease. A negative treadmill test to 9 minutes of the Bruce protocol is often used in the screening process for vocational licensing; myocardial perfusion scintigraphy is an alternative for those unable to exercise, with apparent incremental prognostic power above exercise testing alone. We compared exercise test and myocardial perfusion scintigraphic (MPS) findings and risk of hard cardiac events (median 4 years) in patients completing ≥ 9-minute treadmill exercise.

Are diabetic patients less likely to feel angina than nondiabetic controls for a given extent of myocardial ischaemia?

Objectives: It is widely believed that diabetic patients with coronary artery disease have a reduced ability to feel angina. We investigated whether the diabetic patients referred for myocardial perfusion scintigraphy (MPS) are less likely to experience chest pain in daily life or during treadmill exercise than nondiabetic controls with equivalent extents of inducible hypoperfusion.

Methods: One hundred and fifteen diabetic patients with ischaemia on single-photon emission computed tomography (SPECT) MPS were matched with 115 nondiabetic controls for age, sex, ethnic origin, method of stress used for MPS, and the extent of reversible hypoperfusion.

Does myocardial perfusion scintigraphy predict improvement in symptoms and exercise capacity following successful elective percutaneous coronary intervention?

Background: Elective percutaneous coronary intervention (PCI) without inducible ischaemia may not be beneficial. We investigated the prevalence of inducible hypoperfusion using myocardial perfusion scintigraphy (MPS) in patients undergoing PCI, and its ability to predict functional outcome.

Methods And Results: One hundred and twenty-three patients listed for elective PCI underwent MPS, using treadmill exercise where possible.

Is stress-only imaging practical when a 1-day stress-rest 99mTc-tetrofosmin protocol is used?

Objectives: To investigate whether a significant number of normal 1-day stress-rest 99mTc-tetrofosmin myocardial perfusion scintigraphy (MPS) studies can be identified from the low-dose stress acquisition alone, and whether technical staff can find such studies reliably.

Methods: The supervising consultant and four technologists independently graded the stress acquisitions from 200 consecutive MPS studies using a five-point scale. Studies were classified as normal or abnormal according to the final clinical report based on the completed stress-rest protocol.

A shape-space-based approach to tracking myocardial borders and quantifying regional left-ventricular function applied in echocardiography.

This paper presents a new semi-automatic method for quantifying regional heart function from two-dimensional echocardiography. In the approach, we first track the endocardial and epicardial boundaries using a new variant of the dynamic snake approach. The tracked borders are then decomposed into clinically meaningful regional parameters, using a novel interpretational shape-space motivated by the 16-segment model used in clinical practice for qualitative assessment of heart function.