Cardiac nuclear imaging workforce: Trends from Medicare Part B (2013-2022).

Background: Cardiac positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are widely used for the assessment of coronary artery disease. While SPECT remains more available, workforce shortages and training demands contribute to geographic disparities in PET availability, impacting patient access to advanced imaging. Therefore, we assessed trends in the U.

Prognostic Value of PET-Derived Myocardial Flow Reserve in Patients With Very High Coronary Artery Calcium Score.

Background: Coronary artery calcium (CAC) is a strong predictor of cardiovascular outcomes, with patients having high CAC experiencing event rates similar to those in secondary prevention populations. Emerging evidence suggests that patients with extremely high CAC (≥1000) represent a distinct high-risk group. Therefore, this study aims to evaluate the prognostic value of myocardial flow reserve (MFR) in patients with very high CAC.

Cardiac CT and PET for Surveillance of Heart Transplant Recipients: Systematic Review and Bayesian Meta-Analysis.

Background: For noninvasive surveillance of cardiac allograft vasculopathy (CAV), cardiac computed tomography (cardiac computed tomography [CT]) and positron emission tomography (PET) received a Class IIa recommendation by the 2023 ISHLT (International Society for Heart and Lung Transplantation) guidelines. However, implementation has lagged behind because of concerns about their ability to rule out disease and stratify risk.

Objectives: The purpose of this study was to define the diagnostic and prognostic ability of PET and cardiac CT in cardiac transplant recipients.

Targeting Triglycerides: The Rise of Apolipoprotein C3 and Angiopoietin-Like Protein 3 Inhibitors.

Hypertriglyceridemia has been proposed as a risk factor for atherosclerotic cardiovascular disease (ASCVD). Triglycerides (TG) are viewed as a marker for remnant cholesterol in triglyceride-rich lipoproteins, as this remnant cholesterol has been identified as a causal risk factor for ASCVD. The limited number of effective treatments for elevated TG has fueled the search for novel pharmacotherapy options, and multiple medication classes are being explored.

Geographical distribution and accessibility to cardiac CT readers in the United States: A snapshot from the 2022 medicare analysis.

Background: Cardiac computed tomography (CCT) is an increasingly important modality for the diagnosis and management of cardiovascular diseases. However, disparities in the availability of trained CCT readers across the United States limit equal access.

Objective: This study examined the geographical distribution and characteristics of CCT readers who billed Medicare for CCT in 2022.

Differential Association of PET-Derived Rest and Stress Myocardial Blood Flow with Cardiovascular Outcomes.

Although there is strong evidence for the prognostic value of myocardial flow reserve (MFR), there are fewer data on the prognostic implications of its constituents: myocardial blood flow at rest (MBF) and stress (MBF). Consecutive patients undergoing Rb PET imaging with regadenoson stress testing at a tertiary care center between August 2019 and August 2024 were included in this study. The 2 coprimary outcomes were a composite of death or heart failure (HF) hospitalization and a composite of myocardial infarction (MI) or late revascularization.

Temporal trends and geographic accessibility to cardiac magnetic resonance readers across the United States: an analysis of Medicare Part B data.

Background: Cardiovascular magnetic resonance (CMR) has a growing role in the diagnosis and management of cardiac disease. However, there is little recent data on the availability of CMR physicians (readers) in the United States (US).

Objective: To demonstrate the geographic proximity and accessibility of patients to CMR services and CMR physicians across the US.

The impact of attenuation correction and prone positioning on stress-only imaging in cardiac SPECT: An observational study.

Background: Current guidelines recommend stress-only single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) in select patients to reduce time, cost, and radiation. However, stress-only imaging remains underutilized.

Objectives: We assessed techniques to increase the adoption of stress-only SPECT MPI, specifically evaluating whether prone positioning and CT-based attenuation correction (AC) reduce the need for additional rest imaging.

Cardiac positron emission tomography/Computed tomography (PET/CT) in current cardiology guidelines.

Cardiac positron emission tomography (PET) is increasingly utilized in clinical practice. This review examines the latest clinical practice guidelines from the American College of Cardiology/American Heart Association (ACC/AHA), the European Society of Cardiology (ESC), the International Society for Heart and Lung Transplantation (ISHLT), and multisocietal consensus statements as of December 2024, to assess the extent to which cardiac PET is incorporated into their recommendations.

The prognostic interplay of coronary artery calcium volume and density with myocardial flow reserve and incident cardiovascular events.

Aims: It is important to evaluate the relationship between coronary plaque characteristics and myocardial blood flow (MBF) to determine coronary phenotypes that may predispose to cardiovascular disease. Objectives are to study the association between coronary artery calcium (CAC) volume and density and positron emission tomography (PET)-derived myocardial flow reserve (MFR) and their relationship with incident cardiovascular disease.

Methods And Results: The study population consisted of consecutive patients who were referred for clinically indicated PET myocardial perfusion imaging between 2019 and 2024.

The prognostic interplay between PET-derived resting myocardial blood flow and left ventricular ejection fraction.

Aims: Whether the prognostic value of resting myocardial blood flow (MBFrest) and myocardial flow reserve (MFR) is modified by a patient's ejection fraction (EF) has not been studied.

Methods And Results: Consecutive patients undergoing stress/rest MPI using Rb-82 PET between 2019 and 2024 were included. The primary outcome was a composite of death and heart failure (HF) hospitalizations.

The prognostic significance of rate pressure product corrected myocardial flow reserve.

Background: It is unknown whether myocardial flow reserve (MFR) corrected for rate pressure product (RPP) can risk stratify events when added to uncorrected MFR. In this study, we evaluated the relationship between concordant vs discordant corrected and uncorrected MFR and incident outcomes.

Methods: Consecutive patients referred for clinically indicated positron emission tomography were enrolled in a prospective registry.

Myocardial flow reserve and resting contractility modulate the impact of contractile reserve in patients undergoing rubidum-82 positron emission tomography.

Although ejection fraction reserve (EFR) harbors prognostic value in patients undergoing positron emission tomography (PET) myocardial perfusion imaging (MPI), whether resting EF and myocardial flow reserve (MFR) modulate its prognostic value has not been studied. Consecutive patients undergoing stress/rest MPI using Rb-82 PET between 2019 and 2024 were included. The primary outcome was a composite of death and heart failure (HF) hospitalizations.

Advanced cardiac imaging modalities in U.S. heart transplant centers: availability and distribution.

Purpose: This study evaluates the availability of advanced imaging modalities, including cardiac computed tomography (CCT), cardiac magnetic resonance (CMR), cardiac positron emission tomography (PET), and intravascular ultrasound (IVUS)/optical coherence tomography (OCT), at Medicare-approved heart transplant centers across the United States.

Methods: We retrieved the list of Medicare-approved heart transplant centers and data on physicians billing for cardiac imaging procedures from the CMS website. Addresses of billing physicians were matched with those of heart transplant centers to determine the availability of imaging modalities at each center.

The impact of obesity on myocardial flow reserve and its prognostic utility.

Background: Obesity is a major cardiovascular risk factor associated with coronary microvascular dysfunction, which can be noninvasively assessed using myocardial flow reserve (MFR) on positron emission tomography (PET). As impaired MFR identifies high-risk patients, we assessed whether body mass index (BMI) modifies the association between MFR and cardiovascular outcomes.

Methods: Consecutive patients with no known coronary artery disease who had a clinically indicated PET were enrolled and followed prospectively for incident outcomes (all-cause death, major adverse cardiovascular events (MACE), and heart failure admissions).

Inclisiran as a siRNA Inhibitor of Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9); Past, Present, and Future.

Reducing low-density lipoprotein cholesterol (LDL-C) levels has been shown to reduce the risk of developing atherosclerotic cardiovascular disease (ASCVD). Statins are the foundation of LDL-C lowering therapy with other non-statin agents used in circumstances where goal LDL-C levels are not reached or owing to intolerance to adverse effects of statins. In 2003, the discovery of the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) system in promoting elevated LDL-C levels led to new avenues of drug development to achieve target LDL-C.

Vital Exhaustion and Biomarkers Associated With Cardiovascular Risk: The ARIC Study.

Background: Vital exhaustion, defined as excessive fatigue, demoralization, and irritability due to chronic stress, is independently associated with cardiovascular disease (CVD).

Objectives: The purpose of this study was to examine the association of vital exhaustion with biomarkers associated with CVD risk in the ARIC (Atherosclerosis Risk In Communities) study.

Methods: We examined the cross-sectional association of vital exhaustion (assessed using the Maastricht Vital Exhaustion Questionnaire [MVEQ]) with cardiac biomarker (high-sensitivity troponin T [hs-TnT], N-terminal pro-B-type natriuretic peptide [NT-proBNP]) and high-sensitivity C-reactive protein (hs-CRP) levels in 11,542 ARIC study participants without CVD at ARIC visit 2 using multivariable logistic and linear regression models.

The future of hypertension pharmacotherapy: Ongoing and future clinical trials for hypertension.

Hypertension is among the most prevalent diagnoses across the world and increases the risk of many serious health problems, such as stroke, heart disease, and kidney disease. Pharmacological approaches to treat hypertension are often required and reduce blood pressure through mechanisms such as vasodilation, inhibition of the renin-angiotensin-aldosterone pathway, and increased urine output to reduce blood volume, among other mechanisms. Further research is ongoing to find novel pathways and mechanisms to treat hypertension, which we summarize in this review.