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Background In patients with heart failure (HF) sequential imaging studies have demonstrated a relationship between myocardial perfusion and adrenergic innervation. We evaluated the feasibility of a simultaneous low-dose dual-isotope 123I/99mTc-acquisition protocol using a cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) camera. Methods and results Thirty-six patients with HF underwent simultaneous low-dose 123I-metaiodobenzylguanidine (MIBG)/99mTc-sestamibi gated CZT-SPECT cardiac imaging. Perfusion and innervation total defect sizes and perfusion/innervation mismatch size (defined by 123I-MIBG defect size minus 99mTc-sestamibi defect size) were expressed as percentages of the total left ventricular (LV) surface area. LV ejection fraction (EF) significantly correlated with perfusion defect size (P P P P 123I-MIBG heart-to-mediastinum (H/M) ratio. In addition, late H/M ratio was independently associated with reduced LVEF (P P P 123I-MIBG washout rate (WR) correlated with perfusion/innervation mismatch (P Conclusions In patients with HF, a simultaneous low-dose dual-isotope 123I/99mTc-acquisition protocol is feasible and could have important clinical implications.

Purpose We assessed the effects of the COVID-19 pandemic on myocardial perfusion imaging (MPI) for ischemic heart disease during the lockdown imposed by the Italian Government. Methods We retrospectively reviewed the number and the findings of stress single-photon emission computed tomography (SPECT)-MPI performed between February and May 2020 during the COVID-19 pandemic at the University of Napoli Federico II. The number and the findings of stress SPECT-MPI studies acquired in the corresponding months of the years 2017, 2018, and 2019 were also evaluated for direct comparison. Results The number of stress SPECT-MPI studies performed during the COVID-19 pandemic (n = 123) was significantly lower (P < 0.0001) compared with the mean yearly number of procedures performed in the corresponding months of the years 2017, 2018, and 2019 (n = 413). Yet, the percentage of abnormal stress SPECT-MPI studies was similar (P = 0.65) during the pandemic (36%) compared with the mean percentage value of the corresponding period of the years 2017, 2018, and 2019 (34%). Conclusion The number of stress SPECT-MPI studies was significantly reduced during the COVID-19 pandemic compared with the corresponding months of the previous 3 years. The lack of difference in the prevalence of abnormal SPECT-MPI studies between the two study periods strongly suggests that many patients with potentially abnormal imaging test have been missed during the pandemic.

Purpose To assess the impact of the Covid-19 pandemic on FDG-PET/CT work volume and to evaluate the occurrence of abnormal imaging findings suspicious or potentially diagnostic for interstitial pneumonia by Covid-19 infection in south Italy. Methods We retrospectively reviewed the number and the findings of FDG-PET/CT studies acquired between February and April 2020 during the Covid-19 pandemic at the University of Napoli Federico II. The number and the findings of FDG-PET/CT studies acquired in the corresponding period of 2019 were also assessed for direct comparison. Results The number of FDG-PET/CT studies performed during the pandemic (n = 299) and in the corresponding period of 2019 (n = 335) were comparable. The percentage of abnormal FDG-PET/CT findings, suspicious for interstitial pneumonia by Covid-19 infection, was significantly higher during the pandemic (9%) compared with that found in the corresponding period of 2019 (4%) (χ2 5.45, P = 0.02). No significant differences were observed in the distribution of Covid-19 reporting and data system (CO-RADS) classification and in the maximum standardized uptake value between the pandemic (2.6 ± 2.2) and the corresponding period of 2019 (3.2 ± 1.4). Of note, patients with abnormal imaging findings during the pandemic time had clinical data and/or laboratory tests negative for Covid-19 infection. Conclusion Despite the restrictive medical measures for the emergency, the number of FDG-PET/CT studies was unchanged during the pandemic compared with the previous year. Our findings also indicate that Covid-19 infection was contained in our series of patients from southern Italy.

Background. Prevention and development of diagnostic and therapeutic techniques reduced morbidity and mortality for coronary artery disease (CAD). In this context, the cardiovascular risk assessment for major adverse cardiac events (MACE) at 2-year (CRAX2MACE) model for prediction of 2-year major adverse cardiac events was developed. We performed an external validation of this model. Methods. We included 1003 patients with suspected CAD undergoing stress-rest single photon emission computed tomography myocardial perfusion imaging at our academic center between March 2015 and April 2019. Results. Considering the occurrence of MACE (death from any cause, acute myocardial infarction, or late coronary revascularization), for the CRAX2MACE model the area under the receiver operating characteristic curve was 0.612 and the Brier score was 0.061. The Hosmer–Lemeshow test estimated a non-optimal fit (X2 28, P < .001). Considering only hard events (cardiac death, acute myocardial infarction), the external validation of the CRAX2MACE model revealed a Brier score of 0.053 and an area under the receiver operating characteristic curve of 0.621. Hosmer–Lemeshow test was calculated by deciles and showed a poor fit (X2 31, P < .001). Conclusion. CRAX2MACE model had a limited value for predicting 2-year major adverse cardiovascular events in an external validation cohort of patients with suspected CAD.

Background. We evaluated the performance of conventional (C) single-photon emission computed tomography (SPECT) and cadmium-zinc-telluride (CZT)-SPECT in a large cohort of patients with suspected or known coronary artery disease (CAD) and compared the diagnostic accuracy of the two systems using machine learning (ML) algorithms. Methods and Results. A total of 517 consecutive patients underwent stress myocardial perfusion imaging (MPI) by both C-SPECT and CZT-SPECT. In the overall population, an excellent correlation between stress MPI data and left ventricular (LV) functional parameters measured by C-SPECT and by CZT-SPECT was observed (all P < .001). ML analysis performed through the implementation of random forest (RF) and k-nearest neighbors (NN) algorithms proved that CZT-SPECT has greater accuracy than C-SPECT in detecting CAD. For both algorithms, the sensitivity of CZT-SPECT (96% for RF and 60% for k-NN) was greater than that of C-SPECT (88% for RF and 53% for k-NN). Conclusions. MPI data and LV functional parameters obtained by CZT-SPECT are highly reproducible and provide good correlation with those obtained by C-SPECT. ML approach showed that the accuracy and sensitivity of CZT-SPECT is greater than C-SPECT in detecting CAD.

We assessed the prognostic value of structural abnormalities and coronary vasodilator function in diabetic patients referred to a PET/CT for suspected coronary artery disease (CAD). We studied 451 diabetics and 451 nondiabetics without overt CAD and normal myocardial perfusion. Myocardial blood flow (MBF) was computed from the dynamic rest and stress imaging. Myocardial flow reserve (MFR) was defined as ratio of hyperemic to baseline MBF and was considered reduced when

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Traditional approach for predicting coronary artery disease (CAD) is based on demographic data, symptoms such as chest pain and dyspnea, and comorbidity related to cardiovascular diseases. Usually, these variables are analyzed by logistic regression to quantifying their relationship with the outcome; nevertheless, their predictive value is limited. In the present study, we aimed to investigate the value of different machine learning (ML) techniques for the evaluation of suspected CAD; having as gold standard, the presence of stress-induced ischemia by 82Rb positron emission tomography/computed tomography (PET/CT) myocardial perfusion imaging (MPI) ML was chosen on their clinical use and on the fact that they are representative of different classes of algorithms, such as deterministic (Support vector machine and Naïve Bayes), adaptive (ADA and AdaBoost), and decision tree (Random Forest, rpart, and XGBoost). The study population included 2503 consecutive patients, who underwent MPI for suspected CAD. To testing ML performances, data were split randomly into two parts: training/test (80%) and validation (20%). For training/test, we applied a 5-fold cross-validation, repeated 2 times. With this subset, we performed the tuning of free parameters for each algorithm. For all metrics, the best performance in training/test was observed for AdaBoost. The Naïve Bayes ML resulted to be more efficient in validation approach. The logistic and rpart algorithms showed similar metric values for the training/test and validation approaches. These results are encouraging and indicate that the ML algorithms can improve the evaluation of pretest probability of stress-induced myocardial ischemia.

Kasai portoenterostomy (KP) represents the first-line treatment for biliary atresia (BA). The purpose was to compare the accuracy of quantitative parameters extracted from laboratory tests, US imaging, and MR imaging studies using machine learning (ML) algorithms to predict the long-term medical outcome in native liver survivor BA patients after KP. Twenty-four patients were evaluated according to clinical and laboratory data at initial evaluation (median follow-up = 9.7 years) after KP as having ideal (n = 15) or non-ideal (n = 9) medical outcomes. Patients were re-evaluated after an additional 4 years and classified in group 1 (n = 12) as stable and group 2 (n = 12) as non-stable in the disease course. Laboratory and quantitative imaging parameters were merged to test ML algorithms. Total and direct bilirubin (TB and DB), as laboratory parameters, and US stiffness, as an imaging parameter, were the only statistically significant parameters between the groups. The best algorithm in terms of accuracy, sensitivity, specificity, and AUCROC was naive Bayes algorithm, selecting only laboratory parameters (TB and DB). This preliminary ML analysis confirms the fundamental role of TB and DB values in predicting the long-term medical outcome for BA patients after KP, even though their values may be within the normal range. Physicians should be alert when TB and DB values change slightly.

OBJECTIVE. The purpose of this study was to perform a systematic review and a meta-analysis of diagnostic accuracy studies that used biparametric MRI (bpMRI) for the detection of clinically significant prostate cancer (csPCa). MATERIALS AND METHODS. Multiple medical databases were systematically searched to identify articles using bpMRI for csPCa detection. Sensitivity, specificity, PPV, and NPV were calculated for each study after enough data were extracted to create a 2 × 2 contingency table. Risk of bias was assessed using the QUADAS-2 tool. Meta-analyses based on bivariate random-effects methods were used to calculate pooled sensitivity, specificity, and summary ROC (SROC) curves. A meta-regression analysis was performed to assess heterogeneity sources. RESULTS. A total of 17 studies (3964 patients) that adopted PI-RADS or other scoring systems were included. Sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio of bpMRI in the detection of csPCa were 0.83 (95% CI, 0.76-0.88), 0.71 (95% CI, 0.63-0.79), 2.9 (95% CI, 2.3-3.7), 0.24 (95% CI, 0.17-0.33), and 12 (95% CI, 8-19), respectively, with an area under the SROC curve of 0.84 (95% CI, 0.81-0.87). The overall quality of the included studies was heterogeneous. CONCLUSION. Our results confirm the feasibility of bpMRI for the detection of csPCa and for reducing acquisition time, patient discomfort, and costs. Nevertheless, the available studies proved to be heterogeneous, indicating a need for a more robust validation of this imaging protocol and a standardization of prostate bpMRI acquisition and reporting.

Highlights • The number of CMR studies significantly decreased during COVID-19 pandemic. • Proportion of abnormal CMR results was similar between two time-interval categories. • Missed or delayed diagnoses may have occurred during the lockdown., Purpose We aimed to assess the impact of COVID-19 pandemic on cardiac magnetic resonance (CMR) imaging studies performed during the lockdown imposed by the Italian Government from March 2020 to May 2020. Materials and method We reviewed the number and the findings of CMR scans performed during the COVID-19 pandemic between March and May 2020 at University of Naples Federico II. The number and the findings of CMR studies acquired in the corresponding months of 2017, 2018 and 2019 were also assessed for direct comparison. Results A total of 117 CMR studies was considered, including the procedures performed during the pandemic (n = 18) and those performed in the corresponding months of the prior 3 years (n = 99). The number of CMR studies performed during the COVID-19 pandemic was significantly (P < .01) lower compared to the mean number (n = 33) of the procedures performed in the corresponding months of 2017−2019. The percentage of abnormal CMR studies was similar (P = 0.73) during the pandemic (67 %) compared to that found in the corresponding months of 2017−2019 (70 %) suggesting that many abnormal tests were missed due to the lockdown. Conclusion The number of CMR studies was significantly reduced during the COVID-19 pandemic compared to the corresponding period of the previous three years. The lack of difference in the prevalence of abnormal CMR studies between the two study time intervals strongly suggests that many patients with potentially abnormal imaging test have been missed during the pandemic.

Objectives: To predict placental accreta spectrum (PAS) in patients with placenta previa (PP) evaluating clinical risk factors (CRF), ultrasound (US) and magnetic resonance imaging (MRI) findings. Methods: Seventy patients with PP were retrospectively selected. CRF were retrieved from medical records. US and MRI images were evaluated to detect imaging signs suggestive of PAS. Univariable analysis was performed to identify CRF, US and MRI signs associated with PAS considering histology as standard of reference. Receiver operating characteristic curve (ROC) analysis was performed, and the area under the curve (AUC) was calculated. Multivariable analysis was also performed. Results: At univariable analysis, the number of previous cesarean section, smoking, loss of the retroplacental clear space, myometrial thinning < 1 mm, placental lacunae, intraplacental dark bands (IDB), focal interruption of myometrial border (FIMB) and abnormal vascularity were statistically significant. The AUC in predicting PAS progressively increased using CRF, US and MRI signs (0.69, 0.79 and 0.94, respectively; p < 0.05); the accuracy of MRI alone was similar to that obtained combining CRF, US and MRI variables (AUC = 0.97) and was significantly higher (p < 0.05) than that combining CRF and US (AUC = 0.83). Multivariable analysis showed that only IDB (p = 0.012) and FIMB (p = 0.029) were independently associated with PAS. Conclusions: MRI is the best modality to predict PAS in patients with PP independently from CRF and/or US finding. It is reasonable to propose the combined assessment of CRF and US as the first diagnostic level to predict PAS, sparing MRI for selected cases in which US findings are uncertain for PAS.

Background. We performed a meta- a meta-analysis to evaluate the prognostic value of coronary flow reserve (CFR) assessed by cardiac positron emission tomography (PET) imaging in patients with suspected or known coronary artery disease (CAD). Methods. Studies published until April 2019 were identified by database search. We included studies if they evaluated CFR by PET providing data on adjusted hazard ratio (HR) for the occurrence of adverse events. Annualized event rates were calculated and the incidence rate ratios (IRR) with 95% confidence interval (CI) were estimated to compare patients with impaired and preserved CFR. Results. We identified 13 eligible articles including 11,867 patients with a follow-up ranging from 0.6 to 7.1 years. The HR for the occurrence of major adverse cardiac events (MACE) was reported in 11 studies and pooled HR was 1.93 (95% CI 1.65-2.27). The HR for the occurrence of hard events was reported in 5 studies and pooled HR was 3.11 (95% CI 1.88-5.14). Six studies reported data useful to calculate separately the incidence rate of MACE in patients with preserved and impaired CFR and pooled IRR was 2.26 (CI 95% 1.79-2.85). Three studies reported data useful to calculate separately the incidence rate of hard events in patients with preserved and impaired CFR and pooled IRR was 4.12 (CI 95% 3.08-5.51). At meta-regression analysis we found an association between HR for MACE and gender, diabetes and hypertension, while no significant association was found between HR for hard events and demographic and clinical variables. Conclusions. In patients with suspected or known CAD an impaired CFR is associated with adverse cardiovascular events. However, the large heterogeneity in study population underlines the need for further investigations to maximize the prognostic role of CFR.

Purpose to assess if tumor segmentation analysis performed at different post-contrast time points (TPs) on dynamic images could influence the extraction of dynamic contrast enhanced (DCE)-MRI parameters in locally advanced breast cancer (LABC), and potentially represent a source of variability. Method forty patients with forty-two LABC lesions were prospectively enrolled and underwent breast DCE-MRI examination at 3 T. On post-processed dynamic images, enhancing tumor lesions were manually segmented at four different TPs: at the first post-contrast dynamic image in which the lesion was appreciable (TP 1) and at 1, 5 and 10 min after contrast-agent administration (TPs 2, 3 and 4, respectively) and corresponding DCE-MRI parameters were extracted. Friedman’s test followed by Bonferroni-adjusted Wilcoxon signed rank test for post-hoc analysis was used to compare DCE-MRI parameters. Intra- and inter-observer reliability of DCE-MRI parameters measurements was assessed using the Intraclass Correlation Coefficient (ICC) analysis. Results Ktrans, Kep and iAUC were significantly higher when extracted from ROIs placed at TP1 and progressively decreased from TP 2–4. The intra-observer reliability ranged from good to excellent (ICC’s: 0.894 to 0.990). The inter-observer reliability varied from moderate to excellent (0.770 to 0.942). The inter-observer reliability was significantly higher for Ktrans and Kep extracted at TPs1 and 2 as compared to TPs 3 and 4. Conclusions A significant variability of DCE-MRI quantitative parameters occurs when tumor segmentation is performed at different TPs. We suggest to performing tumor delineation at an established TP, preferably the earliest, in order to extract reliable and comparable DCE-MRI data.

Aims Cardiac imaging with positron emission tomography/computed tomography (PET/CT) allows measurement of coronary artery calcium (CAC), stress-induced myocardial ischemia and myocardial perfusion reserve (MPR). We evaluated the prognostic role of the combined assessment of regional CAC score, ischemic total perfusion defect (ITPD) and MPR in predicting lesion-related outcome in patients with suspected coronary artery disease (CAD). Methods and results We studied 206 patients with suspected CAD referred to 82Rb PET/CT cardiac imaging and available coronary angiographic data. The outcome end points were cardiac death, target vessel-related myocardial infarction or unstable angina requiring coronary revascularization. Compared to vessels without event, those with event showed higher CAC score and ITPD, and lower hyperemic myocardial blood flow and MPR (all P

Systemic sclerosis is an auto-immune disease characterized by skin involvement that often affects multiple organ systems. Pulmonary hypertension is a common finding that can significantly impact prognosis. Molecular pathophysiological mechanisms underlying pulmonary hypertension in systemic sclerosis can be extremely heterogeneous, leading to distinct clinical phenotypes. In addition, different causes of pulmonary hypertension may overlap within the same patient. Since pulmonary hypertension treatment is very different for each phenotype, it is fundamental to perform an adequate diagnostic work-up to properly and promptly identify the prevalent mechanism underlying pulmonary hypertension in order to start the right therapies. When pulmonary hypertension is caused by a primary vasculopathy of the small pulmonary arteries, treatment with pulmonary vasodilators, often in an initial double-combination regimen, is indicated, aimed at reducing the mortality risk profile. In this review, we describe the different clinical phenotypes of pulmonary hypertension in the scleroderma population and discuss the utility of clinical tools to identify the presence of pulmonary vascular disease. Furthermore, we focus on systemic sclerosis-associated pulmonary arterial hypertension, highlighting the advances in the knowledge of right ventricular dysfunction in this setting and the latest updates in terms of treatment with pulmonary vasodilator drugs.

Background: The subcutaneous implantable cardioverter defibrillator (S-ICD) is an established treatment for the prevention of sudden cardiac death. In the S-ICD studies, inappropriate shocks (IAS) rate were reported to renge between 5% to 25% and to be mainly due to cardiac and noncardiac oversensing. Objective: This review highlights data on IAS complications of the S-ICD and is aimed to help in identifying the causes of extracardiac oversensing to facilitate safe and effective emergency management and to reduce the incidence of adverse outcomes. Methods: Literature between January 2010 and March 2020 on IAS and S-ICD was identified by database search. We included studies assessing IAS rates due to extracardiac oversensing. We identified 12 eligible articles including meta-analysis and 28 selected case reports. Results: The total population included 2654 reported patients. Of these, 84 patients received extracardiac IAS. The malfunction of S-ICD due to extracardiac oversensing was related, in particular, to myopotentials (34%) and electromagnetic interferences (29%). The meta-analysis demonstrates an overall high prevalence of extracardiac IAS of 22% (95% CI 8% - 50%); the prevalence was 6% (95% CI 3% - 12%) in patients without the SP (SMART-Pass) filter and 46% (95% CI 12% - 84%) in patients with the SP filter (P=0.047). Conclusion: Our findings show the high prevalence of extracardiac IAS in patients with S-ICD and demonstrated that the SP is unable to prevent the IAS due to extracardiac reasons. It is important in the Emergency Department for the appropriate management of IAS to identify the various causes.

Diabetes represents a worldwide increasing problem and cardiovascular disease is the most common cause of death in diabetic patients. Pathophysiology that links diabetes to cardiovascular disease is a complex and multifactorial phenomenon evolving over time and involving both large blood vessels (macrovasculature) and small blood vessels (microvasculature). Myocardial perfusion imaging (MPI) imaging by both single-photon emission computer tomography and positron emission tomography with different specific tracers has become an indispensable tool for discriminating normal from diseased myocardial tissues and left ventricular function and monitoring myocardial blood flows, leading to the evaluation of almost overall physiologic consequences of the macro- and microvascular impairment involved in diabetic patients. This review will provide an overview of the role of MPI in the diagnosis and risk assessment of patients with diabetes and suspected or known CAD.

Sympathetic nervous system hyperactivity has a well-recognized role in the pathophysiology of heart failure with reduced left ventricular ejection fraction. Alterations in sympathetic nervous system have been related to the pathophysiology of pulmonary arterial hypertension, but it is unclear whether cardiac sympathetic nervous system is impaired and how sympathetic dysfunction correlates with hemodynamics and clinical status in pulmonary arterial hypertension patients. The aim of this study was to evaluate the cardiac sympathetic nervous system activity by means of 123 Iodine-metaiodobenzylguanidine nuclear imaging in pulmonary arterial hypertension patients and to explore its possible correlation with markers of disease severity. Twelve consecutive pulmonary arterial hypertension patients (nine women, median age 56.5 (17.8), eight idiopathic and four connective tissue-associated pulmonary arterial hypertension) underwent cardiac 123 Iodine-metaiodobenzylguanidine scintigraphy. The results were compared with those of 12 subjects with a negative history of cardiovascular or pulmonary disease who underwent the same nuclear imaging test because of a suspected paraganglioma or pheochromocytoma, with a negative result (controls), and 12 patients with heart failure with reduced left ventricular ejection fraction. Hemodynamics, echocardiography, six-minute walking distance, cardiopulmonary exercise testing, and N-terminal pro brain natriuretic peptide were collected in pulmonary arterial hypertension patients within one week from 123 Iodine-metaiodobenzylguanidine scintigraphy. Cardiac 123 Iodine-metaiodobenzylguanidine uptake, assessed as early and late heart-to-mediastinum ratio, was significantly lower in pulmonary arterial hypertension compared to controls (p = 0.001), but similar to heart failure with reduced left ventricular ejection fraction. Myocardial 123 Iodine-metaiodobenzylguanidine turnover, expressed as washout rate, was similar in pulmonary arterial hypertension and heart failure with reduced left ventricular ejection fraction and significantly higher compared to controls (p = 0.016). In the pulmonary arterial hypertension group, both early and late heart-to-mediastinum ratios and washout rate correlated with parameters of pulmonary arterial hypertension severity including pulmonary vascular resistance, right atrial pressure, tricuspid annular plane systolic excursion, N-terminal pro brain natriuretic peptide, and peak VO 2 . Although we evaluated a small number of subjects, our study showed a significant impairment in cardiac sympathetic nervous system in pulmonary arterial hypertension, similarly to that observed in heart failure with reduced left ventricular ejection fraction. This impairment correlated with indices of pulmonary arterial hypertension severity. Cardiac sympathetic dysfunction may be a contributing factor to the development of right-sided heart failure in pulmonary arterial hypertension.

Background: We evaluated the incremental value of 99mTc-sestamibi single photon-emission computed tomography (SPECT)/computed tomography (CT) over planar imaging for localization of abnormal parathyroid tissue in patients with primary hyperparathyroidism. Methods: Forty-six patients with biochemical evidence of hyperparathyroidism and inconclusive ultrasound underwent 99mTc-sestamibi dual-phase planar scintigraphy and SPECT/CT for preoperative localization of parathyroid adenoma. Imaging findings were compared with histopathological data. Recursive partitioning and regression trees (RPART) analysis was used to assess the value of SPECT/CT over planar scintigraphy for classifying patients with or without adenoma. The added value of SPECT/CT was also evaluated by decision curve analysis. Results: Planar scintigraphy was positive for presence of hyperfunctioning parathyroid in 52% of patients, with sensitivity of 63% and specificity of 100%. SPECT/CT was positive in 80% of patients with sensitivity of 97% and specificity of 100%. At RPART analysis, after an initial split on planar imaging results, no further split was performed in patients with positive results, while those with negative results were further stratified by SPECT/CT. At decision curve analysis, the model including SPECT/CT was associated with the highest net benefit compared to the model including only planar technique and to a strategy considering that all patients should be treated. Conclusion: 99mTc-sestamibi SPECT/CT provides incremental value over dual-phase scintigraphy in preoperative localization of hyperfunctioning parathyroid tissue in subjects with inconclusive ultrasound. Hybrid technique allows a better identification of pathological lesion to perform minimally invasive surgery and showed the highest net benefit, improving selection of surgical approach

Machine Learning is a branch of artificial intelligence that provides algorithms able to learn automatically, improve from experience, and make previsions...

BACKGROUND: Coronary artery calcium (CAC) can be used to estimate vascular age in adults, providing a convenient transformation of CAC from Agatston units into a year's scale. We investigated the role of coronary vascular age in predicting stress-induced myocardial ischemia in subjects with suspected coronary artery disease (CAD). METHODS: A total of 717 subjects referred to CAC scoring and 82Rb PET/CT stress-rest myocardial perfusion imaging for suspected CAD were studied. CAC score was measured according to the Agatston method and coronary vascular age by equating estimated CAD risk for chronological age and CAC using the formula 39.1 + 7.25 × ln(CAC + 1). RESULTS: Stress-induced ischemia was present in 105 (15%) patients. Mean chronological age, CAC score, and coronary vascular age were higher (all P < .001) in patients with ischemia compared to those without. At incremental analysis, the global Chi square increased from 41.26 to 68.77 (P < .001) when chronological age was added to clinical variables. Including vascular age in the model, the global Chi square further increased from 68.77 to 106.38 (P < .001). Adding chronological age to clinical data, continuous net reclassification improvement (cNRI) was 0.57, while adding vascular age to clinical data and chronological age cNRI was 0.62. At decision curve analysis, the model including vascular age was associated with the highest net benefit compared to the model including only clinical data, to the model including chronological age and clinical data, and to a strategy considering that all patients had ischemia. The model including vascular age also showed the largest reduction in false-positive rate without missing any ischemic patients. CONCLUSIONS: In subjects with suspected CAD, coronary vascular age is strongly associated with stress-induced ischemia. The communication of a given vascular age would have a superior emotive impact improving observance of therapies and healthier lifestyles.

This Registry demonstrated that PAD program is essential to increase the survivors, in particular in regions with densely populated area and with insufficient road network. In these areas it is essential to increase the number of AED installation and the Cardiopulmonary Resuscitation (CPR) training among the general population. Strong positive predictive factors of outcome were a short delay to defibrillation, bystander CPR and place of collapse.

Background: Left ventricular (LV) remodeling is associated with adverse cardiovascular events. We evaluated the added prognostic value of LV shape index (SI) assessed by gated single-photon emission tomography (SPECT) in patients without known coronary artery disease (CAD). Methods and results: We studied 674 patients with normal myocardial perfusion and normal LV ejection fraction (EF) on stress gated SPECT imaging. An automated software program was used to calculate end-diastolic and end-systolic LVSI. An LVSI ≤ 0.54 at end-systole was considered normal. Follow-up was 96% complete with a median follow-up of 37 months. During follow-up, 25 events occurred (3.8% cumulative event rate). Event-free survival was lower in patients with abnormal end-systolic LVSI (P

The concept of warranty period, the duration of time during which the patient’s risk remains low, is appealing. However, some points remain to be resolved before its translation in the clinical arena. Methodological issues should be standardized in order to compare the results of studies in different patient populations. Also, the definition of a “normal” study should always take into consideration the history of prior revascularization, the achieved level of exercise, and the stressor used. The promise of warranty can be questioned by the patient’s baseline demographic and clinical characteristics and may also be influenced by life-style modification in the course of the follow-up. The “warranty period” concept should shift from data reflecting the time to a cardiac event to the development of ischemia, given an opportunity for intervention before a cardiac event occurs. In this context, clarify the role of serial imaging can be extremely useful, in particular to evaluate if and when retesting a patient after a normal scan.