308 results on '"Mario Petretta"'
Search Results
2. Cardiovascular risk factors and development of nomograms in an Italian cohort of patients with suspected coronary artery disease undergoing SPECT or PET stress myocardial perfusion imaging
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Rosario Megna, Mario Petretta, Carmela Nappi, Roberta Assante, Emilia Zampella, Valeria Gaudieri, Teresa Mannarino, Adriana D’Antonio, Roberta Green, Valeria Cantoni, Mariarosaria Panico, Wanda Acampa, and Alberto Cuocolo
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cardiovascular risk factors ,coronary artery disease ,SPECT ,PET ,myocardial perfusion imaging ,nomogram ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
IntroductionSingle-photon emission computed tomography (SPECT) and positron emission tomography (PET) are non-invasive nuclear medicine techniques that can identify areas of abnormal myocardial perfusion. We assessed the prevalence of cardiovascular risk factors in patients with suspected coronary artery disease (CAD) undergoing SPECT or PET stress myocardial perfusion imaging (MPI). Based on significant risk factors associated with an abnormal MPI, we developed a nomogram for each cohort as a pretest that would be helpful in decision-making for clinicians.MethodsA total of 6,854 patients with suspected CAD who underwent stress myocardial perfusion imaging by SPECT or PET/CT was studied. As part of the baseline examination, clinical teams collected information on traditional cardiovascular risk factors: age, gender, body mass index, angina, dyspnea, diabetes, hypertension, hyperlipidemia, family history of CAD, and smoking.ResultsThe prevalence of cardiovascular risk factors was different in the two cohorts of patients undergoing SPECT (n = 4,397) or PET (n = 2,457) myocardial perfusion imaging. A statistical significance was observed in both cohorts for age, gender, and diabetes. At multivariable analysis, only age and male gender were significant covariates in both cohorts. The risk of abnormal myocardial perfusion imaging related to age was greater in patients undergoing PET (odds ratio 4% vs. 1% per year). In contrast, male gender odds ratio was slightly higher for SPECT compared to PET (2.52 vs. 2.06). In the SPECT cohort, smoking increased the risk of abnormal perfusion of 24%. Among patients undergoing PET, diabetes and hypertension increased the risk of abnormal perfusion by 63% and 37%, respectively. For each cohort, we obtained a nomogram by significant risk factors at multivariable logistic regression. The area under the receiver operating characteristic curve associated with the nomogram was 0.67 for SPECT and 0.73 for the PET model.ConclusionsPatients with suspected CAD belonging to two different cohorts undergoing SPECT or PET stress myocardial perfusion imaging can have different cardiovascular risk factors associated with a higher risk of an abnormal MPI study. As crude variables, age, gender, and diabetes were significant for both cohorts. Net of the effect of other covariates, age and gender were the only risk factors in common between the two cohorts. Furthermore, smoking and type of stress test were significant for the SPECT cohort, where as diabetes and hypertension were significant for the PET cohort. Nomograms obtained by significant risk factors for the two cohorts can be used by clinicians to evaluate the risk of an abnormal study.
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- 2024
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3. Prevalence of cancer therapy cardiotoxicity as assessed by imaging procedures: A scoping review
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Valeria Cantoni, Roberta Green, Roberta Assante, Adriana D'Antonio, Francesca Maio, Emanuele Criscuolo, Roberto Bologna, Mario Petretta, Alberto Cuocolo, and Wanda Acampa
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cancer therapy ,cardiotoxicity ,imaging ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Advances in treatment and optimization of chemotherapy protocols have greatly improved survival in cancer patients. Unfortunately, treatment can cause a reduction in left ventricular (LV) ejection fraction (EF) leading to cancer therapy‐related cardiac dysfunction (CTRCD). We conducted a scoping review of published literature in order to identify and summarize the reported prevalence of cardiotoxicity evaluated by noninvasive imaging procedures in a wide‐ranging of patients referred to cancer treatment as chemotherapy and/or radiation therapy. Methods Different databases were checked (PubMed, Embase, and Web of Science) to identify studies published from January 2000 to June 2021. Articles were included if they reported data on LVEF evaluation in oncological patients treated with chemotherapeutic agents and/or radiotherapy, measured by echocardiography and/or nuclear or cardiac magnetic resonance imaging test, providing criteria of CTRCD evaluation such as the specific threshold for LVEF decrease. Results From 963 citations identified, 46 articles, comprising 6841 patients, met the criteria for the inclusion in the scoping review. The summary prevalence of CTRCD as assessed by imaging procedures in the studies reviewed was 17% (95% confidence interval, 14–20). Conclusions The results of our scoping review endorse the recommendations regarding imaging modalities to ensure identification of cardiotoxicity in patients undergoing cancer therapies. However, to improve patient management, more homogeneous CTRCD evaluation studies are required, reporting a detailed clinical assessment of the patient before, during and after treatment.
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- 2023
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4. Editorial: Insights in PET and SPECT: 2023
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Mario Petretta, Carmela Nappi, and Alberto Cuocolo
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nuclear medicine ,SPECT ,PET ,metabolic imaging ,molecular imaging ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Published
- 2023
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5. Cardiovascular magnetic resonance native T1 mapping in Anderson-Fabry disease: a systematic review and meta-analysis
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Andrea Ponsiglione, Michele Gambardella, Roberta Green, Valeria Cantoni, Carmela Nappi, Raffaele Ascione, Marco De Giorgi, Renato Cuocolo, Antonio Pisani, Mario Petretta, Alberto Cuocolo, and Massimo Imbriaco
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Anderson-Fabry disease ,CMR ,T1 mapping ,Systematic review ,Meta-analysis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background T1 mapping is an established cardiovascular magnetic resonance (CMR) technique that can characterize myocardial tissue. We aimed to determine the weighted mean native T1 values of Anderson-Fabry disease (AFD) patients and the standardized mean differences (SMD) as compared to healthy control subjects. Methods A comprehensive literature search of the PubMed, Scopus and Web of Science databases was conducted according to the PRISMA statement to retrieve original studies reporting myocardial native T1 values in AFD patients and healthy controls. A random effects model was used to calculate SMD, and meta-regression analysis was conducted to explore heterogeneity sources. Subgroup analysis was also performed according to scanner field strength and sequence type. Results From a total of 151 items, 14 articles were included in the final analysis accounting for a total population of 982 subjects. Overall, the weighted mean native T1 values was 984 ± 47 ms in AFD patients and 1016 ± 26 ms in controls (P
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- 2022
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6. Age-Specific Cardiovascular Risk Factors for Major Adverse Cardiac Events in Patients Undergoing Myocardial Perfusion Imaging
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Rosario Megna, Mario Petretta, Carmela Nappi, Roberta Assante, Emilia Zampella, Valeria Gaudieri, Teresa Mannarino, Adriana D’Antonio, Roberta Green, Valeria Cantoni, Mariarosaria Panico, Wanda Acampa, and Alberto Cuocolo
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cardiovascular risk factors ,coronary artery disease ,SPECT ,myocardial perfusion imaging ,MACE ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: The prevalence of traditional cardiovascular risk factors shows different age-specific patterns. It is not known whether the prognostic impact of risk factors is similarly age-specific. We evaluated the profiles of cardiovascular risk factors and their prognostic impact on coronary artery disease (CAD) in relation to age. Methods: We included 3667 patients with suspected or known CAD undergoing stress myocardial perfusion imaging (MPI). We evaluated the risk for major adverse cardiac events (MACE) within three years from the index MPI in patients belonging to three groups according to age tertile distribution: 68 years. Gender, body mass index, diabetes, hypertension, dyslipidemia, family history of CAD, smoking, angina, dyspnea, previous CAD, and MPI outcome were assessed as risk factors by a multivariable Cox’s regression. Results: The three-year risk of MACE increased progressively with age and was 9%, 13%, and 18% for each group, respectively (p < 0.0001). Dyspnea and abnormal MPI outcome were significant risk factors for all age groups. Diabetes and smoking were significant from the age of 59 onwards, while hypertension resulted significant for patients older than 68 years. Conclusions: The number of risk factors was significantly associated with the occurrence of MACE increase with age. It is noteworthy that a personal history of CAD was not useful for risk stratification, while MPI results were.
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- 2023
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7. Tracers for Cardiac Imaging: Targeting the Future of Viable Myocardium
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Carmela Nappi, Mariarosaria Panico, Maria Falzarano, Carlo Vallone, Andrea Ponsiglione, Paolo Cutillo, Emilia Zampella, Mario Petretta, and Alberto Cuocolo
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ischemic heart disease ,viable dysfunctional myocardium ,nuclear medicine techniques ,tracers ,new probes ,Pharmacy and materia medica ,RS1-441 - Abstract
Ischemic heart disease is the leading cause of mortality worldwide. In this context, myocardial viability is defined as the amount of myocardium that, despite contractile dysfunction, maintains metabolic and electrical function, having the potential for functional enhancement upon revascularization. Recent advances have improved methods to detect myocardial viability. The current paper summarizes the pathophysiological basis of the current methods used to detect myocardial viability in light of the advancements in the development of new radiotracers for cardiac imaging.
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- 2023
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8. Impact of COVID-19 pandemic on 2-[18F]FDG PET/CT imaging work-flow in a single medical institution: comparison among the three Italian waves
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Simone Maurea, Claudia Bombace, Ciro Gabriele Mainolfi, Alessandra Annunziata, Ludovica Attanasio, Arnaldo Stanzione, Elide Matano, Brigitta Mucci, Alessandro D'Ambrosio, Claudia Giordano, Mario Petretta, Silvana Del Vecchio, and Alberto Cuocolo
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COVID-19 ,PET/CT ,South Italy ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
Purpose: To compare the impact of COVID-19 pandemic on 2-[18F]FDG PET/CT imaging work-flow during the three waves in a medical institution of southern of Italy. Methods: We retrospectively reviewed the numbers and results of 2-[18F]FDG PET/CT studies acquired during the following three periods of the COVID-19 waves: 1) February 3-April 30, 2020; 2) October 15, 2020–January 15, 2021; and 3) January 18-April 16, 2021. Results: A total of 861 PET/CT studies in 725 patients (388 men, mean age 64 ± 4 years) was acquired during the three waves of COVID-19 pandemic. The majority (94%) was performed for diagnosis/staging (n = 300) or follow-up (n = 512) of neoplastic diseases. The remaining 49 studies (6%) were acquired for non-oncological patients. The distribution of number and type of clinical indications for PET/CT studies in the three waves were comparable (p = 0.06). Conversely, the occurrence of patients positive for COVID-19 infection progressively increased (p < 0.0001) from the first to third wave; in particular, patients with COVID-19 had active infection before PET/CT study as confirmed by molecular oro/nasopharyngeal swab. Conclusion: Despite the restrictive medical measures for the emergency, the number of 2-[18F]FDG PET/CT studies was unchanged during the three waves guaranteeing the diagnostic performance of PET/CT imaging for oncological patients.
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- 2022
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9. The cardiac conundrum: a systematic review and bibliometric analysis of authorship in cardiac magnetic resonance imaging studies
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Renato Cuocolo, Andrea Ponsiglione, Serena Dell’Aversana, Ludovica D’Acierno, Giulia Lassandro, Lorenzo Ugga, Valeria Romeo, Elena Augusta Vola, Arnaldo Stanzione, Francesco Verde, Valentina Picariello, Iolanda Capaldo, Giuseppe Pontillo, Valeria Cantoni, Roberta Green, Mario Petretta, Alberto Cuocolo, and Massimo Imbriaco
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Magnetic resonance imaging ,Systematic review ,Heart ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Abstract Purpose We aimed to assess the role of radiologists, cardiologists, and other medical and non-medical figures in cardiac magnetic resonance imaging (MRI) research in the last 34 years, focusing on first and last authorship, number of published studies, and journal impact factors (IF). Methods Articles in the field of cardiac MRI were considered in this systematic review and retrospective bibliometric analysis. For included studies, the first and last authors were categorized as cardiologists, radiologists/nuclear medicine physicians, medical doctors (MD) with specialties in both cardiology and radiology/nuclear medicine, and other MD and non-MD. Differences in the number of papers published overall and by year and institution location for the first and last author category were assessed. Mean IF differences between author categories were also investigated. Results A total of 2053 articles were included in the final analysis. For the first authors (n = 2011), 52% were cardiologists, 22% radiologists/nuclear medicine physicians, 16% other MD, 10% other non-MD, and 1% both cardiologists and radiologists/nuclear medicine physicians. Similarly, the last authors (n = 2029) resulted 54% cardiologists, 22% radiologists/nuclear medicine physicians, 15% other MD, 8% other non-MD, and 2% both cardiologists and radiologists/nuclear medicine physicians. No significant differences due to institution location in the first and last authorship proportions were found. Average journal IF was significantly higher for cardiologist first and last authors when compared to that of radiologists/nuclear medicine physicians (both p < 0.0001). Conclusion Over 50% of studies in the field of cardiac MRI published in the last 34 years are conducted by cardiologists.
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- 2020
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10. Combined bone scintigraphy and fluorocholine PET/computed tomography predicts response to radium-223 therapy in patients with prostate cancer
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Michele Klain, Valeria Gaudieri, Mario Petretta, Emilia Zampella, Giovanni Storto, Carmela Nappi, Carlo Buonerba, Felice Crocetto, Rosj Gallicchio, Fabio Volpe, Leonardo Pace, Martin Schlumberger, and Alberto Cuocolo
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18F-fluorocholine PET/CT outcome ,223radium ,bone scintigraphy ,prostate cancer ,Medicine ,Medicine (General) ,R5-920 - Abstract
Aim: To assess the value of bone scintigraphy and 18F-fluorocholine PET/computed tomography (CT) in predicting outcome in patients with prostate cancer and bone metastases treated with 223radium. Materials & methods: Retrospective analysis of 48 patients that underwent 223radium therapy. End points were pain relief and overall survival. Results: After therapy, pain relief was observed in 27 patients. Patients without pain relief had more bone lesions at PET/CT than at bone scintigraphy (pretherapy imaging mismatch). In 39 patients who completed treatment protocol, post-therapy alkaline phosphatase and pretherapy imaging mismatch were independent predictors of poor overall survival. Conclusion: Patients with more lesions at 18F-fluorocholine PET/CT than at bone scintigraphy had a poor prognosis. The combined imaging approach could be useful to predict outcome after 223radium therapy.
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- 2021
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11. Quantification of Coronary Artery Atherosclerotic Burden and Muscle Mass: Exploratory Comparison of Two Freely Available Software Programs
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Carmela Nappi, Rosario Megna, Fabio Volpe, Andrea Ponsiglione, Elisa Caiazzo, Leandra Piscopo, Ciro Gabriele Mainolfi, Emilia Vergara, Massimo Imbriaco, Michele Klain, Mario Petretta, and Alberto Cuocolo
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calcium score ,muscle area ,sarcopenia ,positron emission tomography ,Technology ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Biology (General) ,QH301-705.5 ,Physics ,QC1-999 ,Chemistry ,QD1-999 - Abstract
Coronary artery calcification and sarcopenia may have a relevant prognostic impact in oncological and non-oncological patients. The use of freeware software is promising for quantitative evaluation of these parameters after whole-body positron emission tomography (PET)/computed tomography (CT) and might be useful for one-stop shop risk stratification without additional radiation ionizing burden and further charges to health care costs. In this study, we compared two semiautomatic freeware software tools (Horos Medical Image software and LIFEx) for the assessment of coronary artery calcium (CAC) score and muscle mass in 40 patients undergoing whole-body PET/CT. The muscle areas obtained by the two software programs were comparable, showing high correlation with Lin’s concordance coefficient (0.9997; 95% confidence intervals: 0.9995–0.9999) and very good agreement with Bland–Altman analysis (mean difference = 0.41 cm2, lower limit = −1.06 cm2, upper limit = 1.89) was also found. For CAC score, Lin’s concordance correlation coefficient was 0.9976 (95% confidence intervals: 0.9965–0.9984) and in a Bland–Altman analysis an increasing mean difference from 8 to 78 by the mean values (intercept = −0.050; slope = 0.054; p < 0.001) was observed, with a slight overestimation of Horos CAC score as compared to LIFEx, likely due to a different calculation method of the CAC score, with the ROI being equal for the two software programs. Our results demonstrated that off-line analysis performed with freeware software may allow a comprehensive evaluation of the oncological patient, making available the evaluation of parameters, such as muscle mass and calcium score, that may be relevant for the staging and prognostic stratification of these patients, beside standard data obtained by PET/CT imaging. For this purpose, the Horos and LIFEx software seem to be interchangeable.
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- 2022
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12. Cardiac magnetic resonance imaging during the COVID-19 pandemic: A southern Italian single-center experience
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Andrea Ponsiglione, Carmela Nappi, Massimo Imbriaco, Raffaele Ascione, Rosario Megna, Mario Petretta, and Alberto Cuocolo
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COVID-19 ,SARS-CoV-2 ,Cardiac magnetic resonance imaging ,Southern Italy ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
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.
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- 2021
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13. Machine Learning Evaluation of Biliary Atresia Patients to Predict Long-Term Outcome after the Kasai Procedure
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Martina Caruso, Carlo Ricciardi, Gregorio Delli Paoli, Fabiola Di Dato, Leandro Donisi, Valeria Romeo, Mario Petretta, Raffaele Iorio, Giuseppe Cesarelli, Arturo Brunetti, and Simone Maurea
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artificial intelligence ,bilirubin ,ultrasound ,magnetic resonance ,shear-wave elastography ,Technology ,Biology (General) ,QH301-705.5 - Abstract
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.
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- 2021
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14. Cardiac sympathetic dysfunction in pulmonary arterial hypertension: lesson from left-sided heart failure
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Valentina Mercurio, Teresa Pellegrino, Giorgio Bosso, Giacomo Campi, Paolo Parrella, Valentina Piscopo, Carlo G. Tocchetti, Paul M. Hassoun, Mario Petretta, Alberto Cuocolo, and Domenico Bonaduce
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Diseases of the respiratory system ,RC705-779 - Abstract
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.
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- 2019
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15. Incremental Value of Sestamibi SPECT/CT Over Dual-Phase Planar Scintigraphy in Patients With Primary Hyperparathyroidism and Inconclusive Ultrasound
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Roberta Assante, Emilia Zampella, Emanuele Nicolai, Wanda Acampa, Emilia Vergara, Carmela Nappi, Valeria Gaudieri, Giovanni Fiumara, Michele Klain, Mario Petretta, and Alberto Cuocolo
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hyperparathyroidism ,ultrasound ,sestamibi ,planar imaging ,SPECT/CT ,Medicine (General) ,R5-920 - Abstract
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 sestamibi dual-phase planar scintigraphy and SPECT/CT for preoperative localization of parathyroid adenoma. Imaging findings were compared with histopathological data. Decision tree analysis was performed to evaluate the value of SPECT/CT over planar scintigraphy for classifying patients with or without hyperfunctioning parathyroid tissue. 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 decision tree 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: 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.
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- 2019
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16. Pulmonary Hypertension Phenotypes in Systemic Sclerosis: The Right Diagnosis for the Right Treatment
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Umberto Attanasio, Alessandra Cuomo, Flora Pirozzi, Stefania Loffredo, Pasquale Abete, Mario Petretta, Gianni Marone, Domenico Bonaduce, Amato De Paulis, Francesca Wanda Rossi, Carlo Gabriele Tocchetti, and Valentina Mercurio
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systemic sclerosis ,pulmonary hypertension ,pulmonary vascular disease ,pulmonary vasodilators ,risk stratification ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
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.
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- 2020
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17. Imaging techniques for assessment of coronary flow reserve
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Mario Petretta, Wanda Acampa, Emilia Zampella, Roberta Assante, Maria Piera Petretta, Renato Cuocolo, Irma Fabiani, Giuseppe Luca Della Ratta, Pasquale Perrone-Filardi, and Alberto Cuocolo
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coronary artery disease ,coronary flow reserve ,cardiovascular imaging. ,Medicine - Abstract
The assessment of coronary flow reserve (CFR) may be useful for the functional evaluation of coronary artery disease (CAD). Invasive techniques, such as intracoronary Doppler ultrasound and pressure-derived method, directly assess CFR velocity and fractional flow reserve. Positron emission tomography (PET) has emerged as an accurate noninvasive technique to quantify CFR. Nevertheless, this approach has not been applied to routine studies because of its high cost and complexity. Recently, attempts to estimate CFR with single-photon emission computed tomography (SPECT) tracers have been made in order to obtain, with noninvasive methods, data for quantitative functional assessment of CAD. This review analyzes the relative merit and limitations of CFR measurements by cardiac imaging techniques and describes the potential clinical applications.
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- 2015
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18. Prevalence and Severity of Myocardial Perfusion Imaging Abnormalities in Inmate Subjects.
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Roberta Assante, Emilia Zampella, Wanda Acampa, Carmela Nappi, Valeria Gaudieri, Nicola Frega, Davide D'Arienzo, Marianna Tuccillo, Pierpaolo Di Lorenzo, Claudio Buccelli, Mario Petretta, and Alberto Cuocolo
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Medicine ,Science - Abstract
We evaluated the prevalence and severity of myocardial perfusion abnormalities among inmates undergoing cardiac single-photon emission computed tomography. We also compared the results with those obtained in a cohort of non-inmates.Between January 2009 and December 2013, 2420 consecutive subjects (258 inmates and 2162 non-inmates) with suspected or known coronary artery disease underwent stress myocardial perfusion single-photon emission computed tomography (MPS) to our institution. The decision to submit inmates to MPS was taken by the physicians of the penal institutions or ordered by the court based on the survey of part. To account for differences in clinical characteristics between inmates and non-inmates, we created a propensity score-matched cohort considering clinical variables and stress type.Before matching, inmates were younger and had higher prevalence of male gender, smoking, chest pain, and previous myocardial infarction or revascularization (all p < 0.001). After matching, all characteristics were comparable in 258 inmates and 258 non-inmates. The total amount of abnormal myocardium was similar in inmates and non-inmates before and after matching. Infarct size and severity were larger in inmates before (p < 0.001) and after (p < 0.01) matching and left ventricular ejection fraction was lower in inmates compared to non-inmates (p < 0.01).Detention is associated with larger infarct size compared to a general population of subjects referred to stress MPS also after matching for clinical variables and stress type. The similar prevalence of normal MPS in the matched cohort suggests that this imaging technique might be appropriate in inmates.
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- 2015
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19. Regional myocardial perfusion imaging in predicting vessel-related outcome: interplay between the perfusion results and angiographic findings
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Teresa Mannarino, Adriana D’Antonio, Roberta Assante, Emilia Zampella, Valeria Gaudieri, Pietro Buongiorno, Valeria Cantoni, Roberta Green, Carmela Nappi, Emanuele Criscuolo, Roberto Bologna, Mario Petretta, Piotr Slomka, Alberto Cuocolo, Wanda Acampa, Mannarino, Teresa, D’Antonio, Adriana, Assante, Roberta, Zampella, Emilia, Gaudieri, Valeria, Buongiorno, Pietro, Cantoni, Valeria, Green, Roberta, Nappi, Carmela, Criscuolo, Emanuele, Bologna, Roberto, Petretta, Mario, Slomka, Piotr, Cuocolo, Alberto, and Acampa, Wanda
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Tomography, Emission-Computed, Single-Photon ,Perfusion ,Myocardial Perfusion Imaging ,Humans ,Reproducibility of Results ,Radiology, Nuclear Medicine and imaging ,Coronary Artery Disease ,General Medicine ,Coronary Angiography ,Regional MPI, Outcome, SPECT ,Cadmium - Abstract
Background Despite myocardial perfusion imaging (MPI) by cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) camera is largely used in the diagnosis and risk stratification of patients with suspected or known coronary artery disease (CAD), no data are available on the prognostic value of a regional MPI evaluation. We evaluated the prognostic value of regional MPI by the CZT camera in predicting clinical outcomes at the vessel level in patients with available angiographic data. Methods and results Five hundred and forty-one subjects with suspected or known CAD referred to 99mTc-sestamibi gated CZT-SPECT cardiac imaging and with available angiographic data were studied. Both regional total perfusion deficit (TPD) and ischemic TPD (ITPD) were calculated separately for each vascular territory (left anterior descending, left circumflex, and right coronary artery). The outcome end points were cardiac death, target vessel-related myocardial infarction, or late coronary revascularization. The prevalence of CAD ≥ 50%, regional stress TPD, and regional ITPD was significantly higher in vessels with events as compared to those without (both P < 0.001). The receiver operating characteristics area under the curve for regional ITPD for the identification of vessel-related events was 0.81 (95% confidence interval 0.75–0.86). An ITPD value of 2.0% provided the best trade-off for identifying the vessel-related event. At multivariable analysis, both CAD ≥ 50% and ITPD ≥ 2.0% resulted in independent predictors of events. Conclusions Regional myocardial perfusion assessed by the CZT camera demonstrated good reliability in predicting vessel-related events in patients with suspected or known CAD.
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- 2022
20. Prognostic Value of Myocardial Perfusion Imaging by Cadmium Zinc Telluride Single-photon Emission Computed Tomography in Patients with Suspected or Known Coronary Artery Disease A Systematic Review and Meta-analysis
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Roberta Assante, Emilia Zampella, Valeria Cantoni, Roberta Green, Adriana D’Antonio, Teresa Mannarino, Valeria Gaudieri, Carmela Nappi, Pietro Buongiorno, Mariarosaria Panico, Mario Petretta, Alberto Cuocolo, and Wanda Acampa
- Abstract
BackgroundAim of this study was to define the prognostic value of stress myocardial perfusion imaging by cadmium zinc telluride (CZT) single-photon emission computed tomography (SPECT) for prediction of adverse cardiovascular events in patients with known or suspected coronary artery disease (CAD).Methods and ResultsStudies published until November 2022 were identified by database search. We included studies using stress myocardial perfusion imaging by CZT-SPECT to evaluate subjects with known or suspected CAD and providing primary data of adverse cardiovascular events. Total of 12 studies were finally included recruiting 36,415 patients. Pooled hazard ratio (HR) for the occurrence of adverse events was 2.17 (95% confidence interval, CI, 1.78-2.65) and heterogeneity was 66.1% (P=0.001). Five studies reported data on adjusted HR for the occurrence of adverse events. Pooled HR was 1.69 (95% CI, 1.44-1.98) and heterogeneity was 44.9% (P=0.123). Seven studies reported data on unadjusted HR for the occurrence of adverse events. Pooled HR was 2.72 (95% CI, 2.00-3.70). Nine studies reported data useful to calculate separately the incidence rate of adverse events in patients with abnormal and normal myocardial perfusion. Pooled incidence rate ratio was 2.38 (95% CI, 1.39-4.06) and heterogeneity was 84.6% (PP=0.517). At meta-regression analysis, we found an association between HR for adverse events and presence of angina symptoms and family history of CAD.ConclusionsStress myocardial perfusion imaging by CZT-SPECT is a valuable noninvasive prognostic indicator for adverse cardiovascular events in patients with known or suspected CAD.
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- 2023
21. Time adaptive ECG driven cardiovascular disease detector.
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Muhammad Salman Haleem, Rossana Castaldo, Silvio Marcello Pagliara, Mario Petretta, Marco Salvatore, Monica Franzese, and Leandro Pecchia
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- 2021
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22. External validation and update of the J-ACCESS model in an Italian cohort of patients undergoing stress myocardial perfusion imaging
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Mario Petretta, Rosario Megna, Roberta Assante, Emilia Zampella, Carmela Nappi, Valeria Gaudieri, Teresa Mannarino, Roberta Green, Valeria Cantoni, Adriana D’Antonio, Mariarosaria Panico, Wanda Acampa, Alberto Cuocolo, Petretta, Mario, Megna, Rosario, Assante, Roberta, Zampella, Emilia, Nappi, Carmela, Gaudieri, Valeria, Mannarino, Teresa, Green, Roberta, Cantoni, Valeria, D’Antonio, Adriana, Panico, Mariarosaria, Acampa, Wanda, and Cuocolo, Alberto
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Abstract
Background Cardiovascular risk models are based on traditional risk factors and investigations such as imaging tests. External validation is important to determine reproducibility and generalizability of a prediction model. We performed an external validation of t the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) model, developed from a cohort of patients undergoing stress myocardial perfusion imaging. Methods We included 3623 patients with suspected or known coronary artery disease undergoing stress single-photon emission computer tomography (SPECT) myocardial perfusion imaging at our academic center between January 2001 and December 2019. Results In our study population, the J-ACCESS model underestimated the risk of major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and severe heart failure requiring hospitalization) within three-year follow-up. The recalibrations and updated of the model slightly improved the initial performance: C-statistics increased from 0.664 to 0.666 and Brier score decreased from 0.075 to 0.073. Hosmer–Lemeshow test indicated a logistic regression fit only for the calibration slope (P = .45) and updated model (P = .22). In the update model, the intercept, diabetes, and severity of myocardial perfusion defects categorized coefficients were comparable with J-ACCESS. Conclusion The external validation of the J-ACCESS model as well as recalibration models have a limited value for predicting of three-year major adverse cardiac events in our patients. The performance in predicting risk of the updated model resulted superimposable to the calibration slope model.
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- 2023
23. Including myocardial flow reserve by PET in prediction models: Ready to fly?
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Mario Petretta, Mariarosaria Panico, Ciro Gabriele Mainolfi, Alberto Cuocolo, Petretta, Mario, Panico, Mariarosaria, Mainolfi, Ciro Gabriele, and Cuocolo, Alberto
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Abstract
NA
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- 2023
24. Ventilation/perfusion SPECT: One more promising resource to fight the medical Hydra
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Mario Petretta, Alberto Cuocolo, Cuocolo, Alberto, and Petretta, Mario
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medicine.medical_specialty ,Resource (biology) ,business.industry ,MEDLINE ,Medicine ,Radiology, Nuclear Medicine and imaging ,Lernaean Hydra ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Ventilation/perfusion ratio - Abstract
NA
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- 2021
25. Incremental value of 18F-FDG cardiac PET imaging over dobutamine stress echocardiography in predicting myocardial ischemia in patients with suspected coronary artery disease
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Letizia Spinelli, Roberta Assante, Mario Petretta, Ciro Mainolfi, Carmela Nappi, Adriana D'Antonio, Pietro Buongiorno, Teresa Mannarino, Emilia Zampella, Wanda Acampa, Alberto Cuocolo, Mariarosaria Panico, Valeria Gaudieri, Zampella, Emilia, Assante, Roberta, Acampa, Wanda, Gaudieri, Valeria, Nappi, Carmela, Mannarino, Teresa, D’Antonio, Adriana, Buongiorno, Pietro, Panico, Mariarosaria, Mainolfi, Ciro Gabriele, Spinelli, Letizia, Petretta, Mario, and Cuocolo, Alberto
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medicine.medical_specialty ,Myocardial ischemia ,business.industry ,Dobutamine stress echocardiography ,Ischemia ,medicine.disease ,Coronary artery disease ,Cardiac PET ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Cardiac imaging - Abstract
Background. To assess the incremental value of 18F-fluorodeoxyglucose (FDG) cardiac positron emission tomography (PET) over dobutamine stress echocardiography (DSE) in predicting myocardial ischemia in patients with suspected coronary artery disease (CAD). Methods. Forty-one patients with suspected CAD underwent within 7 days apart rest-stress cardiac PET with 82Rb and DSE followed by cardiac 18F-FDG PET imaging. 18F-FDG images were scored on a 0 (no discernible uptake) to 2 (intense uptake) scale. Logistic regression analysis was performed to identify predictors of stress-induced ischemia. The incremental value of 18F-FDG PET over DSE in detecting ischemia at 82Rb PET cardiac imaging was assessed by the likelihood ratio chi-square and net reclassification index. Results. On 82Rb-PET imaging, myocardial ischemia (ischemic total perfusion defect > 5%) was detected in 20 (49%) patients. Inducible ischemia was found in 22 (54%) patients on DSE (biphasic or worsening response pattern in > 1 segment) and in 21 (51%) patients on 18FFDG PET (uptake score of 2 in ‡ 1 segment). 18F-FDG PET resulted as statistically significant predictor of ischemia on 82Rb-PET. The addition of 18F-FDG PET to DSE increased the likelihood of ischemia on 82Rb-PET (P < .05). 18F-FDG PET was able to reclassify the probability of stress-induced myocardial ischemia on both patient and vessel analyses. Conclusion. 18F-FDG PET performed after dobutamine stress test may provide incremental value to DSE in the evaluation of myocardial ischemia. These results suggest that stress induced myocardial ischemia can be imaged directly using 18F-FDG PET after dobutamine stress test.
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- 2021
26. Comparing the Prognostic Value of Stress Myocardial Perfusion Imaging by Conventional and Cadmium-Zinc Telluride Single-Photon Emission Computed Tomography through a Machine Learning Approach
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Carmela Nappi, Mario Petretta, Leandro Donisi, Teresa Mannarino, Roberta Green, Emilia Zampella, Vincenzo Sannino, Andrea Genova, Alessia Giordano, Alberto Cuocolo, Valeria Cantoni, Giuseppe Cesarelli, Valeria Gaudieri, Wanda Acampa, Giovanni De Simini, Roberta Assante, Adriana D'Antonio, Carlo Ricciardi, Cantoni, Valeria, Green, Roberta, Ricciardi, Carlo, Assante, Roberta, Donisi, Leandro, Zampella, Emilia, Cesarelli, Giuseppe, Nappi, Carmela, Sannino, Vincenzo, Gaudieri, Valeria, Mannarino, Teresa, Genova, Andrea, De Simini, Giovanni, Giordano, Alessia, D'Antonio, Adriana, Acampa, Wanda, Petretta, Mario, Cuocolo, Alberto, and D’Antonio, Adriana
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Male ,Article Subject ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Coronary Artery Disease ,Single-photon emission computed tomography ,Machine learning ,computer.software_genre ,General Biochemistry, Genetics and Molecular Biology ,Machine Learning ,Myocardial perfusion imaging ,Naive Bayes classifier ,medicine ,Humans ,Myocardial infarction ,Aged ,Tomography, Emission-Computed, Single-Photon ,Univariate analysis ,General Immunology and Microbiology ,medicine.diagnostic_test ,business.industry ,Applied Mathematics ,Myocardial Perfusion Imaging ,Computational Biology ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Random forest ,Support vector machine ,Zinc ,Modeling and Simulation ,Exercise Test ,Female ,Neural Networks, Computer ,Artificial intelligence ,Tellurium ,business ,computer ,Algorithms ,Emission computed tomography ,Research Article ,Cadmium - Abstract
We compared the prognostic value of myocardial perfusion imaging (MPI) by conventional- (C-) single-photon emission computed tomography (SPECT) and cadmium-zinc-telluride- (CZT-) SPECT in a cohort of patients with suspected or known coronary artery disease (CAD) using machine learning (ML) algorithms. A total of 453 consecutive patients underwent stress MPI by both C-SPECT and CZT-SPECT. The outcome was a composite end point of all-cause death, cardiac death, nonfatal myocardial infarction, or coronary revascularization procedures whichever occurred first. ML analysis performed through the implementation of random forest (RF) and k -nearest neighbors (KNN) 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 KNN) was greater than that of C-SPECT (88% for RF and 53% for KNN). A preliminary univariate analysis was performed through Mann-Whitney tests separately on the features of each camera in order to understand which ones could distinguish patients who will experience an adverse event from those who will not. Then, a machine learning analysis was performed by using Matlab (v. 2019b). Tree, KNN, support vector machine (SVM), Naïve Bayes, and RF were implemented twice: first, the analysis was performed on the as-is dataset; then, since the dataset was imbalanced (patients experiencing an adverse event were lower than the others), the analysis was performed again after balancing the classes through the Synthetic Minority Oversampling Technique. According to KNN and SVM with and without balancing the classes, the accuracy ( p value = 0.02 and p value = 0.01) and recall ( p value = 0.001 and p value = 0.03) of the CZT-SPECT were greater than those obtained by C-SPECT in a statistically significant way. ML approach showed that although the prognostic value of stress MPI by C-SPECT and CZT-SPECT is comparable, CZT-SPECT seems to have higher accuracy and recall.
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- 2021
27. Simultaneous assessment of myocardial perfusion and adrenergic innervation in patients with heart failure by low-dose dual-isotope CZT SPECT imaging
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Roberta Assante, Adriana D’Antonio, Teresa Mannarino, Carmela Nappi, Valeria Gaudieri, Emilia Zampella, Pietro Buongiorno, Valeria Cantoni, Roberta Green, Nicola Frega, Hein J. Verberne, Mario Petretta, Alberto Cuocolo, Wanda Acampa, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, Assante, Roberta, D’Antonio, Adriana, Mannarino, Teresa, Nappi, Carmela, Gaudieri, Valeria, Zampella, Emilia, Buongiorno, Pietro, Cantoni, Valeria, Green, Roberta, Frega, Nicola, Verberne, Hein J., Petretta, Mario, Cuocolo, Alberto, and Acampa, Wanda
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Perfusion agents ,Innervation tracers ,SPECT ,Radiology, Nuclear Medicine and imaging ,Heart failure ,Cardiology and Cardiovascular Medicine ,Heart failure, Innervation tracers, Perfusion agents, SPECT - Abstract
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.
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- 2022
28. Prediction of outcome by 82Rb PET/CT in patients with ischemia and nonobstructive coronary arteries
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Emilia Zampella, Teresa Mannarino, Adriana D’Antonio, Roberta Assante, Valeria Gaudieri, Pietro Buongiorno, Mariarosaria Panico, Valeria Cantoni, Roberta Green, Carmela Nappi, Parthiban Arumugam, Mario Petretta, Alberto Cuocolo, Wanda Acampa, Zampella, Emilia, Mannarino, Teresa, D’Antonio, Adriana, Assante, Roberta, Gaudieri, Valeria, Buongiorno, Pietro, Panico, Mariarosaria, Cantoni, Valeria, Green, Roberta, Nappi, Carmela, Arumugam, Parthiban, Petretta, Mario, Cuocolo, Alberto, and Acampa, Wanda
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Abstract
Background. The purpose of this study was to assess the prognostic value of cardiac 82Rb positron emission tomography (PET)/computed tomography (CT) imaging in patients with myocardial ischemia of nonobstructive coronary arteries (INOCA). Methods. We retrospectively evaluated 311 INOCA patients who underwent rest stress 82Rb PET/CT. Cardiac end points were cardiac death, myocardial infarction, or late coronary revascularization. A parametric survival model was also used to identify how the variables influenced time to event. Results. During a median follow-up of 37 months (range 6–108), 23 (7%) cardiac events occurred. In patients with events total perfusion defect (TPD) was higher and myocardial flow reserve (MFR) lower compared to those without events (both P < .001). At multivariable Cox analysis, increased TPD (i.e., ‡ 5%) and reduced MFR (i.e., < 2) were predictors of events (both P < .001). At Weibull survival analysis, the highest probability of cardiac events and risk acceleration were observed in patients with both increased TPD and reduced MFR. Annualized event rate was higher in patients with reduced MFR compared to those with preserved MFR (P < .001). Conclusion. In patients with INOCA, the combined evaluation of myocardial perfusion and coronary vascular function by 82Rb PET/CT is able to identify those at higher risk of cardiac events.
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- 2022
29. Prostate Volume Estimation on MRI: Accuracy and Effects of Ellipsoid and Bullet-Shaped Measurements on PSA Density
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Arnaldo Stanzione, Stefano Giusto Picchi, Martina Di Stasi, Gianluca Armando Di Fiore, Massimo Imbriaco, Andrea Ponsiglione, Mario Petretta, Renato Cuocolo, Francesco Verde, Stanzione, Arnaldo, Ponsiglione, Andrea, Di Fiore, Gianluca Armando, Picchi, Stefano Giusto, Di Stasi, Martina, Verde, Francesco, Petretta, Mario, Imbriaco, Massimo, and Cuocolo, Renato
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Male ,Prostate biopsy ,Magnetic Resonance Imaging, Prostate volume, Prostate specific antigen density, Bullet-shaped formula, Prostate cancer ,Intraclass correlation ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Prostate ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Retrospective Studies ,Reproducibility ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Prostatic Neoplasms ,Reproducibility of Results ,Magnetic resonance imaging ,Prostate-Specific Antigen ,Magnetic Resonance Imaging ,Bonferroni correction ,medicine.anatomical_structure ,Concordance correlation coefficient ,ROC Curve ,030220 oncology & carcinogenesis ,symbols ,business ,Nuclear medicine - Abstract
Rationale and Objectives PSA density (PSAd), an important decision-making parameter for patients with suspected prostate cancer (PCa), is dependent on magnetic resonance imaging prostate volume (PV) estimation. We aimed to compare the accuracy of the ellipsoid and bullet-shaped formulas with manual whole-gland segmentation as reference standard and to evaluate the corresponding PSAd diagnostic accuracy in predicting clinically significant PCa. Materials and Methods We retrospectively analysed 195 patients with suspected PCa who underwent magnetic resonance imaging and prostate biopsy. Patients with PCa were categorized according to ISUP score. PV and corresponding PSAd were calculated with manual segmentation (mPV and mPSAd) as well as with ellipsoid (ePV and ePSAd) and bullet-shaped (bPV and bPSAd) formulas. Inter and intra-reader reproducibility were assessed with Lin's concordance correlation coefficient and the intraclass correlation coefficient (ICC). A 2-way analysis of variance with post-hoc Bonferroni test was used for assessing PV differences. Predictive values of PSAd calculated with different methods for detecting clinically significant PCa were evaluated by receiver operating characteristic curve analysis and Youden's index. Results Both intra (ρ = 0.99, ICC = 0.99) and inter-reader (ρ = 0.98, ICC = 0.98) reproducibility were excellent. No significant difference was found between ePV and reference standard (p = 1.00). bPV was significantly different from both (p = 0.00). PSAd (mPSAd/ePSAd cut-off ≥ 0.15, bPSAd cut-off ≥ 0.12) had sensitivity = 69–70%, specificity = 72–75%, areas under the curve = 0.757–0.760 (p = 0.70–0.88). Conclusions Our work shows that when using bullet-shaped formula, a different PSAd cut-off must be considered to avoid PCa under-diagnosis and inaccurate risk-stratification.
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- 2021
30. Ablation rate after radioactive iodine therapy in patients with differentiated thyroid cancer at intermediate or high risk of recurrence: a systematic review and a meta-analysis
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Martin Schlumberger, Michele Klain, Emilia Zampella, Mario Petretta, Mariarosaria Manganelli, Fabio Volpe, Alberto Cuocolo, Carmela Nappi, Elisa Caiazzo, Valeria Cantoni, Roberta Green, Leandra Piscopo, Klain, Michele, Nappi, Carmela, Zampella, Emilia, Cantoni, Valeria, Green, Roberta, Piscopo, Leandra, Volpe, Fabio, Manganelli, Mariarosaria, Caiazzo, Elisa, Petretta, Mario, Schlumberger, Martin, and Cuocolo, Alberto
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,030209 endocrinology & metabolism ,131I ,Adenocarcinoma ,Iodine Radioisotopes ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Recurrent disease ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Thyroid Neoplasms ,030212 general & internal medicine ,education ,Thyroid cancer ,Retrospective Studies ,education.field_of_study ,High risk ,business.industry ,Intermediate risk ,General Medicine ,Differentiated thyroid cancer ,Ablation ,medicine.disease ,Meta-analysis ,Orthopedic surgery ,Thyroidectomy ,Original Article ,Radioactive iodine therapy ,Neoplasm Recurrence, Local ,business - Abstract
Purpose We performed a systematic review and a meta-analysis to investigate the successful ablation rate after radioiodine (RAI) administration in patients with differentiated thyroid cancer (DTC) at intermediate-high risk of recurrence. Methods A comprehensive literature search of the PubMed, Scopus, and Web of Science databases was conducted according to the PRISMA statement. Results The final analysis included 9 studies accounting for 3103 patients at intermediate-high risk of recurrence. In these patients, the successful ablation rates ranged from 51 to 94% with a 71% pooled successful ablation and were higher in intermediate (72%) than in high (52%)-risk patients. Despite the rigorous inclusion standards, a significant heterogeneity among the evaluated studies was observed. Higher administered RAI activities are associated with a lower successful ablation rate in the whole population and in the subgroup of high-risk patients. Furthermore, pooled recurrence rate in intermediate-risk patients achieving successful ablation was only 2% during the subsequent 6.4-year follow-up while the pooled recurrence rate was 14% in patients who did not achieve a successful ablation. Conclusion In a large sample of 3103 patients at intermediate-high risk of persistent/recurrent disease, 71% of patients achieved a successful ablation. In these intermediate-risk patients, the probability of subsequent recurrence is low and most recurrence occurred in those with already abnormal findings at the first control.
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- 2021
31. Imaging prediction with ultrasound and MRI of long-term medical outcome in native liver survivor patients with biliary atresia after kasai portoenterostomy: a pilot study
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Fabiola Di Dato, Arturo Brunetti, Raffaele Iorio, Simone Maurea, Raffaele Liuzzi, Gianfranco Vallone, Valeria Romeo, Carmine Mollica, Pier Paolo Mainenti, Martina Caruso, Mario Petretta, Caruso, Martina, Di Dato, Fabiola, Mollica, Carmine, Vallone, Gianfranco, Romeo, Valeria, Liuzzi, Raffaele, Mainenti, Pier Paolo, Petretta, Mario, Iorio, Raffaele, Brunetti, Arturo, and Maurea, Simone
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medicine.medical_specialty ,Abdominal ultrasound ,Urology ,Portoenterostomy, Hepatic ,Pilot Projects ,Mri studies ,Chronic liver disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Magnetic resonance imaging ,0302 clinical medicine ,Hepatic ,Biliary atresia ,Internal medicine ,Ultrasound ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Survivors ,Retrospective Studies ,Kasai portoenterostomy ,Long-term medical outcome prediction ,Infant ,Liver ,Magnetic Resonance Imaging ,Treatment Outcome ,Biliary Atresia ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Portoenterostomy ,Hepatology ,medicine.disease ,030220 oncology & carcinogenesis ,Radiology ,business ,Clinical progression - Abstract
To comparatively assess the role of abdominal ultrasound (US) and magnetic resonance imaging (MRI) in predicting long-term medical outcome in native liver survivor patients with biliary atresia (BA) after Kasai portoenterostomy (KP). Twenty-four retrospectively enrolled patients were divided in two groups according to clinical and laboratory data at initial evaluation after KP (median follow-up = 9.7 years; range = 5–25 years) as with ideal (Group 1; n = 15) or non-ideal (Group 2; n = 9) medical outcome. All patients were re-evaluated for a period of additional 4 years using clinical and laboratory indices. US and MRI studies were qualitatively analyzed assessing imaging signs suggestive of chronic liver disease (CLD). At re-evaluation, 6 patients (40%) of Group 1 changed their medical outcome in non-ideal (Group 1A); the other 9 patients (60%) remained stable (Group 1B); the mean time to change the medical outcome in non-ideal status at re-evaluation was 43.5 ± 2.3 months. The area under the ROC curve was 0.84 and 0.87 for US and MRI scores to predict long-term medical outcome with the best cut-off value score > 4 for both modalities (p = 0.89). In Group 2, 6 (67%) patients showed a clinical progression (Group 2A) with a mean time of 39.8 ± 3.8 months; in the other 3 (33%) patients, no clinical progression was observed (Group 2B). In BA patients with ideal medical outcome after KP, US and MRI may both predict long-term outcome. US, non-invasive and widely available technique, should be preferred.
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- 2021
32. A machine learning-based approach to directly compare the diagnostic accuracy of myocardial perfusion imaging by conventional and cadmium-zinc telluride SPECT
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Giovanni De Simini, Mario Petretta, Wanda Acampa, Valeria Cantoni, Roberta Green, Roberta Assante, Teresa Mannarino, Carmela Nappi, Emilia Zampella, Andrea Genova, Alessia Giordano, Adriana D'Antonio, Carlo Ricciardi, Alberto Cuocolo, Valeria Gaudieri, Cantoni, Valeria, Green, Roberta, Ricciardi, Carlo, Assante, Roberta, Zampella, Emilia, Nappi, Carmela, Gaudieri, Valeria, Mannarino, Teresa, Genova, Andrea, De Simini, Giovanni, Giordano, Alessia, D’Antonio, Adriana, Acampa, Wanda, Petretta, Mario, and Cuocolo, Alberto
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Population ,Diagnostic accuracy ,CAD ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Machine learning ,computer.software_genre ,030218 nuclear medicine & medical imaging ,Machine Learning ,03 medical and health sciences ,Myocardial perfusion imaging ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Sensitivity (control systems) ,education ,Tomography, Emission-Computed, Single-Photon ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,Cadmium zinc telluride ,Zinc ,chemistry ,Known Coronary Artery Disease ,Artificial intelligence ,Tellurium ,Cardiology and Cardiovascular Medicine ,business ,computer ,Emission computed tomography ,Cadmium - Abstract
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.
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- 2022
33. Correction to: Relation between myocardial blood flow and cardiac events in diabetic patients with suspected coronary artery disease and normal myocardial perfusion imaging
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Mario Petretta, Parthiban Arumugam, Alberto Cuocolo, Wanda Acampa, Roberta Assante, Valeria Gaudieri, Carmela Nappi, Ciro Mainolfi, Teresa Mannarino, Emilia Zampella, Adriana D'Antonio, Assante, Roberta, Mainolfi, Ciro Gabriele, Zampella, Emilia, Gaudieri, Valeria, Nappi, Carmela, Mannarino, Teresa, D'Antonio, Adriana, Arumugam, Parthiban, Petretta, Mario, Cuocolo, Alberto, and Acampa, Wanda
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Blood flow ,medicine.disease ,Stress imaging ,Coronary artery disease ,Myocardial perfusion imaging ,Diabetes mellitus ,Internal medicine ,Cardiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Coronary vasodilator ,Cardiology and Cardiovascular Medicine ,business ,Perfusion - Abstract
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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- 2022
34. External validation of the CRAX2MACE model in an Italian cohort of patients with suspected coronary artery disease undergoing stress myocardial perfusion imaging
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Adriana D'Antonio, Teresa Mannarino, Wanda Acampa, Pietro Buongiorno, Roberta Assante, Rosario Megna, Roberta Green, Mario Petretta, Carmela Nappi, Alberto Cuocolo, Valeria Cantoni, Valeria Gaudieri, Emilia Zampella, Megna, Rosario, Petretta, Mario, Assante, Roberta, Zampella, Emilia, Nappi, Carmela, Gaudieri, Valeria, Mannarino, Teresa, Green, Roberta, Cantoni, Valeria, Buongiorno, Pietro, D’Antonio, Adriana, Acampa, Wanda, and Cuocolo, Alberto
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medicine.medical_specialty ,medicine.diagnostic_test ,Receiver operating characteristic ,business.industry ,Context (language use) ,medicine.disease ,Coronary artery disease ,Myocardial perfusion imaging ,Brier score ,Internal medicine ,Cohort ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,CAD, SPECT, MPI, Diagnostic and prognostic application ,Mace - Abstract
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.
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- 2022
35. Nuclear cardiac imaging between implementation and globalization: The key role of integration
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Alberto Cuocolo, Carmela Nappi, Mario Petretta, Wanda Acampa, Cuocolo, Alberto, Nappi, Carmela, Acampa, Wanda, and Petretta, Mario
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Tomography, Emission-Computed, Single-Photon ,2019-20 coronavirus outbreak ,Internationality ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Computed Tomography Angiography ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Physical Distancing ,Cardiology ,COVID-19 ,Coronary Artery Disease ,Data science ,Globalization ,Positron-Emission Tomography ,Key (cryptography) ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Nuclear Medicine ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care ,Cardiac imaging ,Editor's Page ,Societies, Medical - Abstract
NA
- Published
- 2021
36. Effects of the COVID-19 pandemic on myocardial perfusion imaging for ischemic heart disease
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Mario Petretta, Roberta Green, Teresa Mannarino, Alberto Cuocolo, Roberta Assante, Valeria Gaudieri, Wanda Acampa, Rosario Megna, Carmela Nappi, Emilia Zampella, Valeria Cantoni, Nappi, Carmela, Megna, Rosario, Acampa, Wanda, Assante, Roberta, Zampella, Emilia, Gaudieri, Valeria, Mannarino, Teresa, Green, Roberta, Cantoni, Valeria, Petretta, Mario, and Cuocolo, Alberto
- Subjects
Male ,medicine.medical_specialty ,Multivariate analysis ,Ischemic heart disease ,Ischemia ,Myocardial Ischemia ,Disease ,Single-photon emission computed tomography ,SPECT-MPI ,Myocardial perfusion imaging ,Internal medicine ,Pandemic ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,SARS-CoV-2 ,Myocardial Perfusion Imaging ,COVID-19 ,General Medicine ,Middle Aged ,medicine.disease ,Italy ,Radiology Nuclear Medicine and imaging ,Orthopedic surgery ,Quarantine ,Cardiology ,Original Article ,Female ,Southern Italy ,Emission computed tomography - Abstract
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.
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- 2020
37. FDG-PET/CT imaging during the Covid-19 emergency: a southern Italian perspective
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Alberto Cuocolo, Silvana Del Vecchio, Ciro Mainolfi, Alessandra Annunziata, Mario Petretta, Ludovica Attanasio, Claudia Bombace, Simone Maurea, Maurea, Simone, Mainolfi, Ciro Gabriele, Bombace, Claudia, Annunziata, Alessandra, Attanasio, Ludovica, Petretta, Mario, Del Vecchio, Silvana, and Cuocolo, Alberto
- Subjects
medicine.medical_specialty ,Fluorine Radioisotopes ,Coronavirus disease 2019 (COVID-19) ,Thymoma ,Pneumonia, Viral ,Standardized uptake value ,030218 nuclear medicine & medical imaging ,Imaging ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,Pandemic ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Laryngeal Neoplasms ,Pandemics ,Retrospective Studies ,Fluorodeoxyglucose ,business.industry ,SARS-CoV-2 ,Carcinoma ,COVID-19 ,Retrospective cohort study ,General Medicine ,medicine.disease ,FDG-PET/CT ,Pneumonia ,Italy ,Radiology Nuclear Medicine and imaging ,030220 oncology & carcinogenesis ,Ct technique ,Fdg pet ct ,Original Article ,Radiology ,Southern Italy ,Radiopharmaceuticals ,business ,Coronavirus Infections ,Procedures and Techniques Utilization ,medicine.drug - Abstract
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.
- Published
- 2020
38. Quantification of myocardial perfusion reserve by CZT-SPECT: A head to head comparison with 82Rubidium PET imaging
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Adriana D'Antonio, Giovanni De Simini, Ciro Mainolfi, Emilia Zampella, Teresa Mannarino, Roberta Assante, Carmela Nappi, Alberto Cuocolo, Andrea Genova, Wanda Acampa, Valeria Gaudieri, Pietro Buongiorno, Mario Petretta, Acampa, Wanda, Zampella, Emilia, Assante, Roberta, Genova, Andrea, De Simini, Giovanni, Mannarino, Teresa, D'Antonio, Adriana, Gaudieri, Valeria, Nappi, Carmela, Buongiorno, Pietro, Mainolfi, Ciro Gabriele, Petretta, Mario, and Cuocolo, Alberto
- Subjects
Coronary angiography ,business.industry ,Head to head ,Area under the curve ,Diagnostic and prognostic application ,Pet imaging ,Blood flow ,030204 cardiovascular system & hematology ,Perfusion reserve ,Myocardial blood flow ,030218 nuclear medicine & medical imaging ,Patient management ,03 medical and health sciences ,PET ,0302 clinical medicine ,SPECT ,Medicine ,CAD ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Cardiac imaging - Abstract
BACKGROUND: We measured myocardial blood flow (MBF) and perfusion reserve (MPR) by dynamic CZT-SPECT and 82Rb-PET in patients with suspected or known coronary artery disease (CAD) and compared the accuracy of the two methods in predicting obstructive CAD. METHODS: Twenty-five patients with available coronary angiography data underwent 99mTc-sestamibi CZT-SPECT and 82Rb-PET cardiac imaging. Stress and rest MBF and MPR were calculated by both methods and compared. Diagnostic accuracies of CZT-SPECT and PET were also assessed using a receiver-operator-characteristic curve. RESULTS: CZT-SPECT yielded similar baseline MBF, but higher hyperemic MBF and MPR values compared to PET. There was a modest correlation between the two methods for MPR (r = 0.56, P < .01). MPR by CZT-SPECT showed a good ability in identify a reduced MPR by PET, with an area under the curve of 0.85. A MPR cut-off of 2.5 was identified by CZT-SPECT for detection of abnormal MPR by PET, with a sensitivity, specificity and accuracy of 86%, 73% and 80%. The area under the curve for the identification of obstructive CAD by regional MPR were 0.83 for CZT-SPECT and 0.84 for PET (P = .90). At CZT-SPECT, a regional MPR of 2.1 provided the best trade-off between sensitivity and specificity for identifying obstructive CAD. Diagnostic accuracy of CZT-SPECT and PET using respective cut-off values was comparable (P = .62). CONCLUSION: Hyperemic MBF and MPR values obtained by CZT-SPECT are higher than those measured by 82Rb-PET imaging, with a moderate correlation between the two methods. CZT-SPECT shows good diagnostic accuracy for the identification of obstructive CAD. These findings may encourage the use of this new technique to a better risk stratification and patient management.
- Published
- 2020
39. What Is the Cardiac Impact of Chemotherapy and Subsequent Radiotherapy in Lymphoma Patients?
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Gianni Marone, Domenico Bonaduce, Gilda Varricchi, Giacomo Campi, Carlo G. Tocchetti, Deasy Ciervo, Alessandra Cuomo, Roberta Della Pepa, Marco Picardi, Pasquale Abete, Mario Petretta, Paolo Parrella, Riccardo Franco, Flora Pirozzi, Laura Cella, Roberto Pacelli, Valentina Mercurio, Mercurio, Valentina, Cuomo, Alessandra, Della Pepa, Roberta, Ciervo, Deasy, Cella, Laura, Pirozzi, Flora, Parrella, Paolo, Campi, Giacomo, Franco, Riccardo, Varricchi, Gilda, Abete, Pasquale, Marone, Gianni, Petretta, Mario, Bonaduce, Domenico, Pacelli, Roberto, Picardi, Marco, and Tocchetti, Carlo Gabriele
- Subjects
Adult ,Male ,0301 basic medicine ,Cardiac function curve ,Oncology ,medicine.medical_specialty ,Heart Diseases ,Lymphoma ,Anthracycline ,Physiology ,medicine.medical_treatment ,Clinical Biochemistry ,Population ,Antineoplastic Agents ,Biochemistry ,Young Adult ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Anthracyclines ,Prospective Studies ,education ,Molecular Biology ,Aged ,General Environmental Science ,Aged, 80 and over ,Cardiotoxicity ,education.field_of_study ,Chemotherapy ,Antibiotics, Antineoplastic ,Ejection fraction ,030102 biochemistry & molecular biology ,business.industry ,Cell Biology ,Middle Aged ,medicine.disease ,Radiation therapy ,030104 developmental biology ,Doxorubicin ,Echocardiography ,General Earth and Planetary Sciences ,Female ,business - Abstract
Anthracyclines are widely used in anticancer protocols, but can induce cardiotoxicity by mechanisms that mainly involve oxidative damage and mitochondrial dysfunction. Radiotherapy can also impair cardiac function by promoting myocardial fibrosis, microvascular damage and decreased density of myocardial capillaries. Hence, we aim at investigating prospectively whether radiotherapy impacts heart function in lymphoma patients who had been already treated with anthracyclines. Twenty-nine consecutive patients with Hodgkin or non-Hodgkin lymphomas underwent echocardiography at baseline (before antineoplastic treatments), and then every two months, until 6 months after treatments completion. Echo evaluation included standard 2D and Speckle Tracking. Twenty-two patients treated with anthracycline-based regimens were eligible. Out of the 22 patients, 8 received chemotherapy only (subgroup 1), while 14 underwent radiotherapy after chemotherapy (subgroup 2). At the end of chemotherapy, ejection fraction was significantly reduced in the whole population. At 6 months after completion of therapies, E/E' increased and Global Longitudinal Strain was compromised in subgroup 2, suggesting additional damage induced by radiotherapy after chemotherapy. On the basis of the data from our small prospective study we can hypothesize that in lymphoma patients anthracyclines can worsen cardiac function, and radiotherapy may have an additional unfavorable myocardial impact.
- Published
- 2019
40. A Comparison among Different Machine Learning Pretest Approaches to Predict Stress-Induced Ischemia at PET/CT Myocardial Perfusion Imaging
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Alberto Cuocolo, Valeria Gaudieri, Adriana D'Antonio, Carmela Nappi, Parthiban Arumugam, Roberta Green, Rosario Megna, Roberta Assante, Teresa Mannarino, Emilia Zampella, Wanda Acampa, Mario Petretta, Valeria Cantoni, Megna, Rosario, Petretta, Mario, Assante, Roberta, Zampella, Emilia, Nappi, Carmela, Gaudieri, Valeria, Mannarino, Teresa, D’Antonio, Adriana, Green, Roberta, Cantoni, Valeria, Arumugam, Parthiban, Acampa, Wanda, and Cuocolo, Alberto
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Male ,Support Vector Machine ,Article Subject ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Myocardial Ischemia ,Coronary Artery Disease ,Machine learning ,computer.software_genre ,General Biochemistry, Genetics and Molecular Biology ,Cohort Studies ,Machine Learning ,Myocardial perfusion imaging ,Naive Bayes classifier ,Predictive Value of Tests ,Positron Emission Tomography Computed Tomography ,medicine ,Humans ,AdaBoost ,Aged ,PET-CT ,General Immunology and Microbiology ,medicine.diagnostic_test ,business.industry ,Applied Mathematics ,Decision Trees ,Myocardial Perfusion Imaging ,Computational Biology ,Bayes Theorem ,General Medicine ,Gold standard (test) ,Middle Aged ,Random forest ,Pre- and post-test probability ,Logistic Models ,Positron emission tomography ,Modeling and Simulation ,Exercise Test ,Female ,Artificial intelligence ,business ,computer ,Algorithms ,Research Article - Abstract
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.
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- 2021
41. Risk of primary breast cancer in patients with differentiated thyroid cancer undergoing radioactive iodine therapy: a systematic review and meta-analysis
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Mario Petretta, Fabio Volpe, Simone Maurea, Michele Klain, Roberta Green, Leandra Piscopo, Alberto Cuocolo, Carmela Nappi, Valeria Cantoni, Nappi, Carmela, Klain, Michele, Cantoni, Valeria, Green, Roberta, Piscopo, Leandra, Volpe, Fabio, Maurea, Simone, Petretta, Mario, and Cuocolo, Alberto
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,Breast Neoplasms ,Neoplasms, Second Primary ,General Medicine ,Adenocarcinoma ,medicine.disease ,Malignancy ,Confidence interval ,Iodine Radioisotopes ,Breast cancer ,hemic and lymphatic diseases ,Relative risk ,Internal medicine ,Meta-analysis ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Female ,Thyroid Neoplasms ,business ,Primary breast cancer ,Thyroid cancer - Abstract
Purpose: Although it has been proven that radioactive iodine (RAI) treatment is an effective and well-tolerated procedure in patients with differentiated thyroid cancer (DTC), there is still some concern regarding the risk of developing a second primary malignancy after RAI administration. We performed a systematic review and meta-analysis to investigate the risk of primary breast cancer in patients with DTC undergoing RAI therapy. Methods: A comprehensive literature search of the PubMed, Scopus, and Web of Science databases was conducted according to the PRISMA statement. Results: The final analysis included 14 studies accounting for a total of 200,247 patients with DTC (98,368 treated with RAI and 101,879 not treated with RAI). The relative risk of primary breast cancer in patients with DTC treated with RAI to those not treated with RAI among studies ranged from 0.45 to 2.55, the pooled relative risk was 0.83 (95% confidence interval, 0.70–0.99), and the heterogeneity was 71.5%. Conclusion: The present meta-analysis indicates that patients with DTC treated with RAI do not have a higher risk of primary breast cancer compared to those not treated with RAI. These findings suggest that RAI therapy does not increase the risk of breast cancer.
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- 2021
42. Impact of COVID-19 infection on short-term outcome in patients referred to stress myocardial perfusion imaging
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Elisa Caiazzo, Ciro Mainolfi, Valeria Cantoni, Emanuele Criscuolo, Wanda Acampa, Teresa Mannarino, Carmela Nappi, Roberta Assante, Roberta Green, Mario Petretta, Roberto Bologna, Emilia Zampella, Giulia Zumbo, Alberto Cuocolo, Adriana D'Antonio, Valeria Gaudieri, Assante, Roberta, D’Antonio, Adriana, Mannarino, Teresa, Gaudieri, Valeria, Zampella, Emilia, Mainolfi, Ciro Gabriele, Cantoni, Valeria, Green, Roberta, Caiazzo, Elisa, Nappi, Carmela, Criscuolo, Emanuele, Bologna, Roberto, Zumbo, Giulia, Petretta, Mario, Cuocolo, Alberto, and Acampa, Wanda
- Subjects
Tomography, Emission-Computed, Single-Photon ,medicine.medical_specialty ,Myocardial ischemia ,medicine.diagnostic_test ,Coronavirus disease 2019 (COVID-19) ,Myocardial perfusion imaging ,business.industry ,Coronary Artery Disease ,General Medicine ,Prognosis ,Median time ,Internal medicine ,Orthopedic surgery ,Exercise Test ,Cardiology ,Humans ,Medicine ,Original Article ,Radiology, Nuclear Medicine and imaging ,In patient ,Covid-19 ,business ,Perfusion ,Emission computed tomography - Abstract
Purpose We assessed the impact of COVID-19 infection on cardiovascular events in patients with suspected or known coronary artery disease (CAD) referred to stress myocardial perfusion single-photon emission computed tomography (MPS). Methods A total of 950 consecutive patients with suspected or known CAD were submitted by referring physicians to stress MPS for assessment of myocardial ischemia between January 2018 and June 2019. All patients underwent stress-optional rest MPS. Perfusion defects were quantitated as % of LV myocardium and expressed as total perfusion defect (TPD), representing the defect extent and severity. A TPD ≥ 5% was considered abnormal. Results During a mean follow-up of 27 months (range 4–38) 31 events occurred. Moreover, 55 (6%) patients had a COVID-19 infection. The median time from index MPS to COVID-19 infection was 16 months (range 6–24). At Cox multivariable analysis, abnormal MPS and COVID-19 infection resulted as independent predictors of events. There were no significant differences in annualized event rate in COVID-19 patients with or without abnormal MPS (p = 0.56). Differently, in patients without COVID-19 the presence of abnormal MPS was associated with higher event rate (p
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- 2021
43. Incremental value of
- Author
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Emilia, Zampella, Roberta, Assante, Wanda, Acampa, Valeria, Gaudieri, Carmela, Nappi, Teresa, Mannarino, Adriana, D'Antonio, Pietro, Buongiorno, Mariarosaria, Panico, Ciro Gabriele, Mainolfi, Letizia, Spinelli, Mario, Petretta, and Alberto, Cuocolo
- Abstract
To assess the incremental value ofForty-one patients with suspected CAD underwent within 7 days apart rest-stress cardiac PET withOn
- Published
- 2021
44. Effect of changes in perfusion defect size during serial stress myocardial perfusion imaging on cardiovascular outcomes in patients treated with primary percutaneous coronary intervention after myocardial infarction
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Ciro Mainolfi, Francesco Giallauria, Adriana D'Antonio, Alberto Cuocolo, Teresa Mannarino, Valeria Gaudieri, Valeria Cantoni, Carmela Nappi, Andrea Genova, Roberta Green, Wanda Acampa, Mario Petretta, Emilia Zampella, Roberta Assante, Zampella, Emilia, Mannarino, Teresa, Gaudieri, Valeria, D’Antonio, Adriana, Giallauria, Francesco, Assante, Roberta, Cantoni, Valeria, Green, Roberta, Mainolfi, Ciro Gabriele, Nappi, Carmela, Genova, Andrea, Petretta, Mario, Cuocolo, Alberto, and Acampa, Wanda
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Revascularization ,Myocardial perfusion imaging ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Myocardial infarction ,medicine.diagnostic_test ,business.industry ,Unstable angina ,Myocardial Perfusion Imaging ,food and beverages ,Percutaneous coronary intervention ,Heart ,medicine.disease ,Perfusion ,Heart failure ,Conventional PCI ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background. We evaluated the prognostic value of changes in perfusion defect size (PDS) on serial MPS in patients treated with primary percutaneous coronary intervention (PCI) after acute myocardial infarction (AMI). Methods. We enrolled 112 patients treated with primary PCI after AMI who underwent two stress MPS within 1 month and after 6 months. Improvement in PDS was defined as a reduction ‡5%. Remodeling was defined as an increase in left ventricular (LV) end-diastolic volume index ‡20%. Cardiac events included cardiac death, nonfatal MI, unstable angina, repeated revascularization, and heart failure. Results. During a median follow-up of 86 months, 22 events occurred. Event rate was higher (P < .01) in patients with worsening of PDS compared to those with unchanged or improved PDS. Moreover, patients with remodeling had a higher (P < .001) event rate compared to those without. At Cox analysis, worsening of PDS and remodeling resulted independent predictors of events (both P < .01). Patients with both worsening of PDS and remodeling had the worst event-free survival (P
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- 2021
45. Machine learning analysis: general features, requirements and cardiovascular applications
- Author
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Carlo Ricciardi, Mario Cesarelli, Rosario Megna, Mario Petretta, Renato Cuocolo, Ricciardi, Carlo, Cuocolo, Renato, Megna, Rosario, Cesarelli, Mario, and Petretta, Mario
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Structure (mathematical logic) ,Focus (computing) ,Technology ,Standardization ,Process (engineering) ,business.industry ,Emerging technologies ,Computer science ,Deep learning ,MEDLINE ,Machine learning ,computer.software_genre ,Machine Learning ,Software deployment ,Artificial Intelligence ,Humans ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business ,computer - Abstract
Artificial intelligence represents the science which will probably change the future of medicine by solving actually challenging issues. In this special article, the general features of machine learning are discussed. First, a background explanation regarding the division of artificial intelligence, machine learning and deep learning is given and a focus on the structure of machine learning subgroups is shown. The traditional process of a machine learning analysis is described, starting from the collection of data, across features engineering, modelling and till the validation and deployment phase. Due to the several applications of machine learning performed in literature in the last decades and the lack of some guidelines, the need of a standardization for reporting machine learning analysis results emerged. Some possible standards for reporting machine learning results are identified and discussed deeply; these are related to study population (number of subjects), repeatability of the analysis, validation, results, comparison with current practice. The way to the use of machine learning in clinical practice is open and the hope is that, with emerging technology and advanced digital and computational tools, available from hospitalization and subsequently after discharge, it will also be possible, with the help of increasingly powerful hardware, to build assistance strategies useful in clinical practice.
- Published
- 2021
46. PET and SPECT Specialty Grand Challenge. When Knowledge Travels at the Speed of Light, Photons Take to the Field
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Alberto Cuocolo and Mario Petretta
- Subjects
Photon ,Optics ,Field (physics) ,business.industry ,Computer science ,Risk stratification ,business ,Speed of light (cellular automaton) - Published
- 2021
47. New Drugs, Therapeutic Strategies, and Future Direction for the Treatment of Pulmonary Arterial Hypertension
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Domenico Bonaduce, Mario Petretta, Giacomo Campi, Angela Mancini, Valentina Mercurio, Paul M. Hassoun, Anna Bianco, Alessandra Cuomo, Nermin Diab, Paolo Parrella, Mercurio, Valentina, Bianco, Anna, Campi, Giacomo, Cuomo, Alessandra, Diab, Nermin, Mancini, Angela, Parrella, Paolo, Petretta, Mario, Hassoun, Paul, and Bonaduce, Domenico
- Subjects
Endothelin Receptor Antagonists ,soluble guanylate cyclase ,0301 basic medicine ,Combination therapy ,Hypertension, Pulmonary ,Genetic enhancement ,030204 cardiovascular system & hematology ,Selexipag ,Pharmacology ,Biochemistry ,Riociguat ,pulmonary arterial denervation ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Drug Discovery ,Animals ,Humans ,Medicine ,prostanoid ,initial combination therapy ,Macitentan ,Pulmonary Hypertension ,business.industry ,Organic Chemistry ,Genetic Therapy ,Phosphodiesterase 5 Inhibitors ,gene therapy ,immunity ,serotonin ,030104 developmental biology ,chemistry ,inflammation ,Investigational Drugs ,Molecular Medicine ,Immunotherapy ,endothelin receptor ,business ,metabolism ,Signal Transduction ,medicine.drug - Abstract
Despite recent advances in Pulmonary Arterial Hypertension (PAH) treatment, this condition is still characterized by an extremely poor prognosis. In this review, we discuss the use of newly-approved drugs for PAH treatment with already known mechanisms of action (macitentan), innovative targets (riociguat and selexipag), and novel therapeutic approaches with initial up-front combination therapy. Secondly, we describe new potential signaling pathways and investigational drugs with promising role in the treatment of PAH.
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- 2019
48. Relationship between epicardial adipose tissue and coronary vascular function in patients with suspected coronary artery disease and normal myocardial perfusion imaging
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Wanda Acampa, Carmela Nappi, Mario Petretta, Renato Cuocolo, Andrea Ponsiglione, Alberto Cuocolo, Serena Dell'Aversana, Roberta Assante, Massimo Imbriaco, Valeria Gaudieri, Teresa Mannarino, Emilia Zampella, Nappi, Carmela, Ponsiglione, Andrea, Acampa, Wanda, Gaudieri, Valeria, Zampella, Emilia, Assante, Roberta, Cuocolo, Renato, Mannarino, Teresa, Dell'Aversana, Serena, Petretta, Mario, Imbriaco, Massimo, and Cuocolo, Alberto
- Subjects
medicine.medical_specialty ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,03 medical and health sciences ,Myocardial perfusion imaging ,0302 clinical medicine ,Positron Emission Tomography Computed Tomography ,Internal medicine ,Heart rate ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,PET-CT ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,General Medicine ,Blood flow ,medicine.disease ,Coronary Vessels ,Coronary Calcium Score ,Adipose Tissue ,Positron emission tomography ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Pericardium ,Perfusion - Abstract
Aims We evaluated the relationship between epicardial adipose tissue (EAT) and coronary vascular function assessed by rubidium-82 (82Rb) positron emission tomography/computed tomography (PET/CT) in patients with suspected coronary artery disease (CAD). Methods and results The study population included 270 patients with suspected CAD and normal myocardial perfusion at stress–rest 82Rb PET/CT. Coronary artery calcium (CAC) score and EAT volume were measured. Absolute myocardial blood flow (MBF) was computed in mL/min/ from the dynamic rest and stress imaging. Myocardial perfusion reserve (MPR) was defined as the ratio of hyperaemic to baseline MBF and it was considered reduced when 0 (n = 156). Conclusion In patients with suspected CAD and normal myocardial perfusion, EAT volume predicts hyperaemic MBF and reduced MPR, confirming that visceral pericardium fat may influence coronary vascular function. Thus, EAT evaluation has a potential role in the early identification of coronary vascular dysfunction.
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- 2019
49. Automated External Defibrillator Availability and CPR Training among Police Officers in the Campania Region: a Comparison of conventional and Peer-Led Trainings
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Domenico Bonaduce, Francesco Elia, Mario Alberto Santomauro, Maurizio Santomauro, Carla Riganti, Mario Petretta, Raffaele Giordano, Ciro Aiello, Riccardo Franco, Santomauro, Maurizio, Riganti, Carla, Aiello, Ciro, Alberto Santomauro, Mario, Giordano, Raffaele, Elia, Francesco, Franco, Riccardo, Petretta, Mario, and Bonaduce, Domenico
- Subjects
business.industry ,General Engineering ,Medicine ,Medical emergency ,business ,medicine.disease ,Cpr training ,Automated external defibrillator - Published
- 2019
50. Diagnostic performance of myocardial perfusion imaging with conventional and CZT single-photon emission computed tomography in detecting coronary artery disease: A meta-analysis
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Emilia Zampella, Wanda Acampa, Alberto Cuocolo, Mario Petretta, Eugenio Di Vaia, Valeria Gaudieri, Renato Cuocolo, Valeria Cantoni, Carmela Nappi, Roberta Green, Roberta Assante, Teresa Mannarino, Cantoni, Valeria, Green, Roberta, Acampa, Wanda, Zampella, Emilia, Assante, Roberta, Nappi, Carmela, Gaudieri, Valeria, Mannarino, Teresa, Cuocolo, Renato, Di Vaia, Eugenio, Petretta, Mario, and Cuocolo, Alberto
- Subjects
medicine.medical_specialty ,Quality Assurance, Health Care ,CAD ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Single-photon emission computed tomography ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,03 medical and health sciences ,Myocardial perfusion imaging ,0302 clinical medicine ,medicine ,Humans ,Gamma Cameras ,Radiology, Nuclear Medicine and imaging ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,Area under the curve ,medicine.disease ,Invasive coronary angiography ,Zinc ,Meta-analysis ,Diameter stenosis ,Radiology ,Tellurium ,Cardiology and Cardiovascular Medicine ,business ,Cadmium - Abstract
Background. We performed a meta-analysis to compare the diagnostic performance of conventional SPECT (C-SPECT) and cadmium-zinc-telluride (CZT)-SPECT systems in detecting angiographically proven coronary artery disease (CAD). Methods. Studies published between January 2000 and February 2018 were identified by database search. We included studies assessing C-SPECT or CZT-SPECT as a diagnostic test to evaluate patients for the presence of CAD, defined as at least 50% diameter stenosis on invasive coronary angiography. A study was eligible regardless of whether patients were referred for suspected or known CAD. Results. We identified 40 eligible articles (25 C-SPECT and 15 CZT-SPECT studies) including 7334 patients (4997 in C-SPECT and 2337 in CZT-SPECT studies). The pooled sensitivity and specificity were 85% and 66% for C-SPECT and 89% and 69% for CZT-SPECT imaging studies. The area under the curve was slightly higher for CZT-SPECT (0.89) compared to C-SPECT (0.83); accordingly, the summary diagnostic OR was 17 for CZT-SPECT and 11 for C-SPECT. The accuracy of the two tests slightly differs between C-SPECT and CZT-SPECT (chi-square 11.28, P < .05). At meta-regression analysis, no significant association between both sensitivity and specificity and demographical and clinical variables considered was found for C-SPECT and CZT-SPECT studies. Conclusions. C-SPECT and CZT-SPECT have good diagnostic performance in detecting angiographic proven CAD, with a slightly higher accuracy for CZT-SPECT. This result supports the use of the novel gamma cameras in clinical routine practices also considering the improvements in acquisition time and radiation exposure reduction.
- Published
- 2019
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