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Huiying Xu,1 Min Sen Yew2 1Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore; 2Department of Cardiology, Tan Tock Seng Hospital, Singapore, SingaporeCorrespondence: Huiying Xu, Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore, Tel +65 6256 6011, Email Huiying_xu@ttsh.com.sgPurpose: Chronic obstructive pulmonary disease (COPD) patients often undergo chest CT for various indications. Coronary artery calcium (CAC) can be quantified visually on ungated chest CT using an ordinal score that has been shown to correlate well with traditional Agatston CAC scoring. The prognostic role of CAC was studied mainly in stable COPD patients. We aim to study the association between ordinal CAC and mortality amongst patients admitted for acute exacerbation of COPD (AECOPD).Patients and Methods: Retrospective study of AECOPD cases with no previous coronary revascularization admitted between 1st January 2016 to 30th June 2017 with a chest CT performed during admission or within 365 days prior. Ordinal CAC scoring (scale of 0– 12) was performed by an experienced CT cardiologist blinded to patient data and outcomes. Patient demographics and future clinical events were retrieved from electronic medical records.Results: There were 93 patients included (87.1% male, mean age 75 years) with the majority (59.1%) in GOLD Stage III. There were 21 (22.6%) patients with no CAC as well as 39 (41.9%) and 33 (35.5%) with ordinal CAC of 1– 3 and 4– 12, respectively. There were no significant differences in Charlson Comorbidity Index (CCI) and the proportion of patients with traditional cardiovascular risk factors (namely hypertension, dyslipidaemia, diabetes and smoking status) between the ordinal CAC score groups. Over a median follow-up period of 2.9 (1.1– 3.9) years, there were 51 (54.8%) deaths. An ordinal CAC score of 4– 12 was the only significant predictor of mortality after multivariate Cox-regression analysis adjustment for age, gender, body mass index, prior exacerbations, FEV1, cardiovascular risk factors and CCI [HR 3.944, (95% confidence interval 1.647– 9.433, p = 0.002)].Conclusion: Ordinal CAC measured from a current or recent ungated chest CT is an independent predictor of all-cause mortality in admitted AECOPD patients with no previous coronary revascularization.Keywords: chronic obstructive pulmonary disease, exacerbation, coronary artery calcium, mortality

Calvin You Jia Chen,1 Min Sen Yew,2 John Arputhan Abisheganaden,3 Huiying Xu3 1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; 2Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore; 3Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, SingaporeCorrespondence: Huiying XuDepartment of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Tel +65 6256 6011Email Huiying_xu@ttsh.com.sgPurpose: Influenza infection is an important cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Clinical features predicting influenza PCR positivity are unknown. We aim to identify predictors of influenza PCR positivity in AECOPD.Patients and Methods: A retrospective study of AECOPD cases admitted between 1st January 2016 to 30 June 2017 with combined nasal/throat swabs sent for influenza PCR (Xpert Xpress Flu/RSV) within 24 hours of admission was performed. Clinical parameters and investigations within 24 hours of admission were retrieved from electronic medical records.Results: Influenza PCR were sent for 925 AECOPD cases (mean age 75 years, 87.9% male). There were 90 PCR positive cases (68 Influenza A, 22 Influenza B). Influenza PCR positive cases had higher temperatures, higher heart rates, lower white cell and lower eosinophil counts. Age, gender, COPD severity, comorbidities and smoking status were similar in both groups. There were no differences in blood pressure, oxygen status, neutrophil or lymphocyte counts, C reactive protein, procalcitonin or chest X-ray consolidation between groups. Higher temperature, higher heart rate, white cell count in the lowest quartile (Q1 < 8.1 x109/L) and non-eosinophilic exacerbations predicted influenza PCR positivity on univariate logistic regression and these factors remained significant after multivariate adjustment (temperature adjusted odds ratio [adj OR] 1.324 [1.009– 1.737], p = 0.043; heart rate adj OR 1.017 [1.004– 1.030], p = 0.011; white cell count Q1 adj OR 3.330 [1.690– 6.562], p = 0.001; eosinophilic exacerbations adj OR 0.390 [0.202– 0.756], p = 0.005).Conclusion: Higher temperature, higher heart rate, low white cell count (especially when < 8.1 x109/L) and non-eosinophilic exacerbations are independent predictors of influenza PCR positivity in AECOPD cases.Keywords: chronic obstructive pulmonary disease, exacerbation, influenza, eosinophil

Aims: To identify differences in CT-derived perivascular (PVAT) and epicardial adipose tissue (EAT) characteristics that may indicate inflammatory status differences between post-treatment acute myocardial infarction (AMI) and stable coronary artery disease (CAD) patients., Methods and Results: A cohort of 205 post-AMI patients (age 59.8±9.2, 92.2% male) was propensity-matched with 205 stable CAD patients (age 60.5±10.0, 90.2% male). Coronary CT angiography and non-contrast CT scans were performed to assess PVAT mean attenuation across major coronary segments and EAT mean attenuation and volumes, respectively. For post-AMI patients, CT scans were conducted 28.6 ± 13.8 days after the AMI incidence. Post-AMI patients showed higher non-culprit PVAT and EAT mean attenuation than stable CAD patients (8.01HU, 95% CI 5.90 to 10.11 HU, p<0.001, 2.48 HU, 95% CI 0.83 to 4.13 HU, p=0.003, respectively). The EAT volume percentage at higher attenuation levels was higher in post-AMI patients compared to stable CAD (33.93cm3, 95% CI 16.86 to 51.00 cm3, p<0.001), with the difference maximized at the -70 HU threshold (4.75%, 95% CI 3.64% to 5.87%, p<0.001). PVAT mean attenuation positively correlated with EAT mean attenuations and the percentage of EAT volume >-70 HU (p<0.001 for both)., Conclusions: Post-AMI patients showed higher PVAT and EAT attenuation than stable CAD patients, potentially indicating AMI-associated inflammatory cardiac adipose tissue changes. -70 HU can act as a potential cut-off for inflamed EAT. These findings highlight the potential of using CT-derived adipose tissue characteristics to assess inflammation and guide post-AMI management strategies., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: Coronary CT angiography (CCTA) is well established for the diagnostic evaluation and prognostication of coronary artery disease (CAD). The growing burden of CAD in Asia and the emergence of novel CT-based risk markers highlight the need for an automated platform that integrates patient data with CCTA findings to provide tailored, accurate cardiovascular risk assessments. This study aims to develop an artificial intelligence (AI)-driven platform for CAD assessment using CCTA in Singapore's multiethnic population. We will conduct a hybrid retrospective-prospective recruitment of patients who have undergone CCTA as part of the diagnostic workup for CAD, along with prospective follow-up for clinical endpoints. CCTA images will be analysed locally and by a core lab for coronary stenosis grading, Agatston scoring, epicardial adipose tissue evaluation and plaque analysis. The images and analyses will also be uploaded to an AI platform for deidentification, integration and automated reporting, generating precision AI toolkits for each parameter., Participants: CCTA images and baseline characteristics have been collected and verified for 4196 recruited patients, comprising 75% Chinese, 6% Malay, 10% Indian and 9% from other ethnic groups. Among the participants, 41% are female, with a mean age of 55±11 years. Additionally, 41% have hypertension, 51% have dyslipidaemia, 15% have diabetes and 22% have a history of smoking., Findings to Date: The cohort data have been used to develop four AI modules for training, testing and validation. During the development process, data preprocessing standardised the format, resolution and other relevant attributes of the images., Future Plans: We will conduct prospective follow-up on the cohort to track clinical endpoints, including cardiovascular events, hospitalisations and mortality. Additionally, we will monitor the long-term impact of the AI-driven platform on patient outcomes and healthcare delivery., Trial Registration Number: NCT05509010., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The comparison of coronary computed tomography angiography plaques and perivascular adipose tissue (PVAT) between patients with acute myocardial infarction (AMI) posttreatment and patients with stable coronary artery disease is poorly understood. Our objective was to evaluate the differences in coronary computed tomography angiography-quantified plaque and PVAT characteristics in patients post-AMI and identify signs of residual inflammation., Methods and Results: We analyzed 205 patients (age, 59.77±9.24 years; 92.20% men) with AMI ≤1 month and matched them with 205 patients with stable coronary artery disease (age, 60.52±10.04 years; 90.24% men) based on age, sex, and cardiovascular risk factors. Coronary computed tomography angiography scans were assessed for nonculprit plaque and vessel characteristics, plaque volumes by composition, high-risk plaques, and PVAT mean attenuation. Both patient groups exhibited similar noncalcified plaque volumes (383.35±313.23 versus 378.63±426.25 mm 3 , P =0.899). However, multivariable analysis revealed that patients post-AMI had a greater patient-wise noncalcified plaque volume ratio (estimate, 0.089 [95% CI, 0.053-0.125], P <0.001), largely attributed to a higher fibrofatty and necrotic core volume ratio, along with higher peri-lesion PVAT mean attenuation (estimate, 3.968 [95% CI, 2.556-5.379], P <0.001). When adjusted for vessel length, patients post-AMI had more high-risk plaques (estimate, 0.417 [95% CI, 0.298-0.536], P <0.001) per patient., Conclusions: Patients post-AMI displayed heightened noncalcified plaque components, largely due to fibrofatty and necrotic core content, more high-risk plaques, and increased PVAT mean attenuation on a per-patient level, highlighting the necessity for refined risk assessment in patients with AMI after treatment.

Background: The use of machine learning (ML) based coronary computed tomography angiography (CCTA) derived fractional flow reserve (ML-FFR CT ), shortens the time of diagnosis of ischemia considerably and eliminates unnecessary invasive procedures, when compared to invasive coronary angiography with invasive FFR (iFFR). This systematic review aims to summarize the current evidence on the diagnostic accuracy of (ML-FFR CT ) compared with iFFR for diagnosis of patient- and vessel-level coronary ischemia., Methods: To identify suitable studies, comprehensive literature search was performed in PubMed, the Cochrane Library, Embase, up to August 2023. The index test was ML derived FFR and studies with diagnostic test accuracy data of ML-FFR CT at a threshold of 0.8 were included for the review and meta -analysis. Quality of evidence was assessed using QUADAS-2 checklist., Results: After full text review of 230 identified studies, 17 were included for analysis, which encompassed 3255 participants (age 62.0 ± 3.7). 8 studies reported patient-level data; and 12, vessel-level data. With iFFR as the reference standard, the pooled patient-level sensitivity, specificity, and area-under-curve (AUC) of ML-FFR CT were 0.86 [95 % CI: 0.79, 0.91], 0.87 [95 % CI: 0.76, 0.94], and 0.92 [95 % CI: 0.89-0.94], respectively; and pooled vessel-level sensitivity, specificity, and AUC, 0.80 [95 % CI: 0.74-0.84], 0.84 [95 % CI: 0.77-0.89), and 0.88 [95 % CI: 0.85-0.91], respectively., Conclusions: This systemic review demonstrated the favourable diagnostic performance of ML-FFR CT against standard iFFR, although heterogeneity exists, providing support for the use of ML-FFR CT as a triage tool for non-invasive screening of coronary ischemia in the clinical setting., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

The auto-labeling of coronary artery segments plays an important role in the diagnosis of cardiovascular diseases. Due to the high degree of complexity and diversity in coronary artery structures, it is still a very challenging task after many years of exploration and study. In this paper, we propose a hierarchical scheme based on PointNet++ models and new topological structural features for automatic labeling of coronary artery segments. The inputs are 3D coronary artery centerline points extracted from CTCA images, and the outputs are the correspondent label indexes. The auto-labeling scheme include two stages: first stage is to identify the three main branches, LAD(LM), LCX and RCA. After that, utilizing the topological connectivity relationship with the three main branches, the indexes of sub-branches are identified in the second stage. We evaluated our method on a private clinical dataset. Experimental results show that the proposed method has achieved a satisfactory accuracy for clinical use.

A 69-year-old man had fistulas arising from the left main, conus and aortic arch complicated by 2 saccular aneurysms with one draining into the pulmonic trunk seen during computed tomography and invasive angiography. These were treated conservatively but required repeat computed tomography and cardiac magnetic resonance imaging 2 years later for new heart failure., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Aims: Transient ischaemic dilation (TID) is a marker of underlying extensive coronary artery disease (CAD) during myocardial perfusion imaging (MPI). The cut-off for a normal TID ratio (TIDr) value is often derived from a cohort of individuals with no apparent CAD. Varying criteria have been used to define the absence of CAD. We aim to derive TIDr cut-offs using patients with normal MPI and coronary artery calcium (CAC) score of zero, and compare the TIDr obtained from different software packages., Methods and Results: We studied 232 patients with zero CAC and normal MPI undergoing exercise or dipyridamole stress using either a 1- or 2-day protocol. All patients were scanned in the supine position with a cadmium-zinc-telluride camera. TIDr was automatically generated using quantitative perfusion SPECT (QPS) software initially, and subsequently using Myometrix for comparison. The TIDr cut-offs calculated using the mean + 2 standard deviation were 1.29 and 1.24 for the 1- and 2-day protocol groups, respectively. In patients undergoing a 2-day protocol, dipyridamole stress resulted in significantly higher mean TIDr when compared to exercise stress (1.07 ± 0.13 vs. 1.01 ± 0.12, P = 0.035). Myometrix-derived TIDr were also significantly lower compared to QPS-derived values for most protocols except for 2-day exercise stress., Conclusion: This study is the first to derive TIDr threshold values using a normal population defined by zero CAC and normal MPI. TIDr was found to vary depending on stress modality, protocol as well as the software used., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Automatic coronary artery stenosis grading plays an important role in the diagnosis of coronary artery disease. Due to the difficulty of learning the informative features from varying grades of stenosis, it is still a challenging task to identify coronary artery stenosis from coronary CT angiography (CCTA). In this paper, we propose a context-aware deep network (CADN) for coronary artery stenosis classification. The proposed method integrates 3D CNN with Transformer to improve the feature representation of coronary artery stenosis in CCTA. We evaluate the proposed method on a multicenter dataset (APOLLO study with NCT05509010). Experimental results show that our proposed method can achieve the accuracy of 0.84, 0.83, and 0.86 for stenosis diagnosis on the lesion, artery, and patient levels, respectively.

Introduction: Normal stress myocardial perfusion imaging (MPI) carries a favourable prognosis. Conversely, elevated coronary artery calcium (CAC) is associated with increased major adverse cardiovascular events (MACE). There is limited information on the prognosis and management of patients with elevated CAC and normal MPI. We aimed to assess the outcomes of patients with elevated CAC and normal MPI in relation to post-MPI statin use., Methods: A retrospective review of normal MPI with CAC score >300 was performed between 1 March 2016 and 31 January 2017 in a Singapore tertiary hospital. Patients with known atherosclerotic cardiovascular disease or left ventricular ejection fraction <50% on MPI were excluded. Patient demographics, prescriptions and MACE (cardiac death, nonfatal myocardial infarction and/or ischaemic stroke) at 24 months after MPI were traced using electronic records. Binary logistic regression was used to evaluate for independent predictors of MACE., Results: We included 311 patients (median age 71 years, 56.3% male), of whom 65.0% were on moderate to high-intensity statins (MHIS) after MPI. MACE was significantly lower in the post-MPI MHIS group (3.5% vs. 9.2%, P = 0.035). On univariate binary logistic regression, post-MPI MHIS use was the only significant predictor for MACE (odds ratio [OR] 0.355 [95% confidence interval (CI) 0.131-0.962], P = 0.042), even after multivariate adjustment (adjusted OR 0.363, 95% confidence interval 0.134-0.984, P = 0.046)., Conclusion: Post-MPI MHIS use is associated with lower MACE and is an independent negative predictor for 24-month MACE among patients with normal MPI and CAC >300., Competing Interests: None

Background: Coronavirus disease 2019 (COVID-19) mRNA vaccine-associated acute myocarditis has been well described, and the demonstration of elevated high-sensitivity cardiac troponin (hs-cTn) is crucial for its diagnosis. However, falsely elevated hs-cTn can occasionally occur, leading to incorrect diagnosis. Here, we report the case of a patient who was given an erroneous diagnosis of COVID-19 mRNA vaccine-associated acute myocarditis due to falsely elevated hs-cTn, likely from assay interference., Case Summary: A 29-year-old Chinese male presented with 3 months of chest pain, dyspnoea, and palpitations starting a few days after his second dose of mRNA-1273 (Moderna) vaccine. High-sensitivity cardiac troponin I was elevated at presentation, which rose further 4 h later. The provisional diagnosis was acute myocarditis after a computed tomography coronary angiogram showed normal coronaries. Cardiac magnetic resonance was also negative for myocardial inflammation. The hs-cTn I levels fluctuated but remained elevated on outpatient serial testing, despite no new symptoms or clinical events. A paired serum sample showed elevated hs-cTn I but normal hs-cTn T, confirming a diagnosis of false-positive hs-cTn I. Further investigations, including blood tests before and after a subsequent uneventful mRNA-1273 booster vaccination, were performed to investigate for assay interference., Discussion: Widespread COVID-19 mRNA vaccination has resulted in an awareness of vaccine-related acute myocarditis and a more thorough evaluation of post-vaccination cardiac symptoms. Although false-positive hs-cTn rarely occurs, extensive testing will inevitably result in a significant number of patients with falsely elevated hs-cTn. Clinicians should exclude this possibility and consider using alternative hs-cTn assay when investigation results and clinical presentation appear discordant., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Purpose: Guidelines recommend stress only (SO) myocardial perfusion imaging (MPI) without follow-up rest imaging if perfusion and left ventricular ejection fraction (LVEF) are normal. However additional rest imaging may show transient ischaemic dilation (TID) and/or impaired LVEF reserve (iLVEFr) suggestive of 'balanced ischemia'. Concurrent coronary artery calcium (CAC) scoring helps to identify subclinical atherosclerosis. The safety of SO MPI when CAC is elevated is unclear. We aim to assess the incidence and outcomes of TID and iLVEFr amongst stress/rest MPIs with normal SO images and elevated CAC., Methods: Retrospective analysis of normal stress/rest MPIs performed between 1 March 2016 to 31 January 2017 with concurrently measured CAC >300. Cases were stratified by presence of TID and/or iLVEFr. Major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction and revascularization) within 24 months were compared., Results: There were 230 cases included of which 43 (18.7%) had TID and/or iLVEFr. Presence of TID and/or iLVEFr was associated with higher 24-month MACE (23.3 vs. 8.6%, p = 0.013), driven by more elective revascularizations (18.6 vs. 4.3%, p = 0.001). Cardiac death and non-fatal myocardial infarction rates were similar. TID and/or iLVEFr significantly predicted overall MACE after multivariate analysis (OR 2.933 [1.214 - 7.087], p = 0.017)., Conclusions: TID and/or iLVEFr is seen in the minority of normal stress MPI with elevated CAC, and is associated with higher 24-month MACE, driven by higher elective revascularizations. Overall cardiac death and non-fatal myocardial infarction rates were low and not significantly different between both groups., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Cardiac troponins (cTn), either conventional or high-sensitive (hscTn) assays, are often performed during acute exacerbations of chronic obstructive pulmonary disease (AECOPD)., Objectives: To compare factors affecting abnormal conventional cTn and hscTn., Methods: We retrospectively studied data from AECOPD patients with conventional or hscTn performed at presentation. Binary logistic regression was used to identify predictors for abnormal conventional cTn (>0.5 ug/L) and hscTn (>40 ng/L)., Results: There were 466 patients in the conventional cTn and 313 patients in the hscTn groups. Ischaemic electrocardiographic change was the only significant predictor for abnormal conventional cTn (OR 6.662 [CI 1.233-35.990], p = 0.028) while B-type natriuretic peptide levels (Adj OR 1.004 [CI 1.000-1.006], p = 0.010) and SpO 2 /FiO 2 ratio (Adj OR 0.115 [CI 0.017-0.069], p = 0.026) were significant predictors of abnormal hscTn., Conclusions: Predictors of abnormal cTn differ between assays and should be taken into consideration when interpreting cTn during AECOPD., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: POEMS syndrome (PS) is a paraneoplastic disorder from plasma cell dyscrasia, characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes. Vascular endothelial growth factors (VEGFs)-driven fluid extracellular matrix expansion plays a key role in this condition. Associated cardiac involvement has been sparsely reported thus far., Case Summary: A 55-year-old woman with PS presented with a pleural effusion and respiratory failure requiring mechanical ventilation. Transthoracic echocardiogram revealed left ventricular (LV) systolic dysfunction with a moderate pericardial effusion. She developed intermittent complete heart block and ventricular standstill, requiring temporary transcutaneous pacing. Further evaluation revealed no significant coronary stenosis on coronary angiogram and cardiac magnetic resonance (CMR) showed elevated T1 and extracellular volume suggestive of myocardial oedema with possible early cardiac infiltration. She had a dual-chamber permanent pacemaker implanted in view of recurrent high-grade heart block. She was initiated on a daratumumab-based chemotherapy regimen prior to discharge. She recovered well subsequently with a promising clinical response to chemotherapy., Discussion: We describe the first case of LV systolic dysfunction with concomitant significant bradyarrhythmia in a patient with PS. CMR revealed evidence suggestive of LV myocardial oedema and/or possible early infiltration. VEGF overexpression could explain oedema-related LV dysfunction which reversed with adequate diuresis, as well as damage to the conduction system. Early cardiac amyloidosis, which can be associated with PS, is an important differential diagnosis. Pacemaker implantation, adequate diuresis, and definitive chemotherapy are key to the management of concomitant ventricular myocardial and electrical dysfunction in such rare case., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Transient ischemic dilation (TID), a marker of severe coronary artery disease (CAD), is the post-stress to rest left ventricular (LV) volume ratio quantified using non ECG gated single photon emission computerized tomography (SPECT). Although prone positioning causes physiological reduction of LV volume in normal subjects, we hypothesize this may not occur in TID with underlying severe CAD as cardiac hemodynamics worsen when prone. We aim to evaluate the utility of the non ECG gated supine to prone LV volume ratio (SPLVr) for identifying severe CAD. Retrospective data analysis from 130 patients with TID ratio ≥ 1.21 and both post-stress supine and prone images. SPLVr had a significant negative correlation with summed stress (r =  - 0.221, p = 0.011) and rest (r =  - 0.292, p = 0.001) scores. Of the 129 cases with follow-up invasive or computed tomography coronary angiography, 52 (40.3%) had severe CAD (left main ≥ 50% stenosis, 3-vessel with ≥ 70% stenosis or 2-vessel with proximal left anterior descending ≥ 70% stenosis). Mean SPLVr was significantly lower in severe CAD cases (1.05 ± 0.14 vs 1.12 ± 0.17, p = 0.012). SPLVr predicted severe CAD on univariate [OR 0.12 (95% CI 0.00-0.35) p = 0.01] but not in multivariate analysis. SPLVr is a novel marker that negatively correlates with extent of perfusion abnormalities and is lower amongst TID patients with severe CAD. Larger studies are needed to assess if SPLVr can reliably identify underlying severe CAD amongst TID cases.

Background: Primary cardiac lymphoma is defined as extranodal lymphoma involving the heart or pericardium. Common presentations of human immunodeficiency virus (HIV)-associated cardiac lymphoma include heart failure, cardiac tamponade, and rhythm abnormalities. Arrhythmia is an uncommon presentation and treatment in young HIV patients is particularly challenging. We present a unique case of primary cardiac lymphoma in an HIV patient presenting with both symptomatic tachy- and bradyarrhythmias., Case Summary: A 27-year-old man presented with intermittent palpitations and chest pain for 2 weeks. He has a significant past history of advanced HIV. He was noted to have complete heart block on cardiac monitoring. Imaging showed a large mass in the right atrioventricular (AV) groove extending into the myocardium, associated with a moderate pericardial effusion. During his stay, he developed symptomatic tachy-brady arrhythmias, with intermittent junctional tachycardia, supraventricular tachycardia, and complete AV block. After a multidisciplinary team discussion, endomyocardial biopsy was performed under fluoroscopy and transthoracic echocardiography guidance. Histology from the interventricular septum was consistent with Epstein-Barr virus positive B-cell lymphoma. The patient was subsequently transferred to a tertiary hospital with cardiothoracic surgical support to initiate chemotherapy., Discussion: To our knowledge, our patient is the first reported case of HIV-related primary cardiac lymphoma presenting with palpitations secondary to paroxysmal supraventricular tachycardia with concomitant AV block. This case illustrates the utility of multi-modality imaging in the investigation of a cardiac mass and the importance of having a high index of suspicion for pathology, such as cardiac lymphoma in HIV patients complaining of apparently minor cardiac complaints., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Dipyridamole stress is commonly used for myocardial perfusion imaging and is generally safe. Myocardial ischaemia can occasionally occur and is classically thought to be due to coronary steal as a result of redistribution of flow away from collateral dependent myocardium. Although ischaemia more commonly presents as electrocardiographic (ECG) ST depression and angina, ST-elevation myocardial infarction may occur as a very rare complication., Case Summary: We report a case of a patient who developed chest pain and ST depression during dipyridamole infusion. The pain persisted despite intravenous aminophylline with new inferior ST elevation soon after. Coronary angiography showed subtotal right coronary artery occlusion with no collateral supply. The symptoms and ECG changes resolved after percutaneous coronary intervention., Discussion: Coronary steal may not fully account for our patient's presentation given the failure of aminophylline and absent angiographic collaterals. Vasospasm may be triggered by dipyridamole and can directly cause ischaemia or provoke rupture of an unstable plaque. Augmentation of cardiac energetics during vasodilator stress may also play a role., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Objective: To determine the prevalence and use of newer technologies among New Zealand general dental practitioners (GDPs)., Design: Cross-sectional survey of a random sample of GDPs., Method: A postal questionnaire was sent to 700 GDPs enrolled on the DCNZ Dentists' Register (response rate 62.8%)., Results: Of all the technologies investigated, the digital apex locator (81.4%) and intra-oral camera (49.6%) were the most commonly used. Males and females differed with respect to the use of dental implant systems (41.6% and 24.1% respectively; P<0.05) and intra-oral cameras (53.6% and 39.8% respectively; P<0.05). New Zealand-trained and overseas-trained dentists differed with respect to their use of dental implant systems, with fewer of the latter (21.3%) using them than the former (40.2%). Power bleaching units were more common among more recent graduates. Compared to their city counterparts, dentists in smaller centres appeared to be slower in adopting most forms of newer technology., Conclusion: This study (the first of its kind internationally) provides an informative snapshot of New Zealand dentists' use of dental technologies during 2007. Efficiency was the most common reason for using newer technology.

Aim: To assess the knowledge and willingness of Singapore adults towards corneal donation., Methods: The study population consists of a cluster random sample of the population living in Bedok North (an area in the eastern part of Singapore). The study population comprised residents aged 21-65 years living in 675 randomly sampled housing units. The participation rate was 65.9% (544/825). All participants were interviewed face to face with a questionnaire formulated according to the modified Horton and Horton model. Knowledge, values, attitudes, and spiritual beliefs of participants were assessed to evaluate their willingness to donate their corneas., Results: 67.0% of participants were willing to donate their corneas. Ethnicity (Chinese) and religion (Christians, Hindus, or those with no religion) were associated with increased willingness to donate corneas. Greater knowledge and increased altruistic values were also associated with increased willingness to donate corneas., Conclusion: A proportion of participants were willing to donate their corneas. Awareness of corneal donation is high but specific knowledge should be further increased among adults.

Biosynthesis of ascorbic acid was found in the kidneys (mesonephros and metanephros) of the chick embryo as well as in the yolk sac membrane. The activity of L-gulonolactone oxidase in the yolk sac membrane suggested that it was the major source of ascorbic acid in the chick embryo.