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Feasibility of simultaneous 99mTc-tetrofosmin and 123I-BMIPP dual-tracer imaging with cadmium-zinc-telluride detectors in patients undergoing primary coronary intervention for acute myocardial infarction
摘要： Background. Simultaneous dual-tracer imaging using isotopes with close photo-peaks may benefit from improved properties of cadmium-zinc-telluride (CZT)-based scanners. Methods. Thirty patients having undergone primary percutaneous coronary intervention for acute myocardial infarction underwent single-(99mTc-tetrofosmin (TF) or 123I-BMIPP first) followed by simultaneous 99mTc-TF /123I-BMIPP dual-tracer imaging using a Discovery NM/CT 670 CZT. The values for the quantitative gated-SPECT (QGS) and the quantitative perfusion SPECT (QPS) were assessed. Results. The intra-class correlation (ICC) coefficients between the single- and dual-tracer imaging were high in all the QGS and QPS data (Summed motion score: 0.95, summed thickening score: 0.94, ejection fraction: 0.98, SRS for 99mTc-TF: 0.97/ for 123I-BMIPP: 0.95). Wall motion, wall thickening and rest scores per coronary-territory-based regions were also comparable between the single- and dual imaging (ICC coefficient > 0.91). The interrater concordance in the visual analysis for the infarction and perfusion-metabolism mismatch was significant for the global and regional left ventricle (P < 0.001). Conclusion. The quantitative/semi-quantitative values for global and regional left-ventricular function, perfusion, and fatty acid metabolism were closely comparable between the dual-tracer imaging and the single-tracer mode. These data suggests the feasibility of the novel CZT-based scanner for the simultaneous 99mTc-TF /123I-BMIPP dual-tracer acquisitions in clinical settings.
关键词： acute myocardial infarction,dual imaging,CZT camera,Perfusion-metabolism mismatch
更新于2025-09-23 15:23:52
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Intracoronary Imaging
摘要： Coronary angiography represents both the gold standard for diagnosis of coronary artery disease and the main guidance for percutaneous coronary intervention (PCI). Yet, coronary angiography is well known to not be optimal in appreciating the whole spectrum of lesions that may cause clinical problems in patients with coronary artery disease. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) represent the 2 contemporary invasive intracoronary imaging modalities aimed at improving the detection of coronary details. Their potential is extraordinary but their use for improving coronary disease diagnosis is not standardized. Moving from diagnosis to treatment, PCI based on drug-eluting stent (DES) implantation often requires a series of manipulations with different techniques and devices. Last generation DES types have similar technical features and share a comparable ability to scaffold coronary lesions. Not surprisingly, lesion complexity is known to be associated with increased procedure challenges that may be tackled by different strategies. The selection of devices and the assessment of appropriate DES implantation may be based on either angiography or intracoronary imaging techniques like IVUS or OCT. Both techniques have evolved over time and offer the possibility to see details of coronary lesions and stent/vessel interactions that are impossible to be captured and measured by angiography. So far, thousands of studies with different designs have been performed, but they have not been able to make interventional cardiologists act in a homogeneous way. Consequently, intravascular imaging is selected on the basis of individual yield, with an impressive variability across different countries and operators. Reimbursement issues are part of the game but do not entirely explain the overall underutilization of intravascular imaging (especially in Western countries where a lot of expensive devices are routinely incorporated in interventional practice). In reality, the application of intracoronary imaging adds complexity to PCI, requires adequate technical skills, and by itself does not necessarily improve the clinical outcome. As compared with angiography guidance, IVUS and OCT are able to provide (in real time) many more coronary details. Such angiographically invisible details need to be recognized by the operator to properly react to improve the clinical outcome of treated patients. Because of the impressive amount of details and possible measures/cutoffs, the identification of both impactful features (deserving attention) and best reactions (additional technical steps with corrective efficacy) is pivotal. Yet, data collected by IVUS studies have not been concordant and this has resulted in overall limited clinical penetration: many catheterization laboratories are actually working without any access to intracoronary imaging. Furthermore, although rare, imaging catheter-related complications may occur so that a safety issue has to be considered any time the expected benefit is not well established in clinical practice. On the bases of these concepts, it is evident that the intracoronary imaging clinical impact may come from the correct identification and appropriate processing of those details that may help (1) to improve the PCI strategy (technique/device selection, that is, PCI planning) and (2) to facilitate the achievement of improved stenting result (ie, PCI optimization). As shown in the Figure, among all the information captured by intracoronary imaging, a limited series of imaging-based pre-PCI findings can be easily incorporated in the PCI planning (lesion preparation and stent selection). Similarly, some key intra-PCI findings (stent underexpansion, stent edge dissections, and strut malapposition) can be searched in order to optimize the stent implantation result. The feasibility of this approach is supported by the daily experience of many high volume centers. Yet, the overall clinical impact of image guidance in PCI is still unrecognized, and large studies in the field are needed. Recently-collected data started shedding new light on both IVUS and OCT. The large study by Maehara et al, although not randomized, allowed to run a propensity-matched comparison between thousands of IVUS-guided and angiography-guided procedures. IVUS use was associated with different procedure conduction and reduced major adverse events incidence at up to 2 years. Of note, the clinical benefit comprised significant improvements of hard end points, namely stent thrombosis, myocardial infarction, and cardiac mortality. Such results fit well with the recent ULTIMATE prospective randomized trial (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in 'All-Comers' Coronary Lesions). The ULTIMATE investigators randomized 1448 all-comer patients who required DES implantation to either IVUS guidance or angiography guidance. As compared with angiography, randomization to IVUS guidance was associated with different procedure course (higher contrast administration, larger and longer stents, and higher inflation pressures) and warranted lower target vessel failures with IVUS at 12 months. OCT, as compared with IVUS, represents a younger technique, but data are growingly been collected because it has the appeal of offering higher resolution. The specific image generation process of OCT translates into the need of dedicated experience but has the potential for shorter learning curve. The possible clinical impact of OCT use in PCI guidance has been started to be highlighted by the results of the CLI-OPCI II study (Centro per la Lotta Contro l'Infarto-Optimisation of Percutaneous Coronary Intervention II). In this large registry, specific definitions for OCT features of suboptimal stent results were found to be independently associated with adverse clinical outcome after PCI. For sure, more complex PCIs (where the risk of stent thrombosis and restenosis is higher), are expected to benefit more from PCI refinements. Thus, two large prospectively randomized trials (OCTOBER, and ILUMIEN IV, and URL: https://www.clinicaltrials.gov. Unique identifier: NCT03507777) comparing OCT and angiographic guidance are actually ongoing and have been powered to explore the benefit of OCT guidance (using rigorous OCT-based PCI optimization algorithms) in, respectively, bifurcated lesions and complex patients. In conclusion, intravascular imaging modalities are entering a new era because the recently collected data seem to show new thresholds and targets for PCI planning and optimization. Thus, IVUS and OCT are going to become the ideal glasses that interventional cardiologists should wear anytime something looks unclear before, during or after PCI. Appropriate education, standardization of operative protocols and definitions of best clinical settings for application represent the future challenges for the intravascular imaging clinical implementation.
关键词： intravascular ultrasound,angiography,myocardial infarction,Editorials,diagnosis,optical coherence tomography,coronary artery disease,percutaneous coronary intervention
更新于2025-09-23 15:22:29
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Diagnosis and prognosis of myocardial infarction on a plasmonic chip
摘要： Cardiovascular diseases lead to 31.5% of deaths globally, and particularly myocardial infarction (MI) results in 7.4 million deaths per year. Diagnosis of MI and monitoring for prognostic use are critical for clinical management and biomedical research, which require advanced tools with accuracy and speed. Herein, we developed a plasmonic gold nano-island (pGold) chip assay for diagnosis and monitoring of MI. On-chip microarray analysis of serum biomarkers (e.g., cardiac troponin I) afforded up to 130-fold enhancement of near-infrared fluorescence for ultra-sensitive and quantitative detection within controlled periods, using 10 μL of serum only. The pGold chip assay achieved MI diagnostic sensitivity of 100% and specificity of 95.54%, superior to the standard chemiluminescence immunoassay in cardiovascular clinics. Further, we monitored biomarker concentrations regarding percutaneous coronary intervention for prognostic purpose. Our work demonstrated a designed approach using plasmonic materials for enhanced diagnosis and monitoring for prognostic use towards point-of-care testing.
关键词： myocardial infarction,plasmonic gold nano-island chip,diagnosis,monitoring,point-of-care testing
更新于2025-09-23 15:21:01
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Anti-Myocardial Infarction Effects of Radix Aconiti Lateralis Preparata Extracts and Their Influence on Small Molecules in the Heart Using Matrix-Assisted Laser Desorption/Ionization–Mass Spectrometry Imaging
摘要： Radix Aconiti Lateralis Preparata (fuzi) is the processed product of Aconitum carmichaelii Debeaux tuber, and has great potential anti-myocardial infarction e?ects, including improving myocardial damage and energy metabolism in rats. However, the e?ects of Radix Aconiti Lateralis Preparata extracts in a rat model of myocardial infarction have not yet been fully illustrated. Herein, Radix Aconiti Lateral Preparata was used to prepare Radix Aconiti Lateralis Preparata extract (RAE), fuzi polysaccharides (FPS), and fuzi total alkaloid (FTA). Then, we aimed to compare the e?ects of RAE, FPS, and FTA in MI rats and further explore their in?uence on small molecules in the heart. We reported that Radix Aconiti Lateralis Preparata extract (RAE) and fuzi total alkaloid (FTA) signi?cantly improved left ventricular function and structure, and reduced myocardial damage and infarct size in rats with myocardial infarction by the left anterior descending artery ligation. In contrast, fuzi polysaccharides (FPS) was less e?ective than RAE and FTA, indicating that alkaloids might play a major role in the treatment of myocardial infarction. Moreover, via matrix-assisted laser desorption/ionization–mass spectrometry imaging (MALDI–MSI), we further showed that RAE and FTA containing alkaloids as the main common components regulated myocardial energy metabolism-related molecules and phospholipids levels and distribution patterns against myocardial infarction. In particular, it was FTA, not RAE, that could also regulate potassium ions and glutamine to play a cardioprotective role in myocardial infarction, which revealed that an appropriate dose of alkaloids generated more obvious cardiotonic e?ects. These ?ndings together suggested that Radix Aconiti Lateralis Preparata extracts containing an appropriate dose of alkaloids as its main pharmacological active components exerted protective e?ects against myocardial infarction by improving myocardial energy metabolism abnormalities and changing phospholipids levels and distribution patterns to stabilize the cardiomyocyte membrane structure. Thus, RAE and FTA extracted from Radix Aconiti Lateralis Preparata are potential candidates for the treatment of myocardial infarction.
关键词： myocardial infarction,left anterior descending artery ligation,phospholipid,energy metabolism,matrix-assisted laser desorption/ionization–mass spectrometry imaging,Radix Aconiti Lateralis Preparata
更新于2025-09-16 10:30:52
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Label-free Evaluation of Myocardial Infarct in Surgically Excised Ventricular Myocardium by Raman Spectroscopy
摘要： Understanding the viability of the ischemic myocardial tissue is a critical issue in determining the appropriate surgical procedure for patients with chronic heart failure after myocardial infarction (MI). Conventional MI evaluation methods are; however, preoperatively performed and/or give an indirect information of myocardial viability such as shape, color, and blood flow. In this study, we realize the evaluation of MI in patients undergoing cardiac surgery by Raman spectroscopy under label-free conditions, which is based on intrinsic molecular constituents related to myocardial viability. We identify key signatures of Raman spectra for the evaluation of myocardial viability by evaluating the infarct border zone myocardium that were excised from five patients under surgical ventricular restoration. We also obtain a prediction model to differentiate the infarcted myocardium from the non-infarcted myocardium by applying partial least squares regression-discriminant analysis (PLS-DA) to the Raman spectra. Our prediction model enables identification of the infarcted tissues and the non-infarcted tissues with sensitivities of 99.98% and 99.92%, respectively. Furthermore, the prediction model of the Raman images of the infarct border zone enabled us to visualize boundaries between these distinct regions. Our novel application of Raman spectroscopy to the human heart would be a useful means for the detection of myocardial viability during surgery.
关键词： label-free evaluation,myocardial viability,Raman spectroscopy,partial least squares regression-discriminant analysis,myocardial infarction
更新于2025-09-11 14:15:04
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IVOCT Has a Bright Future in the Identification of Vulnerable Plaques
摘要： Using intravascular imaging to identify the impact of statins on vulnerable plaques has a long and rich history. Intravascular ultrasound (IVUS) imaging of coronary arteries first provided a more comprehensive assessment of atherosclerotic plaques in vivo than coronary angiography. Subsequent advances in tissue characterization of gray-scale IVUS allowed observers to visually identify the composition of plaques as lipid cores, fibrous tissue, and even thick fibrous caps. Early IVUS trials demonstrated a slowing or halting of progression and even regression of atherosclerosis during statin treatment. The advent of three-dimensional (3D) IVUS image reconstructions allowed more precise characterization of a reduction in lipid volume and increases in fibrous volume as a result of high-dose statin therapy. Following the introduction of virtual histology-intravascular ultrasound (VH-IVUS), with its ability to detect various types of plaques in an automated fashion, statin therapy studies indicated a reduced external elastic membrane area and calcium volume but, surprisingly, decreased fibrous plaque volume and had no effect on necrotic core volume. An obvious question is why this meta-analysis of 9 VH-IVUS trials did not demonstrate the anticipated beneficial effects of statins. Furthermore, the major limitation with IVUS in those studies was the inability to identify changes in thin-cap fibroatheroma(s) (TCFA) thickness due to limited spatial resolution of approximately 100 mm. TCFAs are the lesions most likely to rupture and are strongly predictive of major adverse cardiovascular events.
关键词： optical coherence tomography,atherosclerosis,statin,myocardial infarction
更新于2025-09-09 09:28:46
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Current OCT Approaches Do Not Reliably Identify TCFAs
摘要： It is now clearly established that Thin-Capped Fibroatheromas (TCFAs) lead to most Acute Coronary Syndromes (ACSs). The ability to selectively intervene on TCFAs predisposed to rupture and ACSs would dramatically alter the practice of cardiology. While the ability of OCT to identify thin walled plaques at micron scale resolutions has represented a major advance, it is a misconception that it can reliably identify TCFAs. One major reason is that the ‘diffuse border’ criteria currently used to determine ‘lipid plaque’ is almost undoubtedly from high scattering in the intima and not because of core composition (necrotic core). A second reason is that, rather than looking at lipid collections, studies need to be focused on identifying necrotic cores with OCT. Necrotic cores are characteristic of TCFAs and not lipid collections. Numerous other OCT approaches are available which can potentially accurately assess TCFAs, but these have not been aggressively pursed which we believe likely stems in part from the misconceptions over the efficacy of ‘diffuse borders’.
关键词： Myocardial infarction,Optical coherence tomography: OCT,Macrophages,Plaque rupture,Acute coronary syndrome: ACS,Thin capped fibroatheroma: TCFA,Lipid,Massachusetts General Hospital Lightlab
更新于2025-09-04 15:30:14
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ST Elevation Infarction after Heart Transplantation Induced by Coronary Spasms and Mural Thrombus Detected by Optical Coherence Tomography
摘要： The case illustrates the possible link between coronary spasms, intraluminal thrombus formation, and widespread organized and layered thrombi in HTx patients. Furthermore, the case underlines the clinical value of OCT as a novel method for high-resolution vessel imaging in heart-transplanted (HTx) patients with coronary spasms and suspected coronary artery disease. Coronary spasms and sudden death are frequent complications after HTx. The underlying mechanisms leading to these complications are unknown. The present case displays the clinical course of a 19-year-old HTx patient who was hospitalized due to acute myocardial infarction induced by severe coronary spasms. The patients remained unstable on conservative therapy. Therefore, an optical coherence tomography (OCT) was performed and revealed massive, organized thrombi in the left main coronary artery, the circumflex coronary artery, and the left anterior descending coronary artery. The patient was stabilized after percutaneous coronary intervention. As a mural thrombus often goes undetected by coronary angiography, OCT may prove beneficial in HTx patients with myocardial infarction or suspected coronary spasms.
关键词： myocardial infarction,coronary spasms,optical coherence tomography,heart transplantation,mural thrombus
更新于2025-09-04 15:30:14