kawai hideki

OBJECTIVES: A new classification of heart failure based on the effects of medication has recently come into use. According to this classification, heart failure is divided into heart failure with normal ejection fraction (HFnEF; defined as an EF ≥55% for men and ≥60% for women) and non-HFnEF. However, the characteristics of patients with HFnEF are still unclear. Accordingly, in this study, we sought to identify the background characteristics, including non-cardiac factors, of patients with HFnEF. METHODS: We retrospectively divided 304 eligible patients who were hospitalized for worsening heart failure at our institution between December 2020 and December 2022 into an HFnEF group (n=37) and a non-HFnEF group (n=267) and compared their demographic and clinical characteristics. RESULTS: There were more elderly patients in the non-HFnEF group, along with fewer patients with coronary artery disease and low serum hemoglobin and NT-proBNP levels and a higher proportion of patients with a low skeletal muscle index (<7.0 kg/m2 for men and <5.7 kg/m2 for women). Multivariate analysis with addition of patient sex identified a low skeletal muscle index (odds ratio 2.96, p<0.01) to be an independent determinant of HFnEF along with older age and low NT-proBNP. CONCLUSIONS: A low skeletal muscle index was significantly more common in patients with HFnEF than in those with non-HFnEF. Intensive nutrition and exercise therapy to increase skeletal muscle mass may improve the prognosis in patients with HFnEF who respond poorly to standard pharmacological treatment.

This study aimed to determine the optimal measurement conditions for accurate standardized uptake value (SUV) analysis of iodine-123 metaiodobenzylguanidine (¹²³I-MIBG) by examining the relationship between image convergence and quantitation. Single-photon emission computed tomography/computed tomography images were acquired using JS-10 and National Electrical Manufacturers Association (NEMA) body phantoms, with acquisition time per view varied (10, 30, 50, and 100 s/view). Image reconstruction was performed using three-dimensional-ordered subset expectation maximization, adjusting the product of subset and iteration (SI product; 60, 120, 180) and Gaussian filter parameters (8, 10, 12 mm). For the JS-10 phantom, we evaluated the dose linearity (DL), the recovery coefficient (RC) of individual rods, the scatter ratio (SR), and the coefficient of variation (CV). For the NEMA body phantom, we assessed the contrast-to-noise ratio (CNR) of the 17-mm-diameter hot sphere. We also evaluated the maximum and mean SUVs for all its hot spheres, and their relative standard error (RSE), using SUVs obtained at 100 s/view as reference. In the JS-10 phantom, the DL remained stable under all conditions. The RC decreased when the Gaussian filter was large and the SI product was small. A trade-off between the CV and the SR emerged, depending on the acquisition time and the SI product; optimal results were observed at 50 − 100 s/view and an SI product of 120 − 180. In the NEMA body phantom, contrast improved with acquisition times of ≥30 s/view, and the CNR increased as noise declined with longer acquisition times. At ≥50 s/view, variation in the maximum and mean SUVs decreased, with the RSE remaining below 5%. In conclusion, accurate SUV measurement with ¹²³I-MIBG requires an acquisition time of ≥50 s/view, an SI product of approximately 120, and a Gaussian filter of 10 − 12 mm. These findings provide a foundation for future studies comparing this method with the heart-to-mediastinum ratio, supporting its clinical application.

OBJECTIVE: To directly compare coronary arterial stenosis evaluations by hybrid-type iterative reconstruction (IR), model-based IR (MBIR), deep learning reconstruction (DLR), and high-resolution deep learning reconstruction (HR-DLR) on coronary computed tomography angiography (CCTA) in both in vitro and in vivo studies. MATERIALS AND METHODS: For the in vitro study, a total of three-vessel tube phantoms with diameters of 3 mm, 4 mm, and 5 mm and with simulated non-calcified stepped stenosis plaques with degrees of 0%, 25%, 50%, and 75% stenosis were scanned with area-detector CT (ADCT) and ultra-high-resolution CT (UHR-CT). Then, ADCT data were reconstructed using all methods, although UHR-CT data were reconstructed with hybrid-type IR, MBIR, and DLR. For the in vivo study, patients who had undergone CCTA at ADCT were retrospectively selected, and each CCTA data set was reconstructed with all methods. To compare the image noise and measurement accuracy at each of the stenosis levels, image noise, and inner diameter were evaluated and statistically compared. To determine the effect of HR-DLR on CAD-RADS evaluation accuracy, the accuracy of CAD-RADS categorization of all CCTAs was compared by using McNemar's test. RESULTS: The image noise of HR-DLR was significantly lower than that of others on ADCT and UHR-CT (p < 0.0001). At a 50% and 75% stenosis level for each phantom, hybrid-type IR showed a significantly larger mean difference on ADCT than did others (p < 0.05). At in vivo study, 31 patients were included. Accuracy on HR-DLR was significantly higher than that on hybrid-type IR, MBIR, or DLR (p < 0.0001). CONCLUSION: HR-DLR is potentially superior for coronary arterial stenosis evaluations to hybrid-type IR, MBIR, or DLR shown on CCTA. KEY POINTS: Question How do coronary arterial stenosis evaluations by hybrid-type IR, MBIR, DLR, and HR-DLR compare to coronary CT angiography? Findings HR-DLR showed significantly lower image noise and more accurate coronary artery disease reporting and data system (CAD-RADS) evaluation than others. Clinical relevance HR-DLR is potentially superior to other reconstruction methods for coronary arterial stenosis evaluations, as demonstrated by coronary CT angiography results on ADCT and as shown in both in vitro and in vivo studies.

BACKGROUND: Cardiac amyloidosis requires quantitative assessment using technetium-99m pyrophosphate (99mTc-PYP) single-photon emission computed tomography (SPECT)/computed tomography (CT) for adequate discrimination and evaluation of disease extent. This study aimed to evaluate the utility of standardized uptake value (SUV) analysis using 99mTc-PYP SPECT/CT in pathologically-confirmed transthyretin amyloid cardiomyopathy (ATTR-CM). The study also explored the relationship between local uptake heterogeneity and indicators of cardiac impairment. METHODS: Forty patients diagnosed via heart biopsy and genetic analysis (20 ATTR-CM; 4 light-chain amyloidosis, 16 non-amyloidosis) were enrolled. The mean SUVs of the heart and aorta were measured using SPECT images. Discrimination performance was evaluated by comparing each SUV, the heart-to-aorta ratio (rSUVH/Ao), and the heart-to-contralateral-lung ratio with pathological findings serving as the gold standard. Polar maps were analyzed to assess local SUV distribution in patients with ATTR-CM. The coefficient of variation (COV) of myocardial uptake, difference score between the septum and lateral wall (%DS), base-to-apex variability, and total cardiac SUV were calculated and compared with echocardiographic parameters. RESULTS: All metrics were significantly different between the ATTR-CM and non-amyloidosis groups. The rSUVH/Ao effectively differentiated patients with ATTR-CM from those with light-chain or non-amyloidosis. Local myocardial SUV distribution correlated with impaired cardiac function. Notably, COV showed significant correlations with e' (R = 0.782) and E/e' (R =  - 0.625), linking heterogeneity to myocardial stiffness and diastolic dysfunction. Larger %DS, which predominantly reflected the ATTR-CM pattern of high septal uptake, correlated significantly with thinner walls (average wall thickness, R =  - 0.655; relative wall thickness, R =  - 0.486). As the total cardiac SUV increased, the %DS decreased (reflecting more homogeneous distribution), and global longitudinal strain worsened (R = 0.614). These observations indicated that greater impairment was associated with a higher disease burden. CONCLUSIONS: This study demonstrated that quantitative SPECT analysis provides a valuable tool for the diagnostic evaluation and differentiation of ATTR-CM. The rSUVH/Ao offers high discriminatory performance. Local heterogeneity and total myocardial uptake are closely related to the disease burden and extent, as reflected by structural and functional abnormalities on echocardiography. These findings suggest potential relevance to the non-invasive assessment of these aspects of the disease at a single time point.

BACKGROUND: Sarcoidosis is a systemic granulomatous disease that occasionally affects the heart and poses the risks of arrhythmias, heart failure, and sudden cardiac death. CASE SUMMARY: We report a rare case of cardiac sarcoidosis presenting as a large intracardiac mass in a 76-year-old woman that was incidentally detected during a health check-up. Transthoracic echocardiography revealed a 25× 33 mm mobile mass in the left atrium. Cardiac magnetic resonance and 18F-fluorodeoxyglucose positron emission tomography/computed tomography demonstrated heterogeneous enhancement and increased metabolic activity, respectively, raising the suspicion of cardiac sarcoidosis. Bronchoscopic biopsy confirmed the presence of epithelioid granulomas, supporting the diagnosis. Surgical resection was performed because of the size of the mass and the potential for mitral valve obstruction. Histopathology confirmed the presence of non-caseating granulomas consistent with sarcoidosis. Postoperatively, corticosteroid therapy with prednisolone (initially 30 mg/day, tapered to 5 mg/day) was initiated to treat the residual lesions identified on imaging. The residual mass showed regression, with resolution of inflammatory activity, through the use of steroid therapy during follow-up. DISCUSSION: This case report highlights the diagnostic and therapeutic challenges associated with cardiac sarcoidosis presenting as a large intracardiac mass. Our findings underscore the importance of a multidisciplinary approach that utilises advanced imaging techniques, histological confirmation, and tailored management strategies that combine surgical intervention and immunosuppressive therapy for diagnosis and treatment.