Fast vs slow rubidium-82 infusion profiles and test-retest precision of myocardial perfusion using contemporary 3D cardiac analog positron emission tomography-computed tomography imaging.

Background: On legacy 2D positron emission tomography (PET) systems utilizing a 50 mL/min Rb-82 profile, test-retest precision of quantitative perfusion is ∼10%. It is unclear whether Rb-82 infusion rate significantly impacts quantitative perfusion and/or image quality on modern analog 3D PET-CT systems. We aimed to determine whether the Rb-82 infusion profile significantly impacts test-retest precision of quantitative perfusion, perfusion metrics, and/or image quality on a modern analog 3D PET-CT scanner.

Assessment of resting myocardial blood flow in regions of known transmural scar to confirm accuracy and precision of 3D cardiac positron emission tomography.

Background: Composite invasive and non-invasive data consistently demonstrate that resting myocardial blood flow (rMBF) in regions of known transmural myocardial scar (TMS) converge on a value of ~ 0.30 mL/min/g or lower. This value has been confirmed using the 3 most common myocardial perfusion agents (N, O-HO and Rb) incorporating various kinetic models on older 2D positron emission tomography (PET) systems.

Impact of Preinfection Left Ventricular Ejection Fraction on Outcomes in COVID-19 Infection.

Coronavirus disease 2019 (COVID-19) has high infectivity and causes extensive morbidity and mortality. Cardiovascular disease is a risk factor for adverse outcomes in COVID-19, but baseline left ventricular ejection fraction (LVEF) in particular has not been evaluated thoroughly in this context. We analyzed patients in our state's largest health system who were diagnosed with COVID-19 between March 20 and May 15, 2020.

PET Stress Testing with Coronary Flow Capacity in the Evaluation of Patients with Coronary Artery Disease and Left Ventricular Dysfunction: Rethinking the Current Paradigm.

Purpose Of Review: Cardiomyopathy with underlying left ventricular (LV) dysfunction is a heterogenous group of disorders that may be present with, and/or secondary to, coronary artery disease (CAD). The purpose of this review is to demonstrate, via case illustrations, the benefits offered by cardiac positron-emission tomography (PET) stress testing with coronary flow capacity (CFC) in the evaluation and treatment of patients with left ventricular (LV) dysfunction and CAD.

Recent Findings: CFC, a metric that is increasing in prominence, represents the integration of several absolute perfusion metrics into clinical strata of CAD severity.

Positron emission tomography absolute stress myocardial blood flow for risk stratification in nonischemic cardiomyopathy.

Introduction: Sudden cardiac death is a substantial cause of mortality in patients with cardiomyopathy, but evidence supporting implantable cardioverter-defibrillator (ICD) implantation is less robust in nonischemic cardiomyopathy (NICM) than in ischemic cardiomyopathy. Improved risk stratification is needed. We assessed whether absolute quantification of stress myocardial blood flow (sMBF) measured by positron emission tomography (PET) predicts ventricular arrhythmias (VA) and/or death in patients with NICM.

Class 1C antiarrhythmic drugs in atrial fibrillation and coronary artery disease.

Background: Class 1C antiarrhythmic drugs (AADs) are effective first-line agents for atrial fibrillation (AF) treatment. However, these agents commonly are avoided in patients with known coronary artery disease (CAD), due to known increased risk in the postmyocardial infarction population. Whether 1C AADs are safe in patients with CAD but without clinical ischemia or infarct is unknown.

Digital Management of Hypertension Improves Systolic Blood Pressure Variability.

Background: Higher systolic blood pressure variability has been shown to be a better predictor of all-cause and cardiovascular disease mortality, stroke, and cardiac disease compared with average systolic blood pressure.

Methods: We evaluated the impact of a digital hypertension program on systolic blood pressure variability in 803 consecutive patients with long-standing hypertension who had been under the care of a primary care physician for a minimum of 12 months prior to enrollment (mean 4.7 years).

The impact of revascularization on myocardial blood flow as assessed by positron emission tomography.

Purpose: Revascularization aims to improve myocardial perfusion. However, changes in regional artery-specific quantitative perfusion after revascularization have not been systematically investigated. It is unclear whether artery-specific thresholds for coronary flow capacity (CFC) and/or relative perfusion predict improved stress perfusion after revascularization.

Reducing Hospital Toxicity: Impact on Patient Outcomes.

Background: Circadian rhythms are endogenous 24-hour oscillations in biologic processes that drive nearly all physiologic and behavioral functions. Disruption in circadian rhythms can adversely impact short- and long-term health outcomes. Routine hospital care often causes significant disruption in sleep-wake patterns that is further compounded by loss of personal control of health information and health decisions.

Hypertension management in the digital era.

Purpose Of Review: Hypertension (HTN) is the most common chronic disease in the United States, and the standard model of office-based care delivery continues to yield suboptimal outcomes, with approximately 50% of affected patients not achieving blood pressure (BP) control. Poor population-level BP control has been primarily attributed to therapeutic inertia and low patient engagement resulting in significant and preventable morbidity and mortality. This review will highlight the rationale for a reengineered model of care delivery for populations with HTN.

New Concepts in Hypertension Management: A Population-Based Perspective.

Hypertension (HTN) is the most common chronic disease in the U.S., and the standard model of office-based care delivery has yielded suboptimal outcomes, with approximately 50% of affected patients not achieving blood pressure (BP) control.

Improving Hypertension Control and Patient Engagement Using Digital Tools.

Hypertension is present in 30% of the adult US population and is a major contributor to cardiovascular disease. The established office-based approach yields only 50% blood pressure control rates and low levels of patient engagement. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record.

The effect of coronary revascularization on regional myocardial blood flow as assessed by stress positron emission tomography.

Objectives: We examined whether regional improvement in stress myocardial blood flow (sMBF) following angiography-guided coronary revascularization depends on the existence of a perfusion defect on positron emission tomography (PET).

Background: Percent stenosis on coronary angiography often is the main factor when deciding whether to perform revascularization, but it does not reliably relate to maximum sMBF. PET is a validated method of assessing sMBF.

The Role of Technology in Chronic Disease Care.

Chronic disease represents the epidemic of our time, present in half the adult population and responsible for 86% of United States (US) healthcare costs and 70% of deaths. The major chronic diseases are primarily due to health risk behaviors that are widely communicable across populations. As a nation, the US has performed poorly in managing chronic disease, in large part because of a failed delivery model of care.

What is ischemia and how should this be defined based on modern imaging?

How do we define myocardial ischemia? This is an important question for clinicians and one that, while conceptually straight forward, can be practically difficult to assess. In this article we describe the various imaging methods available in cardiology to quantify myocardial ischemia. Anatomic assessments of ischemia such as angiography, while the "gold standard", have limitations.