Use of gated myocardial perfusion imaging to assess clinical value of Xinmailong injection in chronic congestive heart failure

OBJECTIVE: This study used gated myocardial perfusion imaging(G-MPI) to assess the clinical value of Xinmailong injection in chronic congestive heart failure(CHF).METHODS: A total of 102 CHF patients were randomly divided into the control group(n=51) and the Xinmailong group(n=51). Patients in the control group were routinely treated. Patients in the Xinmailong group were additionally treated with Xinmailong injection in addition to routine treatment. Before and 3 months after treatment, G-MPI was used to determine changes in the left ventricular ejection fraction(LVEF), left ventricular end-diastolic volume(LVEDV) and left ventricular end-systolic volume(LVESV). Fourteen days after treatment, changes in plasma brain natriuretic peptide(BNP) levels were determined.RESULTS: Before treatment, there were no significant differences in LVEF, LVEDV, LVESV, and BNP levels between the two groups(all P>0.05). After treatment, LVEDV, LVESV, and BNP levels were significantly lower, and LVEF was significantly higher in the Xinmailong group than in the control group(all P<0.05).CONCLUSION: Additional use of Xinmailong injection in addition to routine treatment improves cardiac function of CHF patients. Because of the safety and effectiveness of Xinmailong injection, this therapy should be promoted.

Myocardial perfusion imaging with a contrast agent at a low concentration in the diagnosis of myocardial infarction in the elderly

Objective To evaluate the clinical value of myocardial perfusion imaging with dual-source dual-energy CT and a contrast agent at a low concentration in the diagnosis of myocardial infarction in the elderly.Methods Onestop cardiac imaging with dual-source CT was conducted in 138 elderly patients diagnosed with myocardial infarction between October 2015 and May 2016.The

Predicting major adverse cardiovascular events after orthotopic liver transplantation using a supervised machine learning model:A cohort study

BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress testing loses accuracy when applied to pre-LT cirrhotic patients.AIM To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional cohort.METHODS This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic center.We developed a predictive model for post-LT MACE(defined as a composite outcome of stroke,new-onset heart failure,severe arrhythmia,and myocardial infarction)using the extreme gradient boosting(XGBoost)machine learning model.We addressed missing data(below 20%)for relevant variables using the k-nearest neighbor imputation method,calculating the mean from the ten nearest neighbors for each case.The modeling dataset included 83 features,encompassing patient and laboratory data,cirrhosis complications,and pre-LT cardiac assessments.Model performance was assessed using the area under the receiver operating characteristic curve(AUROC).We also employed Shapley additive explanations(SHAP)to interpret feature impacts.The dataset was split into training(75%)and testing(25%)sets.Calibration was evaluated using the Brier score.We followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for reporting.Scikit-learn and SHAP in Python 3 were used for all analyses.The supplementary material includes code for model development and a user-friendly online MACE prediction calculator.RESULTS Of the 537 included patients,23(4.46%)developed in-hospital MACE,with a mean age at transplantation of 52.9 years.The majority,66.1%,were male.The XGBoost model achieved an impressive AUROC of 0.89 during the training stage.This model exhibited accuracy,precision,recall,and F1-score values of 0.84,0.85,0.80,and 0.79,respectively.Calibration,as assessed by the Brier score,indicated excellent model calibration with a score of 0.07.Furthermore,SHAP values highlighted the significance of certain variables in predicting postoperative MACE,with negative noninvasive cardiac stress testing,use of nonselective beta-blockers,direct bilirubin levels,blood type O,and dynamic alterations on myocardial perfusion scintigraphy being the most influential factors at the cohort-wide level.These results highlight the predictive capability of our XGBoost model in assessing the risk of post-LT MACE,making it a valuable tool for clinical practice.CONCLUSION Our study successfully assessed the feasibility and accuracy of the XGBoost machine learning model in predicting post-LT MACE,using both cardiovascular and hepatic variables.The model demonstrated impressive performance,aligning with literature findings,and exhibited excellent calibration.Notably,our cautious approach to prevent overfitting and data leakage suggests the stability of results when applied to prospective data,reinforcing the model’s value as a reliable tool for predicting post-LT MACE in clinical practice.

Cardiac stress testing and coronary artery disease in liver transplantation candidates： Meta-analysis

dAIMTo evaluate the diagnostic value of dobutamine stress echocardiography （DSE） and myocardial perfusion sci-ntigraphy （MPS） in predicting coronary artery disease （CAD） in cirrhotic patients listed for liver transplanta-tion （LT）, using invasive coronary angiography （ICA） as gold-standard.METHODSRetrieval of studies was based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, EMBASE, MEDLINE （PubMed）, BIREME （Biblioteca Regional de Medicina）, LILACS （Latin American and Cari-bbean Health Sciences Literature）, Cochrane Library for Systematic Reviews and Opengray.eu. There was reference lists of the studies retrieved were searched manually.RESULTSThe search strategy retrieved 322 references for DSE and 90 for MPS. In the fnal analysis, 10 references for DSE and 10 for MPS were included. Pooled sensitivity was 28% and 61% for DSE and MPS and specificity was 82% and 74%, for diagnosis of CAD using ICA as gold-standard, respectively.CONCLUSIONDSE and MPS do not have adequate sensitivity for determination of whether CAD is present, despite having signifcant specifcity.

Significance of inferior wall ischemia in non-dominant right coronary artery anatomy

AIM To investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with nondominant right coronary artery anatomy.METHODS This was a retrospective observational analysis of consecutive patients who presented to the emergency department with primary complaint of chest pain.Only patients who underwent single photon emission computed tomography(SPECT)myocardial perfusion imaging(MPI)were included.Patients who showed a reversible defect on SPECT MPI and had coronary angiography during the same hospitalization was analyzed.Patients with prior history of coronary artery disease(CAD)including history of percutaneous coronary intervention and coronary artery bypass graft surgerys were excluded.True positive and false positive results were identified on the basis of hemodynamically significant CAD on coronary angiography,in the same territory as identified on SPECT MPI.Coronary artery dominance was determined on coronary angiography.Patients were divided into group 1 and group 2.Group1 included patients with non-dominant right coronary artery(RCA)(left dominant and codominant).Group2 included patients with dominant RCA anatomy.Demographics,baseline characteristics and positive predictive value(PPV)were analyzed for the two groups.RESULTS The mean age of the study cohort was 57.6 years.Sixtyone point seven percent of the patients were males.The prevalence of self-reported diabetes mellitus,hypertension and dyslipidemia was 36%,71.9%and 53.9%respectively.A comparison of baseline characteristics between the two groups showed that patients with a non-dominant RCA were more likely to be men.For inferior wall ischemia on SPECT MPI,patients in study group 2 had a significantly higher PPV,32/42(76.1%),compared to patients in group 1,in which only 3 out of the 29 patients(10.3%)had true positive results(P value<0.001 Z test).The difference remained statistically significant even when only patients with left dominant coronary system(without co-dominant)were compared to patients with right dominant system(32/40,76.1%in right dominant group,3/19,15.8%in left dominant group,P value<0.001 Z test).There was no significant difference in mean hospital stay,re-hospitalization,and in-hospital mortality between the two groups.CONCLUSION The positive predictive value of SPECT MPI for inferior wall ischemia is affected by coronary artery dominance.More studies are needed to explain this phenomenon.

Hige namine as a Potential Pharmacologic Stress Age nt in the Detection of Coro nary Artery Disease

Myocardial perfusion imaging(MPI) is valuable for the diagnosis,prognosis,and management of coronary artery disease(CAD).The most commonly used pharmacologic stress agents at present are vasodilators and adrenergic agents.However,these agents have contraindications and may cause adverse effects in some patients.Thus,other stress agents feasible for more patients are required.Higenamine(HG) is a β-adrenergic receptor agonist currently approved for clinical trials as a stress agent for myocardial infarction.It also has a promising value in MPI for the detection of CAD in preclinical and clinical studies.This review summarizes the application of HG on MPI,including its mechanism of action,stress protocol,efficacy,and safety.