scholarly journals Improved cardiovascular risk stratification with PET: [18F]meta-fluorobenzylguanidine as a potential cardiac radiotracer

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Austin Meyer ◽  
Scott Snyder
Keyword(s):  
Cardiovascular Disease ◽  
Neuroendocrine Tumors ◽  
Cardiac Imaging ◽  
Imaging Modality ◽  
Cardiac Injury ◽  
The United States ◽  
Direct Access ◽  
Cardiac Events ◽  
One Pot ◽  
Personalized Care

Background and Hypothesis:  Cardiovascular disease is the leading cause of death in the United States each year, exceeding 600,000 deaths and costing over $200B. Sympathetic dysfunction in cardiac tissue has been shown to occur in patients with recent cardiac injury or longstanding disease. The SPECT radiotracer, meta-[123I]iodobenzylguanidine (MIBG), has been used to image neuroendocrine tumors as well as global cardiac sympathetic tone through the human norepinephrine transporter-1. We will determine the utility and improved imaging the PET radiotracer meta-[18F]fluorobenzylguanidine (MFBG) can afford in cardiac care. MFBG has shown several improvements over MIBG in neuroendocrine tumors but has proven difficult to reliably synthesize.  Project Methods:  A novel synthetic pathway of MFBG utilizing copper accelerated Sandmeyer fluorination conditions is being developed to streamline its radiosynthesis from seven manipulations and an unstable precursor to four with more stable intermediates.   We also explored where MFBG may be useful in cardiology by performing a literature review through the PubMed MeSH database published after 2010.  Results:  We have developed a new MFBG precursor in one step from commercially available compounds and a one-pot automated radiosynthesis is currently in development. This improves upon current methods and may provide increased clinical availability of MFBG for future studies.  MIBG has shown prognostic value for the incidence of severe cardiac events but cannot provide any local innervation data. The PET radiotracer, [11C]hydroxyephedrine, can display local denervation within the myocardium. However, its 20.3 minute half-life prevents its widespread use beyond hospitals with direct access to a radiochemistry laboratory. To our knowledge, no cardiac imaging has been investigated using MFBG.  Conclusion and Potential Impact:  We believe MFBG could provide similar improvements to cardiac imaging as in neuroendocrine tumors. With a novel synthetic method being developed, we hope to begin pre-clinical imaging studies and provide future cardiologists with a new prognostic imaging modality which can direct personalized care to patients with cardiovascular disease. 

Effects of Cardiovascular Disease and Related Risk Factors on Neurocognition

2019 ◽  
pp. 83-116
Author(s):  
Spencer W. Liebel ◽  
Lawrence H. Sweet
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Cognitive Processing ◽  
Health Care Providers ◽  
The United States ◽  
Research Literature ◽  
Neurocognitive Functioning ◽  
Care Providers ◽  
Cardiac Events ◽  
Related Risk

Cardiovascular disease (CVD) affects approximately 44 million American adults older than age 60 years and remains the leading cause of death in the United States, with approximately 610,000 each year. With improved survival from acute cardiac events, older adults are often faced with the prospect of living with CVD, which causes significant psychological, social, and economic hardship. The various disease processes that constitute CVD also exert a deleterious effect on neurocognitive functioning. Although existing knowledge of neurocognitive functioning in CVD and its subtypes is substantial, a review of these findings by CVD type and neurocognitive domain does not exist, despite the potential impact of this information for patients, health care providers, and clinical researchers. This chapter provides a resource for clinicians and researchers on the epidemiology, mechanisms, and neurocognitive effects of CVDs. This chapter includes a discussion of neurocognitive consequences of CVD subtypes by neuropsychological domain and recommendations for assessment. Overall, the CVD subtypes that have the most findings available on specific neurocognitive domains are heart failure, hypertension, and atrial fibrillation. Despite a large discrepancy between the number of available studies across CVD subtypes, existing literature on neurocognitive effects by domain is consistent with the literature on the neurocognitive sequelae of unspecified CVD. Specifically, the research literature suggests that cognitive processing speed, attention, executive functioning, and memory are the domains most frequently affected. Given the prevalence of CVDs, neuropsychological assessment of older adults should include instruments that allow consideration of these potential neurocognitive consequences of CVD.

scholarly journals Cardio-Oncology: The Role of Echocardiography in Cancer Patients

2021 ◽  
Author(s):  
Theodoros Ntoskas
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Cardiac Imaging ◽  
Early Recognition ◽  
Cardiac Injury ◽  
Three Dimensional ◽  
Cardiovascular Complications ◽  
Cardiac Events ◽  
Ongoing Research ◽  
Wide Availability

Cardio-oncology is a rapidly emerging medical field that focusses on the improvement of the quality of life of cancer patients by preventing and treating the adverse cardiovascular complications of cancer therapy. Early recognition of cancer therapy-related cardiac dysfunction (CTRCD) provides an opportunity to mitigate cardiac injury and risk of developing late cardiac events. Cardiac imaging, and in particular, transthoracic echocardiography, plays an essential role in the baseline assessment, the detection and the surveillance of CRTCD in patients during and after the cancer therapy. Although the frequency of screening for the cardiotoxicity in patients undergoing active treatments and cancer survivors remains a topic of debate and ongoing research, echocardiography continues to be the leader for continuous monitoring by imaging due to the wide availability, lack of exposure to radiation, ability to recognise the effects on cardiac function and assess haemodynamics and other cardiac structures. The cardiac imaging applied to cardio-oncology includes standard and advanced (speckle tracking and three-dimensional (3D)) echocardiography.

scholarly journals Appropriate utilization of cardiac computed tomography for the assessment of stable coronary artery disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael Hammer ◽  
Muhtashim Mian ◽  
Levi Elhadad ◽  
Mary Li ◽  
Idan Roifman
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Imaging ◽  
Cardiac Computed Tomography ◽  
The United States ◽  
Appropriate Use ◽  
Potential Cost ◽  
Cardiac Computed Tomography Angiography ◽  
Artery Disease

Abstract Background Appropriate use criteria (AUC) have been developed in response to growth in cardiac imaging utilization and concern regarding associated costs. Cardiac computed tomography angiography (CCTA) has emerged as an important modality in the evaluation of coronary artery disease, however its appropriate utilization in actual practice is uncertain. Our objective was to determine the appropriate utilization of CCTA in a large quaternary care institution and to compare appropriate utilization pre and post publication of the 2013 AUC guidelines. We hypothesized that the proportion of appropriate CCTA utilization will be similar to those of other comparable cardiac imaging modalities and that there would be a significant increase in appropriate use post AUC publication. Methods We employed a retrospective cohort study design of 2577 consecutive patients undergoing CCTA between January 1, 2012 and December 30, 2016. An appropriateness category was assigned for each CCTA. Appropriateness classifications were compared pre- and post- AUC publication via the chi-square test. Results Overall, 83.5% of CCTAs were deemed to be appropriate based on the AUC. Before the AUC publication, 75.0% of CCTAs were classified as appropriate whereas after the AUC publication, 88.0% were classified as appropriate (p < 0.001). The increase in appropriate utilization, when extrapolated to the Medicare population of the United States, was associated with potential cost savings of approximately $57 million per year. Conclusions We report a high rate of appropriate use of CCTA and a significant increase in the proportion of CCTAs classified as appropriate after the AUC publication.

scholarly journals Lessons Learned from Development of a Mobile App for Cardiovascular Health Awareness

2021 ◽  
Vol 13 (11) ◽  
pp. 5985
Author(s):  
Bryan Weichelt ◽  
Jeffrey VanWormer ◽  
Yin Xu ◽  
Chris Kadolph ◽  
Simon Lin
Keyword(s):  
Cardiovascular Disease ◽  
Health Information ◽  
Healthcare System ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
The United States ◽  
Mobile App ◽  
Lessons Learned ◽  
Health Concern ◽  
Development Processes

Cardiovascular disease (CVD) is a major public health concern in the United States. In response to the federally sponsored Million Hearts Risk Check Challenge, a team of programmers, software developers, health-information technologists, and clinicians in an integrated healthcare system in Wisconsin collaborated to develop Heart Health MobileTM (HHM), designed to improve awareness of cardiovascular disease risk and promote risk factor control among users. This paper outlines the development processes and highlights key lessons learned for mobile health applications. An agile project management methodology was used to dedicate adequate resources and employ adaptive planning and iterative development processes with a self-organized, cross-functional team. The initial HHM iOS app was developed and tested, and after additional modifications, gamified and HTML 5 versions of the app were released. The development of an iOS app is low in cost and sustainable by a healthcare system. Future app modifications to enhance data security and link self-reported cardiovascular risk assessment data to patient medical records may improve performance, patient relevance, and clinician acceptance of HHM in the primary-care setting. Legal and institutional barriers regarding the capture and analyses of protected health information must be mitigated to fully capture, analyze, and report patient health outcomes for future studies.

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