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Background and aims High coronary artery calcium (CAC) scores were shown to predict a higher likelihood of inducible myocardial ischemia and to be associated with a poor cardio-vascular prognosis. However the predictive value for coronary stenoses (CS) has not been tested in asymptomatic diabetic patients. This study aimed to evaluate the predictive value of a high CAC score for silent myocardial ischemia (SMI) and CS in high risk asymptomatic diabetic patients. Materials and methods CAC score was measured by computed tomography in 150 diabetic patients without cardiac history or symptom, with a normal resting ECG and ≥1 additional risk factors. SMI was assessed using stress myocardial scintigraphy and/or stress echocardiography, and CS using coronary angiography in those with an abnormal SMI test. Results CAC score was ≥100 Agatston units in 35.3% of the patients. SMI was detected in 27 patients (18.0%). A coronary angiography was performed in 17 of SMI patients and detected significant CS in six of them. CAC score was associated with coronary status (no SMI: median value 14 (range 0-2900); SMI without CS: 101 (23-3230) and SMI with CS: 800 (76-2978); (p<0.01)), and similarly for a CAC score ≥100 (in 37/123 patients without SMI (30.2%), 6/11 with SMI and no CS (54.5%) and 5/6 patients with SMI and CS (83.3%) (p<0.05). A CAC score ≥100 predicted the presence of SMI: 30.2% of patients had SMI vs 11.3% of those with CAC <100 (odds ratio 3.4 [1.4-8.0], p<0.01), with a sensitivity and specificity of 59% and 70%, and positive and negative predictive values of 30 and 87%, respectively. Conclusion These data suggest that in asymptomatic high risk diabetic patients CAC score is associated with cardiac ischemic status, with a 3.4-fold increased risk of SMI when the score is ≥100. The negative predictive value of CAC score for SMI is an interesting finding. The predictive value for CS remains to be determined in a larger sample of patients with CS. [ABSTRACT FROM AUTHOR]

Abstract: This study shows for the first time, that dexfenfluramine, a 5-HT2 receptor agonist, attenuates the development of chronic hypoxia-induced pulmonary hypertension. Chronic exposure to hypoxia, 4 weeks, induced hypoxic pulmonary hypertension in adult rat as haemodynamic and cardiac measurements showed significant modifications in right ventricle parameters (free wall right ventricle thickness; pulmonary acceleration time and velocity time integral) in chronic hypoxic control when compared to normoxic control animals. We observed that free wall right ventricle thickness and pulmonary velocity time integral were significantly less in chronic hypoxic rats treated with dexfenfluramine when compared to chronic hypoxic control rats. Similarly, rats exposed to chronic hypoxia exhibited an increase in both right ventricle pressure and weight by comparison to normoxic control animals but those variations were significantly diminished in dexfenfluramine-treated rats, indicating the moderating influence exerted by dexfenfluramine on chronic hypoxia-induced pulmonary hypertension and cardiac alterations. Thus, we report here the ability of dexfenfluramine to limit chronic hypoxia-induced pulmonary hypertension, emphasizing the importance of the time after the dexfenfluramine treatment discontinuation to assess the influence of this 5-HT receptor agonist on the development of chronic hypoxia-induced pulmonary hypertension. [Copyright &y& Elsevier]

Abstract: This paper presents a method to analyze the local wall motion of the left ventricle of the heart. Data are sets of points (obtained from various medical imaging modalities) corresponding to surfaces of the left ventricle, which evolve as a function of time. After re-sampling, the surfaces are segmented in order to create regions of equivalent volume. Then, the local cardiac parameters are estimated: evolution of the regional volumes as a function of time, ejection fraction, end-diastolic and end-systolic volumes, end-diastolic and end-systolic instants. The method has been validated using deformable surfaces synthesized from an ellipsoidal model. It has also been tested in vivo on a set of 59 patients using a specially developed software product, which satisfies severe constraints of robustness, real-time, interactivity and ergonomics. The results obtained are similar to those provided by a reference nuclear medicine examination, but the proposed method is faster and gives a more precise localization of the cardiac wall motion anomalies. [Copyright &y& Elsevier]

Abstract: Objectives: We aimed to assess the clinical value of FDG-PET/CT in patients with ANCA-associated vasculitis. Materials and methods: We retrospectively included 16 patients with ANCA-associated vasculitis who underwent 21 FDG-PET/CT between 2009 and 2013, in 2 university hospitals from the Paris suburb area. All FDG-PET/CTs were retrospectively analyzed and compared to clinical, biological and conventional imaging data at baseline and during the follow-up. Results: ANCA-associated vasculitis was granulomatosis with polyangiitis (GPA, n=10), microscopic polyangiitis (MPA, n=4), and eosinophilic GPA (EGPA, n=2). PET was performed at initial presentation in 14 cases and during the follow-up in 7 cases. At baseline, PET was positive in 100% of GPA patients (8/8) and in 50% (3/6) of patients with other ANCA-vasculitis (p=0.05). FDG uptake tended to be higher in patients with GPA in comparison to patients with MPA/EGPA (median SUVmax: 5 versus 2.5; p=0.08). Sinonasal, lung, cardio-vascular and kidney involvements were all accurately identified by PET, except in one MPA patient with glomerulonephritis. As expected, skin, joint, eye and peripheral nervous system impairments were not detected by PET. No occult site was detected by PET, except in 2 salivary gland FDG uptake without clinical abnormalities. Patients with GPA exhibited a higher number of positive sites on PET (2 [1.75–2.25] versus 0.5 [0–1], p=0.006) than patients with MPA/EGPA. In pooled data including our study and the literature data of GPA patients (n=31), SUVmax was associated with Birmingham Vasculitis Activity Score (BVAS) (r=0.49; p=0.03). Conclusion: FDG-PET/CT accurately identifies organ localizations in GPA, other than in nervous system, eye and skin, but do not bring additional benefit to the usual organ screening. The value of FDG-PET/CT in other ANCA-associated vasculitis need to be further addressed. [Copyright &y& Elsevier]

Abstract: Objective: This study aims to determine the value of FDG-PET/CT to assess disease activity in patients with Sjögren's syndrome (SS). Methods: Thirty-two patients with SS who underwent PET/CT were retrospectively analyzed. PET/CT activity score was measured using a 6-point scale including the 6 following items (0/1: absence or presence of an item): lymphadenopathy on CT, high-resolution CT (HRCT) evidence of interstitial lung disease (ILD), parotid glands SUVmax >3, submandibular glands SUVmax >3, lymph node uptake, ILD uptake. Combined PET/CT score was correlated to ESSDAI (EULAR Sjögren's Syndrome Disease Activity Index) score and other parameters of SS activity. Results: Pathological FDG uptake was observed in 75% of patients (24/32): lymph-nodes (n=19, 60%), salivary glands (n=17, 53%), lungs (n=9, 28%), and thyroid (n=2). Median ESSDAI and PET/CT activity scores were 9.5 [5–12] and 2 [0–3], respectively. PET/CT activity score correlated with ESSDAI (r=0.49, p=0.005), unlike SUVmax. Patients with a high ESSDAI score had a higher PET/CT activity score than patients with a low ESSDAI score (3 vs 1, p=0.004). PET was also correlated with gammaglobulin levels (r=0.43, p=0.02), but not with the presence of cryoglobulinemia, activated complement or beta-2 microglobulin levels. The FDG uptake in patients with lymphoma (n=4) was higher than in patients without lymphoma (SUVmax=5.4 vs. 3.2, p=0.05). Conclusion: We described a new PET/CT activity score, which correlates to ESSDAI and could help to assess disease activity in SS patients. PET can also help in the diagnosis of lymphoma, even if inflammatory lymph nodes can be frequently observed in SS patients. [Copyright &y& Elsevier]

Abstract: The aim of the experiments was to assess the toxicity of minoxidil, a potent vasodilator, in marmosets. The animals were treated either at escalating doses from 2 to 40mg/kg, escalating doses from 40 to 200mg/kg or single doses of 150mg/kg or 200mg/kg. ECG recording and echocardiographic examination were conducted before and 1h after treatment. Necropsy and histopathology were performed 24h after the last dose. The treatment with minoxidil induced myocardial necrosis, coronary arteriopathy and degeneration of renal tubules in animals treated with 150mg/kg or 200mg/kg. Myocardial necrosis associated with fibrosis in some animals was located mainly in the left and right ventricles (including papillary muscles), but also in the right atrium, left atrium and/or interventricular septum. Arteriopathy was observed in small coronary arteries of the right or left atrium. ECG and echocardiographic examinations showed that in animals treated with 150mg/kg or 200mg/kg, there were positive chronotropic and inotropic effects that compensated for the hypotensive effect of the drug and were considered to have played a key role in the pathogenesis of the cardiovascular lesions. The cardiotoxicity of minoxidil in marmosets was similar to that described in dogs, but occurred at much higher doses. In conclusion minoxidil produced cardiovascular toxicity in the marmoset, which was probably due to the marked changes in the cardiac function associated with exaggerated pharmacological effects of the compound. The marmosets were found to be less sensitive than dogs to the cardiotoxicity of minoxidil. [Copyright &y& Elsevier]