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Myocardial bridging (MB) is a common anatomic variant in coronary arteries with unclear functional significance. We evaluated regional myocardial strain by speckle tracking during dobutamine stress echocardiography (DSE) in patients with MB in the left anterior descending coronary artery (LAD). We studied 11 patients with MB in the LAD and no obstructive coronary artery disease (CAD), 7 patients without MB, but obstructive CAD in the LAD, and 12 controls without MB or obstructive CAD. MB was defined as either > 1 mm (superficial) or > 2 mm (deep) intramyocardial course of the LAD in coronary CT angiography. Regional longitudinal, radial and circumferential strains and strain rates as well as post-systolic strain index (PSI) were measured at rest, peak stress, and early recovery (1 min after stress). Strain parameters during DSE were similar in the myocardium distal to MB and other myocardial regions of the same patients as well as the LAD territory in controls. However, patients with obstructive CAD showed impaired LS and strain rate as well as increased PSI at peak stress. None of the MB was associated with systolic compression in invasive coronary angiography and strain parameters were similar between superficial and deep MB. Stress myocardial blood flow by positron emission tomography correlated with LS and RS at peak stress in the myocardium distal to MB (r = - 0.73, p = 0.03, and r = 0.64, p = 0.04, respectively). Myocardial strain is not reduced during DSE in patients with MB in the LAD and no significant systolic compression., (© 2024. The Author(s).)

Background: Cardiac sarcoidosis (CS) is a rare but potentially fatal inflammatory cardiomyopathy., Objectives: The authors studied temporal changes in the incidence, characteristics, and outcome of CS., Methods: A retrospective analysis was made of a 30-year nationwide cohort of CS., Results: The cohort comprised 511 patients with a median age of 52 years and female preponderance (69%). Altogether 77, 166, and 268 cases of CS were diagnosed in years 1988 to 2009, 2010 to 2014, and 2015 to 2019, respectively; the 5-year count of 2015 to 2019 was 134-fold the count of 1990 to 1994 (268/2) and 18-fold the count of 2000 to 2004 (268/15). Prior to 2010, compared with the later periods, CS presented more often with ventricular tachycardia/fibrillation (prevalence 36% vs 19% in 2010-2014 and 11% in 2015-2019, P  < 0.001), left ventricular ejection fraction <50% (49%, 35%, and 31%; P  = 0.010), and elevation of natriuretic peptides (87%, 57%, and 49%; P  < 0.001). On magnetic resonance imaging, late gadolinium enhancement involved a median of 15% (IQR: 11%-22%) of left ventricular mass in studies of 1988 to 2009 (n = 16), 15% (IQR: 9%-22%) in studies of 2010 to 2014 (n = 87), and 11% (IQR: 5%-19%) in studies of 2015 to 2019 (n = 150) ( P  = 0.031). The respective 5-year incidences of the composite of death, heart transplantation, left ventricular-assisted device implantation, or ventricular tachyarrhythmia were 40% (95% CI: 29%-51%), 32% (95% CI: 25%-39%), and 23% (95% CI: 16%-30%) ( P  = 0.002). The prognostic trend disappeared after adjustment for differences in the presenting phenotype., Conclusions: Diagnoses of incident CS have increased exponentially in Finland. Concurrently, the phenotype has turned milder and prognosis better, suggesting detection of CS at an earlier stage of its course., Competing Interests: Dr Pöyhönen was supported by the 10.13039/501100003125Finnish Cultural Foundation (Helsinki, Finland), 10.13039/501100005633Finnish Foundation for Cardiovascular Research (Helsinki, Finland) and Finnish government grant for medical research (Helsinki, Finland). Dr Uusitalo has scientific collaboration with lecture fees with GE Healthcare; and has received lecture fee and advisory board activity with Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Competing Interests: Disclosures Dr Uusitalo reports advisory board activity with and lecture honoraria from GE Healthcare and Pfizer. Dr Lehtonen reports lecture honoraria from Pfizer. The other authors report no conflicts.

Mitigation actions in all sectors of society, including sports, to limit global warming have become an increasingly hot topic in public discussions and sports management. However, so far, there has been a lack of understanding and practical examples of how these organizations, especially in team sports, can holistically assess and reduce their climate impacts to achieve carbon neutrality. This paper presents a carbon footprint assessment, implemented actions for GHG emission reduction, and offers the example of a professional Finnish ice hockey team that achieved carbon neutrality. The study is based on a life cycle assessment method. The Results show that the team's carbon footprint was reduced from 350 tCO 2eq by more than 50% between seasons 2018-2019 and 2021-2022 in the assessed categories. The most GHG emission reductions were achieved in the team's and spectators' mobility and ice hall energy consumption. Furthermore, the team compensated for their remaining emissions to achieve carbon neutrality. Multiple possibilities for further GHG emission reductions were recognized. The majority of the GHG emissions were linked to the Scope 3 category, indicating that co-operation with partners and stakeholders was a key to success in attaining carbon neutrality. This paper also discusses the possible limitations and challenges that sport organizations face in assessing climate impacts and reducing GHG emissions, as well as the prospects of overcoming them. Since there are many opportunities for sports to contribute to climate change mitigation, relevant targets and actions to reduce GHG emissions should be integrated into all sport organizations' management., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Cardiac transthyretin amyloidosis (ATTR) is a possible incidental finding on bone scintigraphy imaged due to prostate cancer. We investigated its significance in 1426 elderly prostate cancer patients (>70 years) who underwent bone scintigraphy in three nuclear medicine departments in Finland. Patients with Perugini grade two or three uptakes were considered positive for cardiac uptake. Heart failure diagnoses and pacemaker implantations were collected from the hospital's records. Mortality data were gathered from the Finnish national statistical service (Statistics Finland). The Median follow-up time was 4 years (interquartile range: 2-5 years). Cardiac uptake was detected in 37 individuals (2.6%), and it was associated with an elevated risk of both overall and cardiovascular death in univariable analysis. However, cardiac uptake did not predict overall mortality in the multivariable analysis when adjusted to age, bone metastases or the diagnosis of heart failure (p > 0.05). The risk of heart failure was higher in patients with cardiac uptake (47% vs. 15%, p < 0.001), while the risk of pacemaker implantations was not elevated (5% vs. 5%, p = 0.89). In conclusion, cardiac uptake on bone scintigraphy imaged due to prostate cancer is associated with an elevated risk of heart failure and both overall and cardiovascular death. However, cardiac uptake was not independently associated with overall mortality when adjusted to age, bone metastasis or heart failure. Therefore, they are essential to consider when incidental cardiac uptake is detected on bone scintigraphy. The need for pacemaker implantation was not elevated in patients with cardiac uptake., (© 2023 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.)

Background: Coronary computed tomography angiography is increasingly used as the first-line test for suspected coronary artery disease. Its overuse in a low pretest probability (PTP) population may lead to low diagnostic yield without change in patient management. We evaluated the clinical consequences of the updated 2019 European Society of Cardiology (ESC) chronic coronary syndromes guidelines' PTP estimation and whether imaging could be safely deferred in patients with a low PTP., Methods and Results: This retrospective cohort included all 1753 consecutive patients who underwent coronary computed tomography angiography for suspected coronary artery disease at Helsinki University Hospital between 2009 and 2017. PTP was calculated according to the 2013 and 2019 ESC guidelines. The overall mortality, cardiac deaths, myocardial infarctions, and hospitalizations for unstable angina were acquired from national registry data for 1 to 10 years of follow-up (median, 4 years). Updated 2019 ESC guidelines classified 72% of the patients as having low PTP, whose imaging could have been deferred. The revascularization rate (4.7%) and annual cardiac mortality (0.4%) were low in the 857 patients reclassified from the recommendation to test, according to the 2013 ESC guideline, to deferral of coronary computed tomography angiography, according to the new 2019 guideline., Conclusions: The updated 2019 ESC guideline PTP score aids clinicians in safely preventing the overuse of cardiac imaging in patients deemed at low PTP of coronary artery disease. Diagnostic yield, revascularization rate, and cardiac mortality are low in patients with low pretest risk.

Background: Splenic switch-off (SSO) is a marker of adequate adenosine-induced vasodilatation on cardiac magnetic resonance perfusion imaging. We evaluate the feasibility of quantitative assessment of SSO in myocardial positron emission tomography (PET) perfusion imaging using [ 15 O]H 2 O., Methods: Thirty patients underwent [ 15 O]H 2 O PET perfusion with adenosine stress. Time-activity curves, as averaged standardized uptake values (SUV avg ), were extracted from dynamic PET for spleen and liver. Maximum SUV avg , stress and rest spleen-to-liver ratio (SLR), and the splenic activity concentration ratio (SAR) were computed. Optimal cut-off values for SSO assessment were estimated from receiver operating characteristics (ROC) curve for maximum SUV avg and SLR. Also, differences between coronary artery disease, myocardial ischemia, beta-blockers, and diabetes were assessed. Data are presented as median [interquartile range]., Results: In concordance with the SSO phenomenon, both the spleen maximum SUV avg and SLR were lower in adenosine stress when compared to rest perfusion (8.1 [6.5, 9.2] versus 16.4 [13.4, 19.0], p < 0.001) and (0.81 [0.63, 1.08] versus 1.86 [1.73, 2.06], p < 0.001), respectively. During adenosine stress, the SSO effect was most prominent 40-160 s after radiotracer injection. Cut-off values of 12.6 and 1.57 for maximum SUV avg  and SLR, respectively, were found based on ROC analysis. No differences in SAR, SLR Rest , or SLR Stress were observed in patients with coronary artery disease, myocardial ischemia, or diabetes., Conclusions: SSO can be quantified from [ 15 O]H 2 O PET perfusion and used as a marker for adequate adenosine-induced vasodilatation response. In contrary to other PET perfusion tracers, adenosine-induced SSO is time dependent with [ 15 O]H 2 O., (© 2023. The Author(s).)

The climate impacts of biowaste collection and utilisation were assessed based on data from two regional pilots. The EU's waste legislation will require biowaste source separation and collection from detached houses in communities with over 10,000 inhabitants starting from 2024 onwards. Two novel biowaste collection approaches were piloted in two Finnish case regions. One with biowaste collection to larger biolinks with a van and another with composting biowaste bins. The biolink approach reduces the need for waste truck driving, while composting biowaste bins enable an extended collection period. A life cycle assessment method was applied to assess the climate impacts of biowaste collection options and utilisation compared with current practices. The results show that source separation of biowaste and direction to biogas production leads to lower overall greenhouse gas (GHG) emissions at the system level compared with the current waste incineration option. Waste logistics has only a minor role in total GHG emissions, but a system based on biolinks and biowaste collection using a van led to the lowest GHG emission levels. Therefore, from a GHG emissions perspective, encouraging people to source separate their biowaste should be made as easy and encouraging as possible, no matter how the actual logistics is provided. However, novel and improved approaches for source-separated biowaste collection provide the potential for additional GHG emissions reductions., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Ville Uusitalo reports financial support was provided by European Regional Development Fund.]., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Plastics are essential materials for modern societies, but their production contributes to significant environmental issues. Power-to-X processes could produce plastics from captured CO 2 and hydrogen with renewable electricity, but these technologies may also face challenges from environmental perspective. This paper focuses on environmental sustainability assessment of CO 2 -based low-density polyethylene (LDPE) compared to bio-based LDPE. Life cycle assessment has been applied to study climate impacts and land use related biodiversity impacts of different plastic production scenarios. According to the climate impact results, the carbon footprint of the produced plastic can be negative if the energy used is from wind, solar, or bioenergy and the carbon captured within the plastic is considered. In terms of biodiversity, land-use related biodiversity impacts seem to be lower from CO 2 -based polyethylene compared to sugarcane-based polyethylene. Forest biomass use for heat production in CO 2 -based polyethylene poses a risk to significantly increase biodiversity impacts. Taken together, these results suggest that CO 2 -based LDPE produced with renewable electricity could reduce biodiversity impacts over 96 % while carbon footprint seems to be 6.5 % higher when compared to sugarcane-based polyethylene., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: We evaluated the residual vascular and adipose tissue inflammation in patients with chronic coronary artery disease (CAD) using positron emission tomography (PET)., Methods: Our study population consisted of 98 patients with known CAD and 94 control subjects who had undergone 18 F-fluorodeoxyglucose ( 18 F-FDG) PET due to non-cardiac reasons. Aortic root and vena cava superior 18 F-FDG uptake were measured to obtain the aortic root target-to-background ratio (TBR). In addition, adipose tissue PET measurements were done in pericoronary, epicardial, subcutaneous, and thoracic adipose tissue. Adipose tissue TBR was calculated using the left atrium as a reference region. Data are presented as mean ± standard deviation or as median (interquartile range)., Results: The aortic root TBR was higher in CAD patients compared to control subjects, 1.68 (1.55-1.81) vs. 1.53 (1.43-1.64), p  < 0.001. Subcutaneous adipose tissue uptake was elevated in CAD patients 0.30 (0.24-0.35) vs. 0.27 (0.23-0.31), p  < 0.001. Metabolic activity of CAD patients and control subjects was comparable in the pericoronary (0.81 ± 0.18 vs. 0.80 ± 0.16, p  = 0.59), epicardial (0.53 ± 0.21 vs. 0.51 ± 0.18, p  = 0.38) and thoracic (0.31 ± 0.12 vs. 0.28 ± 0.12, p  = 0.21) adipose tissue regions. Aortic root or adipose tissue 18 F-FDG uptake was not associated with the common CAD risk factors, coronary calcium score, or aortic calcium score ( p value > 0.05)., Conclusion: Patients with a chronic CAD had a higher aortic root and subcutaneous adipose tissue 18 F-FDG uptake compared to control patients, which suggests residual inflammatory risk., Competing Interests: Competing InterestsValtteri Uusitalo had advisory board activity and lecture fees from Pfizer. Sini Toivonen, Miia Lehtinen, Peter Raivio, Juha Sinisalo and Antti Loimaala declare no conflict of interest., (© The Author(s) 2022.)

Cardiac sarcoidosis (CS) results from epithelioid cell granulomas infiltrating the myocardium and predisposing to conduction disturbances, ventricular tachyarrhythmias, and heart failure. Manifest CS, however, constitutes only the top of an iceberg as advanced imaging uncovers cardiac involvement 4 to 5 times more commonly than what is clinically detectable. Definite diagnosis of CS requires myocardial biopsy and histopathology, but a sufficient diagnostic likelihood can be achieved by combining extracardiac histology of sarcoidosis with clinical manifestations and findings on cardiac imaging. CS can appear as the first or only organ manifestation of sarcoidosis or on top of pre-existing extracardiac disease. Due to the lack of controlled trials, the care of CS is based on observational evidence of low quality. Currently, the treatment involves corticosteroid-based, tiered immunosuppression to control myocardial inflammation with medical and device-based therapy for symptomatic atrioventricular block, ventricular tachyarrhythmias, and heart failure. Recent outcome data indicate 90% to 96% 5-year survival in manifest CS with the 10-year figures ranging from 80% to 90%. Major progress in the care of CS awaits the key to its molecular-genetic pathogenesis and large-scale controlled clinical trials., Competing Interests: Conflict of interest Lecture and/or advisory board fees from Boehringer Ingelheim, Bristol-Myers Squibb, MSD, Takeda, Bayer, Amgen, Roche, and Aiforia technologies oy (M.I.M.). Lecture fee from Pfizer and research collaboration with GE healthcare (V.U.)., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Long-term symptoms are frequent after coronavirus disease 2019 (COVID-19). We studied the prevalence of post-acute myocardial scar on cardiac magnetic resonance imaging (CMR) in patients hospitalized due to COVID-19 and its association with long-term symptoms., Materials and Methods: In this prospective observational single-center study, 95 formerly hospitalized COVID-19 patients underwent CMR imaging at the median of 9 months after acute COVID-19. In addition, 43 control subjects were imaged. Myocardial scar characteristic of myocardial infarction or myocarditis were noted from late gadolinium enhancement images (LGE). Patient symptoms were screened using a questionnaire. Data are presented as mean ± standard deviation or median (interquartile range)., Results: The presence of any LGE was higher in COVID-19 patients (66% vs. 37%, p<0.01) as was the presence of LGE suggestive of previous myocarditis (29% vs. 9%, p = 0.01). The prevalence of ischemic scar was comparable (8% vs. 2%, p = 0.13). Only two COVID-19 patients (7%) had myocarditis scar combined with left ventricular dysfunction (EF <50%). Myocardial edema was not detected in any participant. The need for intensive care unit (ICU) treatment during initial hospitalization was comparable in patients with and without myocarditis scar (47% vs. 67%, p = 0.44). Dyspnea, chest pain, and arrhythmias were prevalent in COVID-19 patients at follow-up (64%, 31%, and 41%, respectively) but not associated with myocarditis scar on CMR., Conclusions: Myocardial scar suggestive of possible previous myocarditis was detected in almost one-third of hospital-treated COVID-19 patients. It was not associated with the need for ICU treatment, greater symptomatic burden, or ventricular dysfunction at 9 months follow-up. Thus, post-acute myocarditis scar on COVID-19 patients seems to be a subclinical imaging finding and does not commonly require further clinical evaluation., Competing Interests: Valtteri Uusitalo has received a lecture fee and had advisory board activity with Pfizer. There are no other conflicts of interest to state. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Yar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Cardiac sarcoidosis (CS) predisposes to sudden cardiac death (SCD). Guidelines for implantable cardioverter defibrillators (ICDs) in CS have been issued by the Heart Rhythm Society in 2014 and the American College of Cardiology/American Heart Association/Heart Rhythm Society consortium in 2017. How well they discriminate high from low risk remains unknown., Methods: We analyzed the data of 398 patients with CS detected in Finland from 1988 through 2017. All had clinical cardiac manifestations. Histological diagnosis was myocardial in 193 patients (definite CS) and extracardiac in 205 (probable CS). Patients with and without Class I or IIa ICD indications at presentation were identified, and subsequent occurrences of SCD (fatal or aborted) and sustained ventricular tachycardia were recorded, as were ICD indications emerging first on follow-up., Results: Over a median of 4.8 years, 41 patients (10.3%) had fatal (n=8) or aborted (n=33) SCD, and 98 (24.6%) experienced SCD or sustained ventricular tachycardia as the first event. By the Heart Rhythm Society guideline, Class I or IIa ICD indications were present in 339 patients (85%) and absent in 59 (15%), of whom 264 (78%) and 30 (51%), respectively, received an ICD. Cumulative 5-year incidence of SCD was 10.7% (95% CI, 7.4%-15.4%) in patients with ICD indications versus 4.8% (95% CI, 1.2%-19.1%) in those without (χ 2 =1.834, P =0.176). The corresponding rates of SCD were 13.8% (95% CI, 9.1%-21.0%) versus 6.3% (95% CI, 0.7%-54.0%; χ 2 =0.814, P =0.367) in definite CS and 7.6% (95% CI, 3.8%-15.1%) versus 3.3% (95% CI, 0.5%-22.9%; χ 2 =0.680, P =0.410) in probable CS. In multivariable regression analysis, SCD was predicted by definite histological diagnosis ( P =0.033) but not by Class I or IIa ICD indications ( P =0.210). In patients without ICD indications at presentation, 5-year incidence of SCD, sustained ventricular tachycardia, and emerging Class I or IIa indications was 53% (95% CI, 40%-71%). By the American College of Cardiology/American Heart Association/Heart Rhythm Society guideline, all patients with complete data (n=245) had Class I or IIa indications for ICD implantation., Conclusions: Current ICD guidelines fail to distinguish a truly low-risk group of patients with clinically manifest CS, the 5-year risk of SCD approaching 5% despite absent ICD indications. Further research is needed on prognostic factors, including the role of diagnostic histology. Meanwhile, all patients with CS presenting with clinical cardiac manifestations should be considered for an ICD implantation.

Background: In cardiac sarcoidosis (CS), the risk and predictors of new-onset atrial fibrillation (AF) are poorly known., Objectives: The authors evaluated the incidence and characteristics of AF in newly diagnosed CS., Methods: The authors studied 118 patients (78 women, mean age 50 years) with AF-naive CS having undergone cardiac 18 F-fluorodexoyglucose positron emission tomography ( 18 F-FDG PET) at the time of diagnosis. Details of patient characteristics and medical or device therapy were collected from hospital charts. The PET scans were re-analyzed for presence of atrial and ventricular inflammation, and coincident cardiac magnetic resonance (CMR) studies and single-photon emission computed tomography (SPECT) perfusions were analyzed for cardiac structure and function, including the presence and extent of myocardial scarring. Detection of AF was based on interrogation of intracardiac devices and on ambulatory or 12-lead electrocardiograms., Results: Altogether 34 patients (29%) suffered paroxysms of AF during follow-up (median, 3 years) with persistent AF developing in 7 patients and permanent AF in 4. The estimated 5-year incidence of AF was 55% (95% CI: 34%-72%) in the 39 patients with atrial 18 F-FDG uptake at the time of diagnosis vs 18% (95% CI: 10%-28%) in the 79 patients without atrial uptake (P < 0.001). In cause-specific Cox regression analysis, atrial uptake was an independent predictor of AF (P < 0.001) with HR of 6.01 (95% CI: 2.64-13.66). Other independent predictors were an increased left atrial maximum volume (P < 0.01) and history of sleep apnea (P < 0.01). Ventricular involvement by PET, SPECT, or CMR was nonpredictive. Symptoms of AF prompted electrical cardioversion in 12 patients (35%). Three of the 34 patients (9%) experiencing AF suffered a stroke versus none of those remaining free of AF., Conclusions: In newly diagnosed CS, future AF is relatively common and associated with atrial inflammation and enlargement on multimodality cardiac imaging., Competing Interests: Funding Support and Author Disclosures This study was supported by a Finnish government grant for medical research, the Aarne Koskelo Foundation, and the Finnish Foundation for Cardiovascular Research. Dr Uusitalo has received scientific collaboration with and a lecture fee from GE Healthcare; and has received a lecture fee and has advisory board activity with Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Patients with diabetes mellitus (DM) may show diffuse coronary artery atherosclerosis on coronary computed tomography angiography (CTA). The present study aimed at quantification of atherosclerotic plaque with CTA and its association with myocardial ischemia on positron emission tomography (PET) in DM patients. Of 922 symptomatic outpatients without previously known coronary artery disease who underwent CTA, 115 with DM (mean age 65 ± 8 years, 58% male) who had coronary atherosclerosis and underwent both quantified CTA (QCTA) and PET were included in the study. QCTA analysis was performed on a per-vessel basis and the most stenotic lesion of each vessel was considered. Myocardial ischemia on PET was based on absolute myocardial blood flow at stress ≤ 2.4 ml/g/min. Of the 345 vessels included in the analysis, 135 (39%) had flow-limiting stenosis and were characterized by having longer lesions, higher plaque volume, more extensive plaque burden and higher percentage of dense calcium (37 ± 22% vs 28 ± 22%, p = 0.001). On univariable analysis, QCTA parameters indicating the degree of stenosis, the plaque extent and composition were associated with presence of ischemia. The addition of the QCTA degree of stenosis parameters (x 2 36.45 vs 88.18, p < 0.001) and the QCTA plaque extent parameters (x 2 88.18 vs 97.44, p = 0.01) to a baseline model increased the association with ischemia. In DM patients, QCTA variables of vessel stenosis, plaque extent and composition are associated with ischemia on PET and characterize the hemodynamic significant atherosclerotic lesion., (© 2022. The Author(s).)

Background: Transthyretin amyloidosis (ATTR) is an occasional incidental finding on bone scintigraphy. We studied its prognostic impact in elderly patients., Methods: The study population consisted of 2000 patients aged over 70 years who underwent bone scintigraphies with clinical indications in three nuclear medicine departments (Kymenlaakso, Jorvi and Meilahti hospitals) in Finland. All studies were performed using 99m Technetium labeled hydroxymethylene diphosphonate (HMDP). ATTR was suspected in patients with ≥grade 2 Perugini grade uptake (grade 0-3). Heart-to-contralateral ratio (H/CL) of ≥ 1.30 was considered positive for ATTR. The overall and cardiovascular mortality were obtained from the Finnish National Statistical Service., Results: There were a total of 1014 deaths (51%) and 177 cardiovascular deaths (9%) during median follow-up of 4 ± 2 years. ATTR was suspected in 69 patients (3.6%) of which 54 (2.7%) had grade 2 and 15 (.8%) had grade 3 uptake and in 47 patients (2.4%) by H/CL ratio. In multivariate analyses age, bone metastasis, H/CL ratio and grade 3 uptake were independent predictors of overall and cardiovascular mortality. Grade 2 uptake was a predictor of cardiovascular mortality., Conclusions: A suspected ATTR as an incidental finding on bone scintigraphy predicts elevated overall and cardiovascular mortality in elderly patients., (© 2020. The Author(s).)

Background: Transthyretin amyloidosis (ATTR) is a progressive disease which can be diagnosed non-invasively using bone avid [ 99m Tc]-labeled radiotracers. Thus, ATTR is also an occasional incidental finding on bone scintigraphy. In this study, we trained convolutional neural networks (CNN) to automatically detect and classify ATTR from scintigraphy images. The study population consisted of 1334 patients who underwent [ 99m Tc]-labeled hydroxymethylene diphosphonate (HMDP) scintigraphy and were visually graded using Perugini grades (grades 0-3). A total of 47 patients had visual grade ≥ 2 which was considered positive for ATTR. Two custom-made CNN architectures were trained to discriminate between the four Perugini grades of cardiac uptake. The classification performance was compared to four state-of-the-art CNN models., Results: Our CNN models performed better than, or equally well as, the state-of-the-art models in detection and classification of cardiac uptake. Both models achieved area under the curve (AUC) ≥ 0.85 in the four-class Perugini grade classification. Accuracy was good in detection of negative vs. positive ATTR patients (grade < 2 vs grade ≥ 2, AUC > 0.88) and high-grade cardiac uptake vs. other patients (grade < 3 vs. grade 3, AUC = 0.94). Maximum activation maps demonstrated that the automated deep learning models were focused on detecting the myocardium and not extracardiac features., Conclusion: Automated convolutional neural networks can accurately detect and classify different grades of cardiac uptake on bone scintigraphy. The CNN models are focused on clinically relevant image features. Automated screening of bone scintigraphy images using CNN could improve the early diagnosis of ATTR., (© 2022. The Author(s).)

Background: This study evaluated the prevalence and prognostic significance of cardiac transthyretin amyloidosis (ATTR) diagnosed using 99m Tc- hydroxymethylene-diphosphonate ( 99m Tc-HMDP) scintigraphy in an elderly heart failure population., Methods: This retrospective study included 335 patients aged >70 years with heart failure and who underwent 99m Tc-HMDP scintigraphy due to non-cardiac reasons in three imaging centres in Finland (Kymenlaakso Central Hospital, Jorvi Central Hospital, and Meilahti University Hospital). A Perugini grade >2 and heart-to-contralateral ratio (H/CL) of ≥1.30 were considered positive for cardiac ATTR. The overall and cardiovascular mortality were obtained from the national statistical service (Statistics Finland)., Results: There were 234 deaths, of which 70 were classified as being due to cardiovascular causes during a median follow-up of 1 (1-3) year. Transthyretin amyloidosis was diagnosed in 22 patients (6.6%) using visual analysis and 17 patients using the H/CL ratio (5.1%). Patients with ATTR were older (85±5 vs 80±5 yrs; p=0.002) and had higher N-terminal pro-brain natriuretic peptide (NT-ProBNP) levels (1,451 [813-3,799] vs 6,192 [2,030-8,833] ng/L; p=0.02). Age, bone metastases, and glomerular filtration rate were independent predictors of overall mortality in multivariable analysis. Age, glomerular filtration rate, ≥grade 2 visual cardiac uptake, and H/CL ratio were independent predictors of cardiovascular mortality., Conclusions: Cardiac uptake suggestive of ATTR was found in 5% of elderly patients with chronic heart failure. The presence of cardiac uptake on bone scintigraphy did not convey independent prognostic value on overall mortality but was independently associated with cardiovascular mortality., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

The coronavirus disease COVID-19 has spread worldwide since early 2020, and it has impacted mobility emissions due to mobility restrictions and e.g. increased remote work. This creates a good opportunity to assess how mobility emissions have reduced due to COVID-19. This research is based on data related to mobility distances and modes that have been automatically collected by using a mobile phone application in the city of Lahti, Finland. The results show that mobility decreased in total by approximately 40% during the first wave of COVID-19 in spring 2020. The global warming potential decreased at the same time by approximately 36%. In addition, a considerable shift in modal shares could be seen. The relative modal share of passenger cars increased by 6 percentage points while the share of public transport decreased by 18 percentage points. Despite the considerable reduction, further reductions in emissions from mobility are needed to meet the 1.5 degree climate targets in the urban mobility sector. However, further reductions can be reached also by increasingly using renewable mobility energy sources., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 World Conference on Transport Research Society. Published by Elsevier Ltd.)

Beekeeping provides honey, protein-containing drone broods and pollen, and yield-increasing pollination services. This study tested the hypothesis that beekeeping can result in net-positive impacts, if pollination services and protein-containing by-products are utilised. As a case example, Finnish beekeeping practices were used. The study was performed using two different approaches. In both approaches, the evaluated impacts were related to climate change, land use, and freshwater use, and were scaled down to represent one beehive. The first approach considered honey production with pollination services and the replacement of alternative products with co-products. The impacts were normalised to correspond with planetary boundary criteria. The second approach evaluated the impacts of the different products and services of beekeeping separately. In the first approach the honey production system moved towards a safe operational space. Freshwater use was the impact category with the largest shift towards a safe operational space (39% shift). The second approach caused a global warming potential of honey production of 0.65 kg CO2-eq kg -1 , when pollen and drone broods were considered as by-products and the influence of pollination services were not included. When honey, pollen, and drone broods were considered as co-products and pollination services were included, the impacts regarding land use and climate change were net-positive. The impact of freshwater use was relatively small. For honey, the impacts on the climate change, land use, and freshwater use were -0.33 kg CO2-eq kg -1 , -7.89 m 2  kg -1 , and 14.01 kg kg -1 , respectively. The impact allocation with co-products and pollination services was conclusive. A lack of consideration for the impact reduction of pollination led to beekeeping having a negative impact on the environment. Based on these results, beekeeping enhances food security within planetary boundaries, provided that pollination services and protein-containing by-/co-products are utilised., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)

Food production processes may have both positive and negative environmental sustainability impacts. This makes decision-making challenging in the transition towards more sustainable food production systems. In this paper, a new method for presenting environmental impacts in the context of planetary boundaries is demonstrated. This will help food and agricultural producers compare the magnitudes of various environmental impacts. The environmental sustainability impacts of an organic sheep farm in the boreal climate zone in Finland are studied herein first using a life cycle assessment method. The results are then normalized and presented in a planetary boundary framework to ascertain the extent of different environmental impacts. The results show that in the planetary boundary context, there are positive impacts of sheep grazing on biosphere integrity (genetic diversity) and biogeochemical flows and negative impacts on climate change, land use or freshwater use. Magnitudes of the impacts greatly dependent on the assumptions made especially regarding biosphere integrity impacts. In the future, it is crucial that decision-making be based on the evaluation of various environmental impacts and that the focus be more on complex sustainability thinking, rather than on one single environmental impact. This research demonstrates that results from a life cycle assessment can be modified and presented in a planetary boundaries context. A planetary boundary framework approach similar to that proposed herein could be further used to identify different environmental sustainability perspectives and to help one better recognize the multifunctional aspects of the ecosystem processes., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: We aimed to validate the accuracy of imaging of left atrial and ventricular volumes using cardiac cadaveric silicone casts., Methods: Left atrial (n = 14) and ventricular (n = 15) casts were imaged using 64-slice computed tomography (CT). Water displacement (WD) of cardiac casts was used as the gold standard for volume measurements., Results: Compared with WD, CT resulted in slightly higher left atrial and ventricular volumes (54 ± 25 vs 56 ± 26 mL [P = 0.003] and 57 ± 47 vs 66 ± 47 mL [P = 0.0001]). Variability between left atrial and ventricular volumes by CT and WD was low (coefficients of variation [CVs], 4% [intraclass correlation coefficient {ICC}, 0.99] and 12% [ICC, 0.97]). Intraobserver variability of CT was low for both the left atrium and the left ventricle (CVs, 1% [ICC, 1.00] and 4% [ICC, 1.00])., Conclusions: Cardiac CT is both accurate and reproducible in assessment of left ventricular and atrial chamber volumes.

Objectives: The purpose of this study was to evaluate the prognostic value of sequential hybrid imaging strategy in which positron emission tomography (PET) perfusion imaging is performed selectively in patients with suspected obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CTA)., Background: Coronary CTA is an accurate diagnostic test for excluding obstructive CAD. However, the positive predictive value is suboptimal., Methods: We investigated 864 consecutive symptomatic patients with intermediate probability of CAD who adhered to the sequential imaging approach. PET myocardial perfusion imaging using 15 O-labeled water during adenosine stress was performed when suspected obstructive stenosis was present on coronary CTA. The major adverse events (AEs) including all-cause mortality, myocardial infarction (MI), and unstable angina pectoris (UAP) were recorded., Results: During a median follow-up of 3.6 years, 16 deaths, 10 MIs, and 5 UAPs occurred. Obstructive CAD was excluded by coronary CTA in 462 (53%) patients who had significantly lower annual AE rate than did patients with suspected obstructive stenosis on coronary CTA (0.4% vs. 1.5%; p = 0.003). The latter underwent PET study, on which 195 (49%) had normal and 207 had abnormal perfusion. The annual rate of AEs was 5 times higher in those with abnormal perfusion than with normal perfusion (2.5% vs. 0.5%; p = 0.004). Patients with normal perfusion had AE rate comparable to patients without obstructive CAD on coronary CTA (p = 0.77)., Conclusions: In patients with suspected CAD obstructive disease can be excluded in 53% of patients by coronary CTA, and these patients have good outcome. About one-half (49%) of the remaining patients have normal perfusion and event rate comparable to patients without obstructive CAD on coronary CTA while patients with ischemia have clearly worse outcome. Sequential approach utilizing anatomical imaging by coronary CTA followed by selective functional perfusion imaging is a feasible strategy to diagnose and risk-stratify patients with suspected CAD., (Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Aims: Coronary microvascular dysfunction (CMD) can cause angina in the absence of obstructive coronary artery disease (CAD). We studied the frequency and angiographic characteristics of CMD in symptomatic patients with suspected stable CAD and identified CMD as diffusely abnormal coronary vasodilator capacity by positron emission tomography (PET) perfusion imaging., Methods and Results: We recruited prospectively 189 patients with intermediate pre-test probability of CAD who underwent coronary computed tomography angiography and quantitative 15O-water PET perfusion imaging followed by invasive coronary angiography, and assessment of fractional flow reserve when feasible. Prevalence of obstructive epicardial CAD was 37%. Absolute myocardial blood flow was diffusely reduced (<2.4 mL/g/min) within the left ventricle during adenosine stress in 32 (17%) patients. In 15 (8%) patients, this was explained by three-vessel obstructive CAD, whereas the remaining 17 (9%) were diagnosed with CMD. Of these, 2 (1% of all patients) had no coronary atherosclerosis, 5 (3% of all patients) had non-obstructive atherosclerosis, and in 10 (5% of all patients) CMD co-existed with obstructive CAD. Atypical angina or non-anginal chest pain (53%) was the most common presentation. Older age and male sex were associated with CMD, but other risk factors of CAD were equally common in patients with or without CMD., Conclusion: Coronary microvascular dysfunction exists in 9% of symptomatic stable patients with suspected CAD. However, the prevalence of microvascular dysfunction without any coronary atherosclerosis is low (1%) in this population., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.)

Background: We evaluated the prognostic value of an integrated atherosclerosis risk score combining the markers of coronary plaque burden, location and composition as assessed by computed tomography angiography (CTA)., Methods: 922 consecutive patients underwent CTA for suspected coronary artery disease (CAD). Patients without atherosclerosis (n = 261) and in whom quantitative CTA analysis was not feasible due to image quality, step-artefacts or technical factors related to image acquisition or data storage (n = 153) were excluded. Thus, final study group consisted of 508 patients aged 63 ± 9 years. Coronary plaque location, severity and composition for each coronary segment were identified using automated CTA quantification software and integrated in a single CTA score (0-42). Adverse events (AE) including death, myocardial infarction (MI) and unstable angina (UA) were obtained from the national healthcare statistics., Results: There were a total of 20 (4%) AE during a median follow-up of 3.6 years (9 deaths, 5 MI and 6 UA). The CTA risk score was divided into tertiles: 0-6.7, 6.8-14.8 and > 14.8, respectively. All MI (n = 5) and most of the other AE occurred in the highest risk score tertile (3 vs. 3 vs. 14, p = 0.002). After correction for age and gender, the CTA risk score remained independently associated with AE., Conclusions: Comprehensive CTA risk score integrating the location, burden and composition of coronary atherosclerosis predicts future cardiac events in patients with suspected CAD., (Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Contrast-induced nephropathy (CIN) is a potentially serious complication of contrast agents used in computed tomography angiography (CTA). The aim of this study was to evaluate whether persistent renal dysfunction occurs in patients undergoing coronary CTA for suspected stable coronary artery disease (CAD). From a cohort of 957 patients undergone coronary CTA, we identified 402 patients with plasma creatinine levels collected before and within 6 months after CTA. According to the definition of CIN, patients with a ≥25 % increase in plasma creatinine after CTA were evaluated. The post-CTA measurements in 402 patients (195 men, age 62.9 ± 9.3 years) were performed at a median of 99 days after CTA. On average, there was no change in plasma creatinine level between the pre- and post-CTA measurements (75.8 ± 16.0 and 75.7 ± 16.4 µmol/L, respectively; P = 0.63) but both increases and decreases were commonly detected. Fourteen (3.5 %) patients had a ≥25 % increase in plasma creatinine levels after CTA. A more detailed evaluation of these patients revealed that in 4 patients the increase was explained by other morbidities, whereas in 9 patients the creatinine level returned to the previous levels at later follow-up (median time to normalization: 311 days). Only in 1 (0.2 %) remaining patient, there was a persistent increase in plasma creatinine level, possibly related to the iodine contrast agent exposure. Alterations in plasma creatinine concentration occur frequently. Persistent renal dysfunction attributable to iodine contrast agent exposure is rare in patients referred to coronary CTA for suspected CAD.

Background: Two-dimensional speckle-tracking applied to dobutamine stress echocardiography (DSE) may aid in the detection of coronary artery disease (CAD). The aim of this study was to determine the value of strain, strain rate, and postsystolic strain index (PSI) measured by speckle-tracking during DSE in the evaluation of the presence, extent, and severity of myocardial ischemia., Methods: Fifty patients 63 ± 7 years of age with intermediate probability of CAD were prospectively recruited. All patients underwent DSE, quantitative positron emission tomographic perfusion imaging, and invasive angiography. Regional peak systolic longitudinal strain, strain rate, and PSI were measured at rest, at a dobutamine dose of 20 μg/kg/min, at peak stress, and at early recovery (1 min after stress). Obstructive CAD was defined as >75% stenosis or 40% to 75% stenosis combined with either fractional flow reserve < 0.80 or abnormal findings on myocardial perfusion positron emission tomography., Results: Obstructive CAD was detected in 22 patients and in 36 of 150 coronary arteries. Strain analyses showed the highest reproducibility at rest, at a dobutamine dose of 20 μg/kg/min, and at early recovery. Increased PSI and reduced strain during early recovery were the strongest predictors of obstructive CAD and were associated with the extent, localization, and depth of myocardial ischemia by positron emission tomography. On vessel-based analysis, strain, PSI, and visual analysis of wall motion provided comparable diagnostic accuracy, whereas the combination of strain or PSI with visual analysis provided incremental value over visual analysis alone., Conclusions: Assessment of systolic or postsystolic strain by speckle-tracking echocardiography during early recovery after DSE can help in the detection of hemodynamically significant coronary stenosis compared with visual wall motion analysis alone., (Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

In myocardial bridging (MB) a segment of the coronary artery is covered by the myocardium. MB can be seen as a systolic compression by invasive coronary angiography (ICA) or as an intramural course by computed tomography angiography (CTA). Intramural course is a common incidental finding in CTA studies. Only minority of the bridging segments are associated with systolic compression causing a possible impairment of myocardial perfusion. The relationship between myocardial blood flow and MB is complex and poorly evaluated by anatomic imaging. Furthermore, provocation tests are frequently needed to uncover systolic compression. Fractional flow reserve can be used to assess the hemodynamic significance of MB. Nuclear perfusion imaging can demonstrate flow abnormalities associated with MB. Stress echocardiography can demonstrate ischemic wall motion abnormalities. They can be complemented by hybrid imaging with CTA to distinguish epicardial coronary artery disease and MB. This article will review different imaging modalities for the evaluation of the physiologic significance of MB.

Objectives: This study observed hemodynamic consequences of myocardial bridging and its relation to coronary atherosclerosis., Background: Myocardial bridging is seen as intramural course by computed tomography angiography (CTA) or systolic compression by invasive coronary angiography. Segments with myocardial bridging are in previous studies closely associated with proximal atherosclerotic plaques., Methods: We prospectively studied 100 patients 63 ± 7 years of age with intermediate likelihood of coronary artery disease. Segments with superficial (>1 mm) or deep (>2 mm) intramural course were identified using CTA. Myocardial perfusion was studied by 15-Oxygen water positron emission tomography and systolic compression by invasive coronary angiography., Results: Myocardial bridging was detected in 34 (34%) patients in 48 different vascular segments. Of these, 24 (50%) were deep and systolic compression was present in 14 (29%). In patients without obstructive coronary artery disease, myocardial stress perfusion distal to myocardial bridging was comparable with remote control regions (3.3 ± 0.9 ml/g/min vs. 3.3 ± 0.7 ml/g/min, n = 24, p = 0.88). Stress perfusion was comparable in segments with and without systolic compression (3.0 ± 0.9 vs. 2.7 ± 1.0 ml/g/min, p = 0.43). Atherosclerotic plaques were more frequent in proximal (71%) than myocardial bridging (7%) or distal (21%) segments. The presence of atherosclerosis and the average number of plaques were comparable in coronary arteries with and without myocardial bridging (73% vs. 60%, p = 0.14 and 2.0 ± 1.7 vs. 1.5 ± 1.6, p = 0.06). Median Agatston coronary calcium score was not elevated in vessels with myocardial bridge (15 [interquartile range: 0, 129] vs. 50 [interquartile range: 0, 241], p = 0.21)., Conclusions: Myocardial bridging of coronary arteries is common on CTA, but only approximately one-third of these show systolic compression. Myocardial bridging is not associated with reduced myocardial perfusion during vasodilator stress. Atherosclerosis is located predominantly proximal to myocardial bridging but atherosclerotic burden and presence of vulnerable plaques were comparable., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Quantitative myocardial perfusion imaging is increasingly used for the diagnosis of coronary artery disease. Quantitative perfusion imaging allows to noninvasively calculate fractional flow reserve (FFR). This so-called relative flow reserve (RFR) is defined as the ratio of hyperemic myocardial blood flow (MBF) in a stenotic area to hyperemic MBF in a normal perfused area. The aim of this study was to assess the value of RFR in the detection of significant coronary artery disease., Methods and Results: From a clinical population of patients with suspected coronary artery disease who underwent oxygen-15-labeled water cardiac positron emission tomography and invasive coronary angiography, 92 patients with single- or 2-vessel disease were included. Intermediate lesions (diameter stenosis, 30%-90%; n=75) were interrogated by FFR. Thirty-eight (41%) vessels were deemed hemodynamically significant (>90% stenosis or FFR≤0.80). Hyperemic MBF, coronary flow reserve, and RFR were lower for vessels with a hemodynamically significant lesion (2.01±0.78 versus 2.90±1.16 mL·min(-1)·g(-1); P<0.001, 2.27±1.03 versus 3.10±1.29; P<0.001, and 0.67±0.23 versus 0.93±0.15; P<0.001, respectively). The correlation between RFR and FFR was moderate (r=0.54; P<0.01). Receiver operator characteristic curve analysis showed an area under the curve of 0.82 for RFR, which was not significantly higher compared with that for hyperemic MBF and coronary flow reserve (0.76; P=0.32 and 0.72; P=0.08, respectively)., Conclusions: Noninvasive estimation of FFR by quantitative perfusion positron emission tomography by calculating RFR is feasible, yet only a trend toward a slight improvement of diagnostic accuracy compared with hyperemic MBF assessment was determined., (© 2015 American Heart Association, Inc.)

Background: Recent studies have demonstrated improved diagnostic accuracy for detecting coronary artery disease (CAD) when myocardial blood flow (MBF) is quantified in absolute terms, but there are no uniformly accepted cutoff values for hemodynamically significant CAD., Objectives: The goal of this study was to determine cutoff values for absolute MBF and to evaluate the diagnostic accuracy of quantitative [(15)O]H2O positron emission tomography (PET)., Methods: A total of 330 patients underwent both quantitative [(15)O]H2O PET imaging and invasive coronary angiography in conjunction with fractional flow reserve measurements. A stenosis >90% and/or fractional flow reserve ≤0.80 was considered obstructive; a stenosis <30% and/or fractional flow reserve >0.80 was nonobstructive., Results: Hemodynamically significant CAD was diagnosed in 116 (41%) of 281 patients who fulfilled study criteria for CAD. Resting perfusion was 1.00 ± 0.25 and 0.92 ± 0.23 ml/min/g in regions supplied by nonstenotic and significantly stenosed vessels, respectively (p < 0.001). During stress, perfusion increased to 3.26 ± 1.04 ml/min/g and 1.73 ± 0.67 ml/min/g, respectively (p < 0.001). The optimal cutoff values were 2.3 and 2.5 for hyperemic MBF and myocardial flow reserve, respectively. For MBF, these cutoff values showed a sensitivity, specificity, and accuracy for detecting significant CAD of 89%, 84%, and 86%, respectively, at a per-patient level and 87%, 85%, and 85% at a per-vessel level. The corresponding myocardial flow reserve values were 86%, 72%, and 78% (per patient) and 80%, 82%, and 81% (per vessel). Age and sex significantly affected diagnostic accuracy of quantitative PET., Conclusions: Quantitative MBF measurements with the use of [(15)O]H2O PET provided high diagnostic performance, but both sex and age should be taken into account., (Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Aims: We studied whether a reduced coronary flow reserve (CFR) in healthy young men independently predicts the presence of coronary artery disease as assessed by coronary artery calcification after 11 years of follow-up., Methods and Results: Coronary microvascular dysfunction in early stages of coronary artery disease can be detected as a reduced CFR by positron emission tomography (PET). Seventy-seven healthy, lean, normotensive, non-smoking and non-diabetic men underwent 15-Oxygen ((15)O) water myocardial perfusion PET at rest and during vasodilator stress at the age of 35 ± 4 years at baseline. The subjects were followed-up for 11 ± 1 years and the coronary artery calcium score (CCS) was measured with computed tomography at the end of the follow-up. At the end of the follow-up, 30 (39%) individuals had CCS >0 (average 65 ± 93), but none had clinical symptoms or evidence of ischaemia in stress echocardiography. At baseline, the average CFR was comparable in individuals with CCS >0 and CCS = 0 (4.2 ± 1.4 vs. 4.0 ± 1.2, P = 0.4). Logistic regression analysis showed no associations between CFR, serum glucose, cholesterol levels, systolic blood pressure or body mass index at baseline and CCS at the end of the follow-up (P always >0.05). The presence of CCS (CCS >0) was associated with higher systolic and diastolic blood pressures at the end of the follow-up (137 ± 18 vs. 128 ± 11 mmHg, P = 0.04 and 86 ± 12 vs. 78 ± 11 mmHg, P = 0.01)., Conclusions: Coronary reactivity to vasodilator-induced hyperaemia as assessed by perfusion PET was not predictive of the presence of coronary calcification after 11 years of follow-up in asymptomatic men with very low likelihood of coronary artery disease.