Effect of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and structural changes following myocardial infarction: A systematic review and meta-analysis.

BACKGROUND: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are anti-hyperglycemic drugs and have been proven to have cardiovascular protective effects for patients with heart failure regardless of their diabetes status. However, the benefit of SGLT2i following myocardial infarction (MI) remains incompletely established. This review aimed to investigate the impact of SGLT2i on NT-proBNP levels and structural changes post-MI. METHOD: Medline, ClinicalTrial.gov, Scopus, and Directory of open-access journals were searched to retrieve the relevant articles. Eligible studies were randomized clinical trials that assessed NT-proBNP and cardiac structural changes in patients who received SGLT2i compared to placebo following MI. Two reviewers independently screened articles, extracted data, and assessed study quality. RESULT: Four studies were included in this review, including patients with and without diabetes. While two studies showed no marked decrease from the baseline in NT-proBNP levels between the SGLT2i group and the control group, two studies reported a substantial reduction. The meta-analysis included three of these studies, with a total of 238 participants. The meta-analysis did not find a statistically significant drop in NT-proBNP levels post-MI in the SGLT2 inhibitors group compared to placebo (pooled SMD = 0.16, 95% CI 0.57-0.26, P 0.45). Furthermore, different echocardiographic parameters were reported in the included trials, yet no meta-analysis could be conducted to assess the influence of SGLT2i on cardiac remodeling post-MI. CONCLUSION: SGLT2i did not result in a statistically significant reduction of NT-proBNP level subsequent to myocardial infarction. A knowledge gap exists regarding the impact of these agents on cardiac remodeling post-MI. Future high-quality clinical trials are needed to provide more robust evidence.

Facile Transfer Hydrogenation of N-Heteroarenes and Nitroarenes Using Magnetically Recoverable Pd@SPIONs Catalyst.

Catalysts with active, selective, and reusable features are desirable for sustainable development. The present investigation involved the synthesis and characterization of bear-surfaced ultrasmall Pd particles (<1 nm) loaded onto the surface of magnetic nanoparticles (8-10 nm). The amount of Pd loading onto the surface of magnetite is recorded as 2.8 wt %. The characterization process covered the utilization of scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), transmission electron microscopy (TEM), inductively coupled plasma (ICP), and X-ray photoelectron spectroscopy (XPS) methods. The Pd@Fe3O4 catalyst has shown remarkable efficacy in the hydrogenation of quinoline, resulting in the production of >99% N-ring hydrogenated (py-THQ) product. Additionally, the catalyst facilitated the conversion of nitroarenes into their corresponding aniline derivatives, where hydrogen was achieved by H2O molecules with the aid of tetrahydroxydiboron (THDB) as an equilibrium supportive at 80 °C in 1 h. The high efficiency of a transfer hydrogenation catalyst is closely related to the metal-support synergistic effect. The broader scope of functional group tolerance is evaluated. The potential mechanism underlying the hydrogenation process has been elucidated through the utilization of isotopic labeling investigations. The application of the heterocyclic compound hydrogenation reaction is extended to formulate the medicinally important tubular polymerization inhibitor drug synthesis. The investigation of the recyclability of Pd@Fe3O4 has been conducted.

Hydrogenation of CO2 into Value-added Chemicals Using Solid-Supported Catalysts.

Reducing CO2 emissions is an urgent global priority. In this context, several mitigation strategies, including CO2 tax and stringent legislation, have been adopted to halt the deterioration of the natural environment. Also, carbon recycling procedures undoubtedly help reduce net emissions into the atmosphere, enhancing sustainability. Utilizing Earth's abundant CO2 to produce high-potential green chemicals and light fuels opens new avenues for the chemical industry. In this context, many attempts have been devoted to converting CO2 as a feedstock into various value-added chemicals, such as CH4 , lower methanol, light olefins, gasoline, and higher hydrocarbons, for numerous applications involving various catalytic reactions. Although several CO2 -conversion methods have been used, including electrochemical, photochemical, and biological approaches, the hydrogenation method allows the reaction to be tuned to produce the targeted compound without significantly altering infrastructure. This review discusses the numerous hydrogenation routes and their challenges, such as catalyst design, operation, and the combined art of structure-activity relationships for the various product formations.

Advancements in Olive-derived Carbon: Preparation Methods and Sustainable Applications.

In the realm of material science, carbon materials, especially olive-derived carbon (ODC), have become vital due to their sustainability and diverse properties. This review examines the sustainable extraction and use of ODC, a carbohydrate-rich by-product of olive biomass. We focus on innovative preparation techniques like pyrolysis, which are crucial forenhancing ODC's microstructure and surface properties. Variables such as activating agents, impregnation ratios, and pyrolysis conditions significantly influence these properties. ODC's high specific surface area renders it invaluable for applications in energy storage (batteries and supercapacitors) and environmental sectors (water purification, hydrogen storage). Its versatility and accessibility underscore its potential for broad industrial use, makingit as a key element in sustainable development. This review provides a detailed analysis of ODC preparation methodologies, its various applications, and its role in advancing sustainable energy solutions. We highlight the novelty of ODC research and its impact on future studies, establishing this review as a crucial resource for researchers and practitioners in sustainable carbon materials. As global focus shifts towards eco-friendly solutions, ODC emerges as a critical component in shaping a sustainable, innovation-driven future.

Identifying left ventricular dysfunction using prospective electrocardiogram-triggered coronary computed tomography angiography.

PURPOSE: Coronary computed tomography angiography (CCTA) is an important non-invasive tool for the assessment of coronary artery disease and the delivery of information incremental to coronary anatomy. CCTA measured left ventricular (LV) mid-diastolic volume (LVMDV) and LV mass (LVMass) have important prognostic information but the utility of prospectively ECG-triggered CCTA to predict reduced left ventricular ejection fraction (LVEF) is unknown. The objective of this study was to determine if indexed LVMDV (LVMDVi) and the LVMDV:LVMass ratio on CCTA can identify patients with reduced LVEF. MATERIALS/METHODS: 8179 patients with prospectively ECG-triggered CCTA between November 2014 and December 2019 were reviewed. A subset derivation cohort of 4352 healthy patients was used to define normal LVMDVi and LVMDV:LVMass. Sex-specific thresholds were tested in a validation cohort of 1783 patients, excluded from the derivation cohort, with cardiac disease and known LVEF. The operating characteristics for 1 SD above the mean were tested for the identification of abnormal LVEF, LVEF≤35 â€‹% and ≤30 â€‹%. RESULTS: The derivation cohort had a mean LVMDVi of 61.0 â€‹± â€‹13.7 â€‹mL/m2 and LVMDV:LVMass of 1.11 â€‹± â€‹0.24 â€‹mL/g. LVMDVi and LVMDV:LVMass were both higher in patients with reduced LVEF than those with normal LVEF (98.8 â€‹± â€‹40.8 â€‹mL/m2 vs. 63.3 â€‹± â€‹19.7 â€‹mL/m2, p â€‹< â€‹0.001, and 1.32 â€‹± â€‹0.44 â€‹mL/g vs. 1.05 â€‹± â€‹0.28 â€‹mL/g, p â€‹< â€‹0.001). Both mean LVMDVi and LVMDV:LVMass increased with the severity of LVEF reduction. Sex-specific LVMDVi thresholds were 79 â€‹% and 80 â€‹% specific for identifying abnormal LVEF in females (LVMDVi â€‹≥ â€‹69.9 â€‹mL/m2) and males (LVMDVi â€‹≥ â€‹78.8 â€‹mL/m2), respectively. LVMDV:LVMass thresholds had high specificity (87 â€‹%) in both females (LVMDVi:LVMass â€‹≥ â€‹1.39 â€‹mL/g) and males (LVMDVi:LVMass â€‹≥ â€‹1.30 â€‹mL/g). CONCLUSION: Our study provides reference thresholds for LVMDVi and LVMDV:LVMass on prospectively ECG-triggered CCTA, which may identify patients who require further LV function assessment.

Development of Membranes and Separators to Inhibit Cross-Shuttling of Sulfur in Polysulfide-Based Redox Flow Batteries: A Review.

The global rapid transition from fossil fuels to renewable energy resources necessitates the implementation of long-duration energy storage technologies owing to the intermittent nature of renewable energy sources. Therefore, the deployment of grid-scale energy storage systems is inevitable. Sulfur-based batteries can be exploited as excellent energy storage devices owing to their intrinsic safety, low cost of raw materials, low risk of environmental hazards, and highest theoretical capacities (gravimetric: 2600 Wh/kg and volumetric: 2800 Wh/L). However, sulfur-based batteries exhibit certain scientific limitations, such as polysulfide crossover, which causes rapid capacity decay and low Coulombic efficiency, thereby hindering their implementation at a commercial scale. In this review article, we focus on the latest research developments between 2012-2023 to improve the separators/membranes and overcome the shuttle effect associated with them. Various categories of ion exchange membranes (IEMs) used in redox batteries, particularly polysulfide redox flow batteries and lithium-sulfur batteries, are discussed in detail. Furthermore, advances in IEM constituents are summarized to gain insights into different fundamental strategies for attaining targeted characteristics, and a critical analysis is proposed to highlight their efficiency in mitigating sulfur cross-shuttling issues. Finally, future prospects and recommendations are suggested for future research toward the fabrication of more effective membranes with desired properties.

Recent Development of Electrolytes for Aqueous Organic Redox Flow Batteries (Aorfbs): Current Status, Challenges, and Prospects.

In recent years, aqueous organic redox flow batteries (AORFBs) have attracted considerable attention due to advancements in grid-level energy storage capacity research. These batteries offer remarkable benefits, including outstanding capacity retention, excellent cell performance, high energy density, and cost-effectiveness. The organic electrolytes in AORFBs exhibit adjustable redox potentials and tunable solubilities in water. Previously, various types of organic electrolytes, such as quinones, organometallic complexes, viologens, redox-active polymers, and organic salts, were extensively investigated for their electrochemical performance and stability. This study presents an overview of recently published novel organic electrolytes for AORFBs in acidic, alkaline, and neutral environments. Furthermore, it delves into the current status, challenges, and prospects of AORFBs, highlighting different strategies to overcome these challenges, with special emphasis placed on their design, composition, functionalities, and cost. A brief techno-economic analysis of various aqueous RFBs is also outlined, considering their potential scalability and integration with renewable energy systems.

Recent Developments on Electroactive Organic Electrolytes for Non-Aqueous Redox Flow Batteries: Current Status, Challenges, and Prospects.

The ever-increasing threat of climate change and the depletion of fossil fuel resources necessitate the use of solar- and wind-based renewable energy sources. Large-scale energy storage technologies, such as redox flow batteries (RFBs), offer a continuous supply of energy. Depending on the nature of the electrolytes used, RFBs are broadly categorized into aqueous redox flow batteries (ARFBs) and non-aqueous redox flow batteries (NARFBs). ARFBs suffer from various problems, including low conductivity of electrolytes, inferior charge/discharge current densities, high-capacity fading, and lower energy densities. NARFBs offer a wider potential window and range of operating temperatures, faster electron transfer kinetics, and higher energy densities. In this review article, a critical analysis is provided on the design of organic electroactive molecules, their physiochemical/electrochemical properties, and various organic solvents used in NARFBs. Furthermore, various redox-active organic materials, such as metal-based coordination complexes, quinones, radicals, polymers, and miscellaneous electroactive species, explored for NARFBs during 2012-2023 are discussed. Finally, the current challenges and prospects of NARFBs are summarized.

Metal Negatrode Supercapatteries: Advancements, Challenges, and Future Perspectives for High-Performance Energy Storage.

Metal negatrode supercapattery (MNSC) is an emerging technology that combines the high energy storage capabilities of batteries with the high-power delivery of supercapacitors, thereby offering promising solutions for various applications, such as energy storage systems, electric vehicles, and portable electronics. This review article presents a comprehensive analysis of the potential of MNSCs as a prospective energy storage technology. MNSCs utilize a specific configuration in which the negatrode consists of a metal or metal-rich electrode, such as sodium, aluminum, potassium, or zinc, whereas the positrode functions as a supercapacitor electrode. The utilization of negatrodes with low electrochemical potential and high electrical conductivity is crucial for achieving high specific energy in energy storage devices, despite facing numerous challenges. The present study discusses the design and fabrication aspects of MNSCs, including the selection of appropriate metal negatrodes, electrolytes, and positrodes, alongside the fundamental operational mechanisms. Additionally, this review explores the challenges encountered in MNSCs and proposes solutions to enhance their performance, such as addressing dendrite formation and instability of metal electrodes.

The Effect of Diabetes Mellitus on Cardiac Remodeling and Overall Clinical Outcomes in Patients With Acute Myocardial Infarction: A Single-Center Retrospective Study in Saudi Arabia.

BACKGROUND: Diabetes mellitus (DM) is a major chronic condition that is considered a strong indicator of poor cardiovascular outcomes, such as recurrent infarction and heart failure (HF), in individuals with acute myocardial infarction (AMI). However, the concept of left ventricular remodeling (LVR) following AMI in DM patients is not well understood and studied in Saudi Arabia. Thus, the aim of this study is to assess the association between LVR and DM in patients presenting with ST-elevation myocardial infarction (STEMI) who had reperfusion therapy with optimal medical therapy after percutaneous coronary intervention (PCI). METHODS: In this retrospective cohort study, 171 patients diagnosed with AMI who visited King Faisal Cardiac Center in King Abdulaziz Medical City, National Guard Hospital, Jeddah, Saudi Arabia, were chosen via the convenience sampling method. The study included patients with AMI who received echocardiograms upon admission and during a follow-up period of six to 12 months. The patients were divided into two groups based on their diabetic status: diabetic (DM) and non-diabetic (non-DM). To collect the data, trained medical students supervised by the principal investigator used the patients' medical records. RESULTS: The study showed that DM patients were more likely to have a history of hypertension, dyslipidemia, smoking, and stress hyperglycemia and had a higher hospitalization rate compared to the non-DM group. Although there was no statistically significant difference (p=0.253), both groups had a higher incidence of the left main trunk and/or left anterior descending artery affected. Regarding the echocardiographic finding, there were no significant differences between the two groups in terms of left ventricular ejection fraction, left ventricular internal diameter at end-diastole, left ventricular internal diameter at end-systole, and interventricular septum thickness. CONCLUSION: This paper suggests that there is no significant correlation between DM and non-DM patients in terms of LVR after AMI. However, DM patients had a statistically significant increased risk of developing HF and valvular heart disease compared to non-DM patients after AMI.

Preparation and Characterization of Physically Activated Carbon and Its Energetic Application for All-Solid-State Supercapacitors: A Case Study.

Biomass-derived activated carbons have gained significant attention as electrode materials for supercapacitors (SCs) due to their renewability, low-cost, and ready availability. In this work, we have derived physically activated carbon from date seed biomass as symmetric electrodes and PVA/KOH has been used as a gel polymer electrolyte for all-solid-state SCs. Initially, the date seed biomass was carbonized at 600 °C (C-600) and then it was used to obtain physically activated carbon through CO2 activation at 850 °C (C-850). The SEM and TEM images of C-850 displayed its porous, flaky, and multilayer type morphologies. The fabricated electrodes from C-850 with PVA/KOH electrolytes showed the best electrochemical performances in SCs (Lu et al. Energy Environ. Sci., 2014, 7, 2160) application. Cyclic voltammetry was performed from 5 to 100 mV s-1, illustrating an electric double layer behavior. The C-850 electrode delivered a specific capacitance of 138.12 F g-1 at 5 mV s-1, whereas it retained 16 F g-1 capacitance at 100 mV s-1. Our assembled all-solid-state SCs exhibit an energy density of 9.6 Wh kg-1 with a power density of 87.86 W kg-1. The internal and charge transfer resistances of the assembled SCs were 0.54 and 17.86 Ω, respectively. These innovative findings provide a universal and KOH-free activation process for the synthesis of physically activated carbon for all solid-state SCs applications.

A High-Energy Asymmetric Supercapacitor Based on Tomato-Leaf-Derived Hierarchical Porous Activated Carbon and Electrochemically Deposited Polyaniline Electrodes for Battery-Free Heart-Pulse-Rate Monitoring.

A simple and scalable method to fabricate a novel high-energy asymmetric supercapacitor using tomato-leaf-derived hierarchical porous activated carbon (TAC) and electrochemically deposited polyaniline (PANI) for a battery-free heart-pulse-rate monitor is reported. In this study, TAC is prepared by simple pyrolysis, exhibiting nanosheet-type morphology and a high specific surface area of ≈1440 m2 g-1 , and PANI is electrochemically deposited onto carbon cloth. The TAC- and PANI- based asymmetric supercapacitor demonstrates an electrochemical performance superior to that of symmetric supercapacitors, delivering a high specific capacitance of 248 mF cm-2 at a current density of 1.0 mA cm-2 . The developed asymmetric supercapacitor shows a high energy density of 270 µWh cm-2 at a power density of 1400 µW cm-2 , as well as an excellent cyclic stability of ≈95% capacitance retention after 10 000 charging-discharging cycles while maintaining ≈98% Coulombic efficiency. Impressively, the series-connected asymmetric supercapacitors can operate a battery-free heart-pulse-rate monitor extremely efficiently upon solar-panel charging under regular laboratory illumination.

The impact of viability assessment using cardiac MRI and echocardiogram on the outcome of revascularization in patients with multi-vessels coronary artery disease and moderate to severe ischemic cardiomyopathy.

OBJECTIVES: To investigate the influence of viability assessment in the management of patients with ischemic cardiomyopathy (ICM). METHODS: This retrospective cohort study included all patients with ICM with moderate to severely reduced left ventricular ejection fraction (LVEF) who underwent viability assessment using cardiac magnetic resonance imaging (MRI) and echocardiogram as modalities of imaging. In addition, LVEF, modality of choice, and treatment plans were all extracted as main variables from the electronic database. One hundred 6 patients who met the inclusion criteria from December 2014 to December 2019 were included. RESULTS: Posttreatment LVEF improved by 5% in the viable group compared to the nonviable group (p=0.016). Regardless of the treatment received, 6 (8.8%) patients in the viable group died due to cardiac causes after an 18-month follow-up period; in contrast, 7 (18.4%) patients died due to cardiac causes in the nonviable group. However, despite that difference, this was not statistically significant (p=0.153). Medical therapy alone was observed in 32 (84.2%) patients in the nonviable group compared to 32 (47.1%) in the viable group (p<0.001). Although the reduction in hospitalization for cardiac reasons was not statistically significant, the viable arm had 50% fewer hospitalizations than the nonviable arm (p=0.051). CONCLUSION: Patients with viable myocardium had better outcomes in which LVEF significantly improved posttreatment. Additionally, there was a reduction in the number of hospitalizations for cardiac reasons in the viable group compared to the nonviable group, even though the difference was not statistically significant. However, further studies with a larger number of patients are needed to determine a definite conclusion.

High Performance and Long-cycle Life Rechargeable Aluminum Ion Battery: Recent Progress, Perspectives and Challenges.

The rising energy crisis and environmental concerns caused by fossil fuels have accelerated the deployment of renewable and sustainable energy sources and storage systems. As a result of immense progress in the field, cost-effective, high-performance, and long-life rechargeable batteries are imperative to meet the current and future demands for sustainable energy sources. Currently, lithium-ion batteries are widely used, but limited lithium (Li) resources have caused price spikes, threatening progress toward cleaner energy sources. Therefore, post-Li, batteries that utilize highly abundant materials leading to cost-effective energy storage solutions while offering desirable performance characteristics are urgently needed. Aluminum-ion battery (AIB) is an attractive concept that uses highly abundant aluminum while offering a high theoretical gravimetric and volumetric capacity of 2980 mAh g-1 and 8046 mAh cm-3 , respectively. As a result, intensified efforts have been made in recent years to utilize numerous electrolytes, anodes, and cathode materials to improve the electrochemical performance of AIBs, and potentially create high-performance, low-cost, and safe energy storage devices. Herein, recent progress in the electrolyte, anode, and cathode active materials and their utilization in AIBs and their related characteristics are summarized. Finally, the main challenges facing AIBs along with future directions are highlighted.

Diagnostic Value of Single-Photon Emission Tomography Stress Test in Patients With Suspected Coronary Artery Disease in Saudi Arabia.

Background Invasive coronary angiography (ICA) is the gold standard procedure for the diagnosis of coronary artery disease (CAD). ICA allows for clear visualization of the coronary arterial blood flow. Single-photon emission computed tomography (SPECT) is currently in widespread use to non-invasively evaluate patients known or suspected of coronary artery disease (CAD). This study aimed to examine the association between (SPECT) stress test and elective ICA in terms of diagnostic value in patients suspected of coronary artery disease at the King Faisal Cardiac Center (KFCC), Jeddah, Saudi Arabia. Methods This study is a retrospective diagnostic validation study using a consecutive sampling technique to select the study sample at KFCC. The study included all patients who presented with chest pain that were investigated with either exercise or pharmacologic myocardial perfusion SPECT study followed by elective ICA within six months from January 2015 to January 2020. Results A total of 207 patients met the inclusion criteria, where 43% (n = 90) of patients were females and 57% (n = 117) were males; 68% (n = 141) of the patients had both test results concordant (both SPECT and ICA results were in agreement). In 32% of the patients (n = 66), there was a discordant result (discrepant result between SPECT and ICA). SPECT had a sensitivity of 92.4% and a specificity of 26.3%. SPECT had a negative predictive value of 0.68 and a positive predictive value of 0.66 compared to ICA. There was a low degree of reliability between SPECT and ICA. Conclusion Reliability between the SPECT and ICA in exclusion of significant CAD is high. The rate of false-positive tests was high while the accuracy of SPECT in detecting CAD in patients with diabetes and hypertension was high. The overall reliability of SPECT to ICA in the Saudi population was low.

Large left ventricular thrombus surgically resected in a patient with normal ejection: A case report.

INTRODUCTION: A left ventricular thrombus is very rare in a patient with normal systolic function. We are reporting a case of left ventricular thrombus in a patient with an abnormal presentation and normal ejection fraction. PRESENTATION OF CASE: A 57-year-old female patient presented with severe epigastric and central abdominal pain associated with nausea, vomiting, constipation, and a decrease in appetite. Post-contrast abdominal computerized tomography (CT) scan revealed multiple splenic infarcts. On echocardiographic study, a huge hyperechogenic, mobile mass was seen attached to the septo-apical wall of the left ventricle measuring 20 mm × 40 mm. Magnetic resonance imaging (MRI) also showed transmural late gadolinium enhancement in the apex which is suggestive of small myocardial infarction in the distal left anterior descending territory. Coronary angiogram showed non-occluded coronaries. The patient was treated surgically due to the urgency of the situation and the high risk of embolization. DISCUSSION: Our patient was on both progesterone and high dose tofacitinib. It is hypothesised that patient most likely experienced asymptomatic myocardial injury with non-occluded coronaries (MINOCA) weeks prior to the presentation. Involvement of distal left anterior descending artery caused apical akinesia resulting in blood stasis. Accompanying subendocardial injury and hypercoagulable state, due to being on progesterone and tofacitinib, led to the formation of the left ventricular thrombus. CONCLUSION: Due to the serious outcomes associated with an untreated left ventricular thrombus, it is necessary to carefully assess all patients suffering from systemic embolism with echocardiogram. Assessing the left ventricular mass with MRI was crucial to understanding the nature of the mass. Size, mobility, and protruding nature where characteristics that warranted urgent surgical intervention due to the high risk of embolization. Finally, it is important to note that tofacitinib might be a new suspect for left ventricular clots.

Stable metal anodes enabled by a labile organic molecule bonded to a reduced graphene oxide aerogel.

Metallic anodes (lithium, sodium, and zinc) are attractive for rechargeable battery technologies but are plagued by an unfavorable metal-electrolyte interface that leads to nonuniform metal deposition and an unstable solid-electrolyte interphase (SEI). Here we report the use of electrochemically labile molecules to regulate the electrochemical interface and guide even lithium deposition and a stable SEI. The molecule, benzenesulfonyl fluoride, was bonded to the surface of a reduced graphene oxide aerogel. During metal deposition, this labile molecule not only generates a metal-coordinating benzenesulfonate anion that guides homogeneous metal deposition but also contributes lithium fluoride to the SEI to improve Li surface passivation. Consequently, high-efficiency lithium deposition with a low nucleation overpotential was achieved at a high current density of 6.0 mA cm-2 A Li|LiCoO2 cell had a capacity retention of 85.3% after 400 cycles, and the cell also tolerated low-temperature (-10 °C) operation without additional capacity fading. This strategy was applied to sodium and zinc anodes as well.

Effect of proton pump inhibitors on Rubidium-82 gastric uptake using positron emission tomography myocardial perfusion imaging.

BACKGROUND: Rb-82 positron emission tomography (PET) myocardial perfusion imaging (MPI) is a robust tool for the evaluation of coronary artery disease (CAD). However, gastric uptake and spillover can be seen in 10% of Rb-82 PET MPI studies, commonly affecting the inferior wall, and can preclude the accurate identification of myocardial ischemia. We sought to understand the relationship between Rb-82 gastric uptake and the use of proton pump inhibitors (PPI). METHODS: 600 consecutive patients who presented for a clinically indicated Rb-82 PET MPI study were prospectively enrolled. In addition to the clinical history, PPI use was ascertained (medication, dose, frequency and duration of use, and time of last dose). Patients were categorized as PPI and non-PPI users. Rb-82 uptake in the gastrium, myocardium, and liver were measured at rest. Absolute uptake values and gastric:hepatic ratios were compared in PPI and non-PPI users. RESULT: Of 600 enrolled patients, 181 (30.2%) patients were using PPI. The gastric Rb-82 uptake in PPI users was 23% higher than non-PPI users (146 ± 52 kBq/cc vs 119 ± 40 kBq/cc, respectively; P < 0.001). The resting gastric:hepatic Rb-82 uptake ratio was also 23% higher in PPI vs non-PPI users (2.7 ± 1.0 vs 2.2 ± 0.8, respectively; P < 0.001). CONCLUSION: The gastric uptake of Rb-82 appears to be greater in patients actively using PPI and may identify a group who might be at greater risk of non-diagnostic Rb-82 PET MPI.

Percutaneous Device Closure of Patent Ductus Arteriosus in Adult Patients with 10-Year Follow-up.

OBJECTIVES: We report our 10-year experience with transcatheter closure of patent ductus arteriosus (PDA) in adult using different closure devices. BACKGROUND: Transcatheter closure of PDA in adults can be challenging because of frequently associated comorbidities. Reports on immediate and intermediate-term results of PDA closure are excellent. This study aimed to provide the outcomes of PDA closure using different devices on long and very long term follow-up in adults. MATERIALS AND METHODS: Between September 2009 and December 2018, data were retrospectively reviewed from 27 patients who underwent transcatheter closure of PDA. Outcome parameters were procedural success, procedure-related complications, evidence of residual shunt, and improvement in the signs/symptoms for which the procedure was performed. The mean follow-up interval was 72 months. RESULTS: A device was successfully implanted in 27 of 27 patients (15 females). Median age and weight were 24 years (range: 18-57 years) and 69 kg (range: 53-102 kg), respectively. The mean PDA diameter was 4.1 ± 2.1 mm. Devices used were Amplatzer Duct Occluder (19/27), Occlutech Duct Occluder (6/27), and PFM Nit-Occlud (2/27). Doppler transthoracic echocardiography (TTE) demonstrated 92.6% of full occlusion at day 1, rising to 96.3% at 1 month. Three procedure-related complications occurred with no death. Among symptomatic 26 patients (96.3%), there was marked improvement in symptoms. Among 22 patients (81.5%) for whom the procedure was performed to address left ventricular (LV) enlargement, there was reduction or stabilization in LV size on serial TTEs. CONCLUSIONS: Transcatheter closure of PDA in the adult patient appears to be safe and effective.

Optimizing Risk Stratification and Noninvasive Diagnosis of Ischemic Heart Disease in Women.

Ischemic heart disease (IHD) is an important and previously underappreciated cause of significant morbidity and mortality in women. Key differences exist in the pathophysiology, sex-specific risk factors, and clinical presentation in women compared with men, which influence diagnostic accuracy and utility of pretest risk assessments and noninvasive testing. Women are disproportionately affected by ischemia from microvascular dysfunction as evidenced by having less obstructive coronary artery disease on angiography, contributing to the challenge in diagnosis and prognosis of IHD in women via conventional methods, which tend to emphasize detection of epicardial stenoses. In this article, we review the utility, evidence for, and challenges of currently available risk assessments and noninvasive cardiac diagnostic tests in women. We propose an approach to investigation of the symptomatic woman with suspected IHD and selection of the appropriate testing modality. Finally, we explore opportunities for future research and highlight the urgent need for updated, evidence-based, Canadian guidelines specific to women with IHD.