To assess the feasibility of estimating myocardial flow reserve (MFR) from static standardized uptake values (SUVs) derived using stress and rest 13N-ammonia positron emission tomography (PET) images acquired with a silicon photomultiplier-based PET/computed tomography (CT) system. The goal was to simplify MFR assessment by avoiding dynamic acquisition while maintaining diagnostic accuracy. We retrospectively included 121 consecutive patients who underwent 13N-ammonia PET myocardial perfusion imaging. The mean SUVs of the left and right ventricles were measured on transverse-axis slices corresponding to the largest cross-sectional area, and the stress-to-rest SUV ratio was calculated. A logarithmic transformation was applied to the MFR, and linear regression models between the log-transformed MFR and the stress-to-rest left ventricular-SUV ratio were developed using six-fold cross-validation across 121 patients. The predicted MFR values from the test folds were then combined to evaluate model performance across all patients with a comparable MFR distribution. Model performance was assessed using the root mean square error (RMSE) between the estimated and true MFR values, and the diagnostic performance for identifying MFRs < 2.0 by receiver operating characteristic (ROC) curve analysis with 95
BACKGROUND:To provide evidence from randomized controlled trials (RCTs) for large-vessel vasculitis (LVV), including Takayasu arteritis (TAK) and giant cell arteritis (GCA), to inform the forthcoming 2026 Japanese Circulation Society (JCS) clinical practice guideline. METHODS AND RESULTS:We drafted 4 and 7 clinical questions for TAK and GCA, respectively. A systematic review (SR) of RCTs was conducted using PubMed, CENTRAL, EMBASE, and the Japan Medical Abstracts Society through March 2024. Assessed with the GRADE approach, the certainty of evidence was very low for the most critical outcomes, low for some outcomes, and moderate for only 1 outcome. Evidence for TAK was limited. Tocilizumab (TCZ) resulted in a numerically lower relapse rate vs. placebo (risk ratio (RR) 0.73, 95% confidence interval (CI) 0.39-1.37) and was similar to adalimumab. No clear difference between mycophenolate mofetil (MMF) and methotrexate (MTX), or between abatacept (ABA) and placebo was observed. In GCA, TCZ reduced relapse (RR 0.29, 95% CI 0.09-0.98) and increased remission (RR 3.56, 95% CI 2.29-5.54) over placebo at 52 weeks. Tumor necrosis factor inhibitor, ABA, and MTX showed no benefit in cranial GCA. Serious adverse events were comparable between treatment groups. Geographic variation and differences in entry criteria were noted. CONCLUSIONS:This SR was comprehensive synthesis of evidence from RCTs for LVV therapies to support the 2026 JCS guideline.
Background We aimed to evaluate the prognostic effect of serum high-density lipoprotein cholesterol (HDL-c) concentration on the risk of vascular events and functional prognosis in patients with stroke. Methods In this prospective observational study, patients with ischemic stroke were consecutively enrolled within 1 week of symptom onset and followed up for 1 year. Patients were divided into 3 groups according to tertiles of serum HDL-c levels (tertile 1, <47 mg/dL; tertile 2, 47-60 mg/dL; and tertile 3, >60 mg/dL). The primary outcome was a composite of major adverse cardiovascular events, including nonfatal stroke, nonfatal acute coronary syndrome, major peripheral artery disease, and vascular death. The secondary outcome was the modified Rankin scale score. Results A total of 865 patients (mean age, 70.2 years; male, 61.1%) were included. High HDL-c levels were associated with older age, female sex, low body mass index, nonsmoking, and low prevalences of diabetes and coronary artery disease. No significant differences were found in the risk of major adverse cardiovascular events between the 3 groups (annual rates: 17.5%, 11.2%, and 12.4% in tertiles 1, 2, and 3, respectively; log-rank P=0.11). However, significant differences were observed in the modified Rankin scale scores at 3 months and 1 year between these groups. After multivariable adjustments, higher HDL-c levels comparing tertile 3 with tertile 1 were independently associated with good functional outcomes (modified Rankin scale score of 0-2) at 3 months (adjusted odds ratio [OR], 1.71 [95% CI, 1.03-2.83]) and 1 year (adjusted OR, 1.60 [95% CI, 1.00-2.57]), respectively. Conclusions No correlations were observed between HDL-c levels and vascular event risk; however, elevated HDL-c concentrations were associated with favorable functional recovery in patients with stroke.Registration https://upload.umin.ac.jp; Unique Identifier: UMIN000031913
BackgroundSubarachnoid hemorrhage (SAH) is a well-recognized complication after mechanical thrombectomy (MT) and may adversely affect clinical outcomes. SAH commonly results from vessel injury due to overextension or displacement during device retrieval. This risk is particularly concerning in smaller, tortuous vessels, such as in medium vessel occlusions (MeVO). This study evaluated whether a novel low radial and axial force stent retriever (Tron FX II) could reduce post-procedural SAH without compromising recanalization outcomes.MethodsThe study comprised two components: (1) bench testing comparing radial/axial force and vessel displacement during retrieval between Tron FX II (hereafter Tron) and conventional devices; and (2) a prospective observational study of 197 consecutive MT patients. A combined technique was employed in all cases. Conventional stent retrievers were used until July 2023, after which Tron was used exclusively. Post-procedural SAH was assessed using dual-energy CT immediately after MT. The primary outcome was SAH incidence, with or without symptoms. Secondary outcomes included effective recanalization, first-pass rate, and 90-day functional outcomes.ResultsBench testing showed Tron exhibited the lowest radial/axial force and the smallest vessel deviation during retrieval. Clinically, Tron significantly reduced the incidence of post-procedural SAH (7.7% vs. 23.9%, p = 0.027) as well as SAH associated with neurological deterioration (1.9% vs. 12.7%, p = 0.044) in cases of middle cerebral artery occlusion (MCAO) and MeVO. Moreover, both Tron use and fewer stent retriever passes were independently associated with a lower risk of SAH. Overall effective recanalization, first-pass rates, and functional outcomes were not significantly different between groups in this pilot study.ConclusionThe low radial and axial force stent retriever reduced post-procedural SAH while maintaining effective recanalization when combined with an aspiration catheter. These findings support its potential role as a safer option for MCAO and MeVO.
