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Although it is known that assessment and management of the nutritional status of patients are important for treatment of patients with heart failure (HF), there are currently no established indicators. Therefore, we investigated the effects of nutritional parameters as well as conventional parameters on the prognosis of HF patients. A total of 1954 consecutive HF patients with left ventricular ejection fraction (LVEF) less than 50% were enrolled in this study. Transthoracic echocardiography was performed and conventional parameters for HF patients and parameters to assess nutritional status were measured in all patients. Patients were followed up with a primary endpoint of lethal cardiac events (CEs) for 30.2 months. During the follow-up period, cardiac events were documented in 619 HF patients. The CEs group had a lower level of cholinesterase (201.5U/L vs 265.2U/L, P <0.0001), lower estimated GFR (35.2 ml/min/1.73m 2 vs 50.3ml/min/1.73m 2 , P< 0.0001), and lower Geriatric Nutritional Risk Index (GNRI) (91.9 vs 100.0, P< 0.0001) than those in the non-CEs group. Serum cholinesterase, estimated GFR, and GNRI were identified as significant prognostic determinants in multivariate analysis. ROC analyses revealed cut-off values of serum cholinesterase, estimated GFR, and GNRI of 229U/L, 34.2 ml/min/1.73m 2 , and 95.6, respectively, for identifying high-risk HF patients. HF patients with serum cholinesterase< 229U/L, estimated GFR<34.3 ml/min/1.73m 2 , and GNRI< 95.6 had a significantly greater rate of CEs than that in the other patients (P<0.0001). Low serum cholinesterase and low GNRI can predict cardiac mortality risk in systolic HF patients with renal dysfunction.

While coronary heart disease remains a global cause of mortality, the prevalence of heart failure (HF) is increasing in developed countries including Japan. The continuously increasing aging population and the relatively low incidence of ischemic origins are features of the HF background in Japan. Information about nuclear cardiology practice and prognosis has accumulated, thanks to the multicenter prognostic J-ACCESS investigations (Series 1‒4) over two decades in Japan. Although the rate of hard cardiac events is lower in Japan than in the USA and Europe, similar predictors have been identified as causes of major adverse cardiac events. The highest proportion (50–75%) of major events among patients indicated for nuclear cardiology examinations in the J-ACCESS registries is severe HF requiring hospitalization. Therefore, the background and the possible reasons for the higher proportion of severe HF events in Japan require clarification. Combinations of age, myocardial perfusion defects, left ventricular dysfunction, and comorbid diabetes and chronic kidney disease are major predictors of cardiovascular events including severe HF. Although the Japanese Circulation Society has updated its clinical guidelines to incorporate non-invasive imaging modalities for diagnosing chronic coronary artery disease, the importance of risk-based approaches to optimal medical therapy and coronary revascularization is emphasized herein.

Climate change adaptation options need to be prioritized so that decision-makers make the appropriate choice among multiple options using decision analysis methods. Although different decision analysis methods are applied in different sectors, the status and challenges of applying the methods in various sectors have not been investigated to date because this is a rapidly developing research field. We systematically reviewed the decision analysis literature in climate change adaptation to investigate how decision analysis methods have been applied in each sector and to identify ongoing challenges. We found that most articles focused on the agriculture, water resources, coastal disaster, and river flooding subsectors, whereas no articles were found in the poverty, settlement, and wellbeing subsectors. The applications of decision analysis methods that can account for the deep uncertainty of adaptation (the deep uncertainty group) comprised about 15% of the total, and they were concentrated in the water resources and disaster-related subsectors. In the poverty, settlement, and wellbeing subsectors, it can be inferred that academic articles are scarce because it is challenging to study climate change projections due to the strong impact of socioeconomic conditions, and because the actors are often reported at the local or individual levels. Although the sectors where climate change impact projections have been developed may have led to a relatively large proportion of applications of the deep uncertainty group, the small number of applications suggests inadequate consideration of uncertainty in all sectors. In the future, it will be crucial for each sector to develop methods to evaluate deep uncertainty; these include using applications in the deep uncertainty group and combining multiple decision analysis methods.

As a 2-year project of the Japanese Society of Nuclear Medicine working group activity, normal myocardial imaging databases were accumulated and summarized. Stress-rest with gated and non-gated image sets were accumulated for myocardial perfusion imaging and could be used for perfusion defect scoring and normal left ventricular (LV) function analysis. For single-photon emission computed tomography (SPECT) with multi-focal collimator design, databases of supine and prone positions and computed tomography (CT)-based attenuation correction were created. The CT-based correction provided similar perfusion patterns between genders. In phase analysis of gated myocardial perfusion SPECT, a new approach for analyzing dyssynchrony, normal ranges of parameters for phase bandwidth, standard deviation and entropy were determined in four software programs. Although the results were not interchangeable, dependency on gender, ejection fraction and volumes were common characteristics of these parameters. Standardization of 123 I-MIBG sympathetic imaging was performed regarding heart-to-mediastinum ratio (HMR) using a calibration phantom method. The HMRs from any collimator types could be converted to the value with medium-energy comparable collimators. Appropriate quantification based on common normal databases and standard technology could play a pivotal role for clinical practice and researches.

This study aimed to compare tumor lesion detectability and diagnostic accuracy of whole-body magnetic resonance imaging (WB-MRI) and radioiodine-labeled meta-iodo-benzylguanidine ( m IBG) imaging techniques in patients with metastatic pheochromocytoma and paraganglioma (PPGL). This retrospective study included 13 patients had pheochromocytoma and 5 had paraganglioma, who were all suspected of having metastatic tumors. Each patient underwent WB-MRI and 123 I- m IBG as a pretreatment screening for 131 I- m IBG therapy. Two expert reviewers evaluated WB-MRI, 123 I- m IBG images, and post-therapy 131 I- m IBG images for the presence of metastatic lesions in the lungs, bones, liver, lymph nodes, and other organs. Diagnostic measures for detecting metastatic lesions, including sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristics (ROC)—area under the curve (AUC), were calculated for each imaging technique. We analyzed WB-MRI images for detecting metastatic lesions, which demonstrated sensitivity, specificity, accuracy, PPV, NPV, and AUC of 82%, 97%, 90%, 96%, 86%, and 0.92, respectively. These values were 83%, 95%, 89%, 94%, 86%, and 0.90 in 123 I- m IBG images and 85%, 92%, 89%, 91%, 87%, and 0.91 in post-therapy 131 I- m IBG images, respectively. Our results reveal the comparable diagnostic accuracy of WB-MRI to one of the m IBG images.

The aim of this study was to demonstrate the usefulness of SwiftScan with a low-energy high-resolution and sensitivity (LEHRS) collimator for bone scintigraphy using a novel bone phantom simulating the human body. SwiftScan planar image of lateral view was acquired in clinical condition; thereafter, each planar image of different blend ratio (0–80%) of Crality 2D processing were created. SwiftScan planar images with reduced acquisition time by 25–75% were created by Poisson’s resampling processing. SwiftScan single photon emission computed tomography (SPECT) was acquired with step-and-shoot and continuous mode, and SPECT images were reconstructed using a three-dimensional ordered subset expectation maximization incorporating attenuation, scatter and spatial resolution corrections. SwiftScan planar image showed a high contrast to noise ratio (CNR) and low percent of the coefficient of variance (%CV) compared with conventional planar image. The CNR of the tumor parts in SwiftScan SPECT was higher than that of the conventional SPECT image of step and shoot acquisition, while the %CV showed the lowest value in all systems. In conclusion, SwiftScan planar and SPECT images were able to reduce the image noise compared with planar and SPECT image with a low-energy high-resolution collimator, so that SwiftScan planar and SPECT images could be obtained a high CNR. Furthermore, the SwiftScan planar image was able to reduce the acquisition time by 25% when the blend ratio of Clarity 2D processing set to more than 40%.

The 123 I-labeled meta-iodobenzylguanidine (MIBG) is an analogue of noradrenaline that can evaluate cardiac sympathetic activity in scintigraphy. Quantitative analysis of 123 I-MIBG images has been verified in patients with heart failure and neurodegenerative diseases. However, quantitative results differ due to variations in scintigraphic imaging procedures. Here, we created and assessed the clinical feasibility of a calibration method for 123 I-MIBG imaging. The characteristics of scintigraphic imaging systems were determined using an acrylic calibration phantom to generate a multicenter phantom imaging database. Calibration factors corresponding to the scintigraphic imaging procedures were calculated from the database and applied to a clinical study. The results of this study showed that the calibrated analysis eliminated inter-institutional differences among normal individuals. In summary, our standardization methodology for 123 I-MIBG scintigraphy could provide the basis for improved diagnostic precision and better outcomes for patients.

The purpose of this practice recommendation is to specifically identify the critical steps involved in performing and interpreting 123 I-β-methyl-iodophenyl-pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT) and measurement of washout rate (WR) from the heart. This document will cover backgrounds, patient preparation, testing procedure, visual image interpretation, quantitation methods using planar and SPECT studies, and reporting of WR. The pitfall and some tips for the calculation of 123 I-BMIPP WR are also included. The targets of global and regional WR calculation include ischemic heart disease, cardiomyopathy, heart failure, and triglyceride deposit cardiomyovasculopathy, an emerging rare heart disease.