Daisuke Tezuka

Role of FDG PET-CT in Takayasu arteritis: sensitive detection of recurrences.

OBJECTIVES The aim of this study was to investigate whether the maximum standardized uptake value (max SUV) of (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) provides a quantitative indication of disease activity in Takayasu arteritis (TA) cases. BACKGROUND The clinical value of FDG-PET for assessing TA has been investigated. Clinical evaluation of disease activity is often difficult, because most patients develop recurrent inflammation while receiving corticosteroid treatment. METHODS Thirty-nine TA patients underwent FDG-PET/CT at Tokyo Medical and Dental University from 2006 to 2010 (35 women and 4 men; median age, 30 years). Disease activity was defined according to National Institutes of Health criteria. Biomarkers including C-reactive protein and erythrocyte sedimentation rate were measured. Forty subjects without vasculitis served as control subjects. RESULTS The max SUV was significantly higher in active than in inactive cases and control subjects (active [n = 27], median value, 2.7 vs. inactive [n = 12], 1.9; control [n = 40], 1.8; p < 0.001 each). Given a max SUV cutoff of 2.1, sensitivity for active-phase TA was 92.6%, specificity 91.7%, positive predictive value 96.2%, and negative predictive value 84.6%. In receiver-operating characteristic curves comparison, max SUV was superior to C-reactive protein (p < 0.05) and erythrocyte sedimentation rate (p < 0.05). Max SUV was significantly higher in relapsing on treatment cases (n = 17) than in stable on treatment cases (n = 12) (median value, 2.6 vs. 1.9; p < 0.001). CONCLUSIONS FDG-PET/CT is useful for detection of active inflammation not only in patients with active TA before treatment but also in relapsing patients receiving immunosuppressive agents. The max SUV is useful for assessing subtle activity of TA with high sensitivity.

Sensitive Assessment of Activity of Takayasu's Arteritis by Pentraxin3, a New Biomarker

To the Editor: Takayasus arteritis (TA) is a chronic vasculitis mainly involving the aorta and its main branches ([1][1]). The erythrocyte sedimentation rate and C-reactive protein (CRP) level have generally been used to monitor disease activity. In addition to steroids and conventional

Isolated cardiac sarcoidosis: Clinical characteristics, diagnosis and treatment

Sarcoidosis is a systemic disease characterized by the development of noncaseating epithelioid granulomas in multiple organs. Despite extensive investigations over a long period of time, the etiology of this disease remains unknown. Cardiac involvement of this disease is the most ominous complication leading to fatal outcome. Recently, attention has been focused on isolated cardiac sarcoidosis, which exists without clinically apparent sarcoidosis elsewhere. One of the critical issues of isolated cardiac sarcoidosis is difficulty in diagnosis, since existence of the cardiac lesion should be detected from cardiac manifestations alone. Because specificity of biomarkers or sensitivity of histological examination of biopsied sample is very low, diagnosis of isolated cardiac sarcoidosis mainly depends on imaging modalities. In this review article we summarized current knowledge on the pathogenesis of sarcoidosis, clinical features of cardiac sarcoidosis especially that isolated to the heart by showing some typical cases. Utilities and problems of diagnostic imaging tests for this condition including echocardiography, cardiac magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography are discussed. Advances in pharmacological and nonpharmacological treatment for cardiac sarcoidosis have improved the prognosis of cardiac sarcoidosis to a great deal; however, there are many issues that remain to be solved in the management of isolated cardiac sarcoidosis.

An initial case of suppressed restenosis with nuclear factor‐kappa B decoy transfection after percutaneous coronary intervention

Nuclear factor‐kappa B (NF‐κB) is well known for playing a pivotal role in restenosis after percutaneous coronary intervention (PCI).

Vessel Wall Inflammation of Takayasu Arteritis Detected by Contrast-Enhanced Magnetic Resonance Imaging: Association with Disease Distribution and Activity

Aims The assessment of the distribution and activity of vessel wall inflammation is clinically important in patients with Takayasu arteritis. Magnetic resonance imaging (MRI) is a useful tool, but the clinical utility of late gadolinium enhancement (LGE) in Takayasu arteritis has yet to be determined. The aim of the present study was to evaluate the utility of LGE in assessing vessel wall inflammation and disease activity in Takayasu arteritis. Methods and Results We enrolled 49 patients with Takayasu arteritis who had undergone 1.5 T MRI. Patients were divided into Active (n = 19) and Inactive disease (n = 30) groups. The distribution of vessel wall inflammation using angiography and LGE was assessed by qualitative analysis. In 79% and 63% of patients in Active and Inactive groups, respectively, greater distribution of vessel wall inflammation was observed with LGE than with conventional angiography. MRI values of pre- and post-contrast signal-to-noise ratios (SNR), SNR increment (post-SNR minus pre-SNR), pre- and post-contrast contrast-to-noise ratios (CNR), and CNR increment (post-CNR minus pre-CNR) were evaluated at arterial wall sites with the highest signal intensity using quantitative analysis of post-contrast LGE images. No statistically significant differences in MRI parameters were observed between Active and Inactive groups. Contrast-enhanced MRI was unable to accurately detect active disease. Conclusion Contrast-enhanced MRI has utility in detecting the distribution of vessel wall inflammation but has less utility in assessing disease activity in Takayasu arteritis.

Profiles of serum cytokine levels in Takayasu arteritis patients: Potential utility as biomarkers for monitoring disease activity

BACKGROUND Takayasu arteritis (TA) is an autoimmune arteritis of unknown etiology. Currently, the erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) levels are widely used to monitor disease activity of TA. However, sometimes it is difficult to reflect inflammatory symptoms in either CRP or ESR values, especially in TA patients with immunosuppressive therapies. Therefore, higher-accuracy biomarkers for evaluating disease activity need to be explored. METHODS AND RESULTS We examined 21 Japanese patients diagnosed with TA; 17 TA patients were treated with prednisone with or without additional immunosuppressive therapies and the remaining 4 patients were treated with infliximab, a human monoclonal anti-tumor necrosis factor (TNF)-α antibody. In active phase, the serum levels of both TNF-α and interleukin (IL)-6 were significantly higher than in healthy subjects, as is the case with both the levels of CRP and ESR. In contrast, the levels of both IL-12 and IL-23 remained in the normal range. Both TNF-α and IL-6 levels were markedly decreased in response to therapies, on equality with both CRP and ESR levels. Regarding the TA patients treated with infliximab, both CRP and IL-6 levels tended to be decreased after infliximab therapy. Conversely, TNF-α level after infliximab therapy was higher than before therapy. CONCLUSION Both TNF-α and IL-6 levels, but not IL-12 or IL-23 levels, in the serum could be potent biomarkers that can reflect the activity of TA.

An Oxygen Therapy Prevents Ventricular Arrhythmia in Patients with DiastolicHeart Failure and Sleep Apnea

The background and purpose Diastolic and systolic heart failure (DHF and SHF) are the different clinical subsets. Because many heart failure patients have sleep apnea syndrome (SAS), oxygen supply improves the patient’s prognosis. Thus, the purpose of this study was to compare the effects of oxygen treatment for premature ventricular contractions (PVCs) suppression in patients between DHF and SHF. Methods and subjects Patients with heart failure (BNP>80 pg/ml), SAS (AHI> 5) and frequent PVCs (>30/h) were admitted to the hospital for at least 2 consecutive nights. On the first night, the respiratory and Holter monitoring was performed without nasal oxygen treatment; the same monitor with nasal oxygen therapy (3 L/min) was performed on the second night. Essential results The DHF patients (more than 40% of LVEF, n=7) showed a significant decline of PVC numbers (63.1 ± 33.0% post/pre) compared to those (119.8 ± 45.3% post/pre, p<0.05) of the SHF patients (less than 40% of LVEF, n=8) by the oxygen treatment. The DHF patients also showed higher SDNN (253.0 ± 260.0 ms) levels compared to those of SHF patients (52.9 ± 22.4 ms, p<0.05). However, AHI and BNP levels were compatible between the two groups. The principal conclusion The oxygen treatment may be useful for prevention of ventricular arrhythmia in patients with DHF and SAS.

Progression of thrombogenesis in large coronary aneurysms during anticoagulant therapy in a Buerger's disease patient.

Buergers disease results in thrombotic obstructions in small-sized and medium-sized arteries and veins in the arms and legs, and more rarely in the coronary arteries.1 A patient, a habitual smoker, suffered from severe leg pain, and angiography of arteries in the legs showed typical findings of Buergers disease, that is, diffuse stenosis with corkscrew collaterals (figure 1A). Five years later, amputation of his legs was needed due to progressing Buergers disease. During the assessment of his cardiac function, asymptomatic myocardial infarction was diagnosed by echocardiogram showing asynergy of the left ventricular wall with a decreased ejection fraction (40%) and akinesis of the inferior …