Yolande Appelman

Cardiac PET-CT: advanced hybrid imaging for the detection of coronary artery disease.

Hybrid imaging of positron emission tomography (PET) together with computed tomography (CT) is rapidly emerging. In cardiology, this new advanced hybrid imaging modality allows quantification of cardiac perfusion in combination with assessment of coronary anatomy within a single scanning session of less than 45 minutes. The near-simultaneous anatomical evaluation of coronary arteries using CT and corresponding functional status using PET provides a wealth of complementary information in patients who are being evaluated for (suspected) coronary artery disease, and could help guide clinical patient management in a novel manner. Clinical experience gained with this recently introduced advanced hybrid imaging tool, however, is still limited and its implementation into daily clinical practice remains largely unchartered territory. This review discusses principles of perfusion PET, its diagnostic accuracy, and potential clinical applications of cardiac PET-CT in patients with ischaemic heart disease. (Neth Heart J 2010;18:90–8.)

Worse outcome in women with STEMI: a systematic review of prognostic studies

Treatment of ST elevation myocardial infarction (STEMI) has improved enormously since the introduction of primary percutaneous coronary intervention (pPCI). It remains unclear whether differences in survival between women and men treated with pPCI exist and whether these potential differences can be explained by gender or by differences in baseline‐ or procedural characteristics. Therefore we systematically reviewed the available evidence.

Motivations for and barriers to choosing an interventional cardiology career path: Results from the EAPCI Women Committee worldwide survey

AIMS Very few women become interventional cardiologists, although a substantial proportion of cardiologists and the majority of medical students are women. In accordance with the EAPCI Women Committee mission of attaining gender equality at the professional level, a worldwide survey was recently conducted aiming to understand better the motivations and the barriers for women in selecting interventional cardiology (IC) as a career path. METHODS AND RESULTS A total of 1,787 individuals (60.7% women) responded to the survey. Women compared to men were less frequently married (women vs. men, 57.0% vs. 79.8%, p<0.001) and more frequently childless (46.6% vs. 20.5%, p<0.002). The most prevalent reason for choosing IC was passion (83.3% vs. 76.1%, p=0.12), while those for not choosing were, sequentially, lack of opportunity (29.0% vs. 45.7%), radiation concerns (19.9% vs. 11.6%) and preference (16.2% vs. 29.5%), p<0.001. According to 652 men replying to why, in their opinion, women do not choose IC, on-calls and long working hours were the most frequent reasons (35.3%). CONCLUSIONS Several barriers preclude women from choosing IC, including lack of opportunity, concerns regarding radiation exposure and the prejudices of their male colleagues. This highlights the need to develop new strategies for future training, education, and support of women in order to choose IC.

No cardiac damage after endurance exercise in cardiologists cycling to the European Society of Cardiology meeting in Barcelona

Aims There are variable results reported for athletes and potential cardiac damage during exercise. In 2009 a group of cardiologists went by bicycle from the Netherlands to the European Society of Cardiology meeting in Barcelona and collected functional and biochemical parameters during this trip in order to evaluate whether cardiac damage was observed in a group of moderately trained amateur cyclists. Methods and results All of the 20 amateur cyclists (17 men) completed the 1580 km in eight days with an average speed of 27.9 km and an average distance of 190 km/day. Cardiac damage was predefined as wall motion abnormalities detected by echocardiography or an increase of troponin I exceeding three times the upper limit. Although skeletal muscle damage was found in all of the cyclists, no cardiac damage could be detected. Conclusion This long distance bicycle trip performed by moderately trained cardiologists demonstrates that it was safe and feasible and did not lead to cardiac damage although skeletal muscle damage was demonstrated in all participants.

Diagnostic accuracy of quantitative H215O PET measurements of hyperemic myocardial blood flow versus coronary flow reserve for the detection of obstructive coronary artery disease

Carotid artery intima media thickness, but not coronary artery calcium, predicts coronary vascular resistance in patients evaluated for coronary artery diseaseSecretoneurin, a peptide from the chromogranin-secretogranin family, regulates cardiomyocyte calcium homeostasisPredictors of low physical activity in patients with stable coronary heart disease in the global STABILITY study

Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial

Aims Patients with acute coronary syndrome who present initially with ST-elevation on the electrocardiogram but, subsequently, show complete normalization of the ST-segment and relief of symptoms before reperfusion therapy are referred to as transient ST-segment elevation myocardial infarction (STEMI) and pose a therapeutic challenge. It is unclear what the optimal timing of revascularization is for these patients and whether they should be treated with a STEMI-like or a non-ST-segment elevation myocardial infarction (NSTEMI)-like invasive approach. The aim of the study is to determine the effect of an immediate vs. a delayed invasive strategy on infarct size measured by cardiac magnetic resonance imaging (CMR). Methods and results In a randomized clinical trial, 142 patients with transient STEMI with symptoms of any duration were randomized to an immediate (STEMI-like) [0.3 h; interquartile range (IQR) 0.2-0.7 h] or a delayed (NSTEMI-like) invasive strategy (22.7 h; IQR 18.2-27.3 h). Infarct size as percentage of the left ventricular myocardial mass measured by CMR at day four was generally small and not different between the immediate and the delayed invasive group (1.3%; IQR 0.0-3.5% vs. 1.5% IQR 0.0-4.1%, P = 0.48). By intention to treat, there was no difference in major adverse cardiac events (MACE), defined as death, reinfarction, or target vessel revascularization at 30 days (2.9% vs. 2.8%, P = 1.00). However, four additional patients (5.6%) in the delayed invasive strategy required urgent intervention due to signs and symptoms of reinfarction while awaiting angiography. Conclusion Overall, infarct size in transient STEMI is small and is not influenced by an immediate or delayed invasive strategy. In addition, short-term MACE was low and not different between the treatment groups.