Alberto Pupi

Transmural abnormalities in myocardial blood flow (MBF) are important causes of ischaemia in patients with left ventricular (LV) hypertrophy. The study aimed to test whether pixel-wise parametric mapping of ¹³NH₃ MBF can reveal transmural abnormalities in patients with hypertrophic cardiomyopathy (HCM).

Positron emission tomography (PET) of brain amyloid is a technology that has been approved by Food and Drug Administration and European Medical Agency, but its clinical utility in medical practice requires careful definition. To provide guidance to italian dementia care practitioners, patients, and caregivers, a group of experts from “Associazione Italiana di Medicina Nucleare” (AIMN), “Associazione Italiana di Psicogeriatria” (AIP) and “Società Italiana per lo Studio delle Demenze” (SINDEM) convened the Italian Interdisciplinary Working Group on Amyloid Imaging. The Working Group considered a range of clinical scenarios in which amyloid PET should be recommended. Peer-reviewed, published literature was searched to ascertain available evidence relevant to these recommendations. Although empirical evidence of impact on clinical outcomes is not yet available, a set of specific recommended use criteria were agreed to define the types of patients and clinical circumstances in which amyloid PET could be used. Both correct and incorrect uses were considered and formulated. Because both dementia care and amyloid-PET technology are in active development, these recommendations will require periodic reassessment.

The aim of this study was to identify prostate-specific antigen (PSA) kinetics parameters predictive of [(18)F]fluorocholine positron emission tomography/computed tomography ((18)FC PET/CT) features worsening in a cohort of patients with biochemical failure after prostate cancer treatment. This longitudinal cohort study comprised 103 consecutive patients. All patients underwent two (18)FC PET/CT scans: one at baseline (PET1) and one after 6 months (PET2). Total PSA (tPSA), PSA velocity (vPSA), PSA doubling time (PSAdt), absolute variation in PSA values between PET2 and PET1 (ΔPSA), and percentage variation in PSA between the two PSA measurements (PSA%) were measured in each patient. Progression of disease on (18)FC PET/CT findings was compared with the PSA kinetics parameters. The major outcome measure was disease progression at PET2. (18)FC PET/CT progression between PET1 and PET2 was reported in 64 patients (62.1%), while in 39 cases it remained unvaried. The following PSA kinetic parameters correlated with worsened (18)FC PET/CT findings: ΔPSA >5 ng/ml [odds ratio (OR = 6.44, 95% confidence interval (CI) 1.04-39.6; p = 0.04], vPSA >6 ng/ml/month (OR = 5.2, 95% CI 0.9-29.8; p = 0.05) and PSAdt 5 ng/ml, PSAdt 6 ng/ml/month are highly predictive of (18)FC PET/CT features worsening, independently from the treatment received.

Experimental studies suggest that doxycycline attenuates post-infarction remodelling and exerts protective effects on myocardial ischaemia/reperfusion injury. However, the effects of the drug in the clinical setting are unknown. The aim of this study was to examine the effect of doxycycline on left ventricular (LV) remodelling in patients with acute ST-segment elevation myocardial infarction (STEMI) and LV dysfunction. Open-label, randomized, phase II trial. Immediately after primary percutaneous coronary intervention, patients with STEMI and LV ejection fraction < 40% were randomly assigned to doxycycline (100 mg b.i.d. for 7 days) in addition to standard therapy, or to standard care. The echo LV end-diastolic volumes index (LVEDVi) was determined at baseline and 6 months. (99m)Tc-Sestamibi-single-photon emission computed tomography infarct size and severity were assessed at 6 months. We calculated a sample size of 110 patients, assuming that doxycycline may reduce the increase in the LVEDVi from baseline to 6 months > 50% compared with the standard therapy (statistical power > 80% with a type I error = 0.05). The 6-month changes in %LVEDVi were significant smaller in the doxycycline group than in the control group [0.4% (IQR: -16.0 to 14.2%) vs.13.4% (IQR: -7.9 to 29.3%); P = 0.012], as well as infarct size [5.5% (IQR: 0 to 18.8%) vs. 10.4% (IQR: 0.3 to 29.9%) P = 0.052], and infarct severity [0.53 (IQR: 0.43-0.62) vs. 0.44 (IQR: 0.29-0.60), P = 0.014], respectively. In patients with acute STEMI and LV dysfunction, doxycycline reduces the adverse LV remodelling for comparable definite myocardial infarct size (NCT00469261).

The 3-min SBP ratio (SBPR) was proposed to detect significant coronary artery disease (CAD), but its relationship with abnormalities detected by myocardial perfusion-gated single-photon emission computed tomography (SPECT) was never examined. In 156 consecutive patients submitted to resting and exercise gated SPECT for suspect CAD, perfusion scores, ejection fraction and transient ischemic dilatation (TID) were evaluated and compared with SBPR. There were weak correlations between SBPR and summed stress score (ρ = 0.232, P < 0.004), and summed difference score (SDS) (ρ = 0.228, P < 0.004). According to receiver operating characteristic analysis, SBPR was poorly effective for identifying patients with inducible ischemia (SDS ≥ 2): area under curve = 0.64, (P < 0.002), sensitivity = 82%, specificity = 40%. No relationship was registered between SBPR and postexercise ejection fraction drop, and the relationship with TID was poor (ρ = 0.263, P < 0.001). In patients submitted to gated SPECT for suspect CAD, SBPR appears poorly effective for the detection of significant CAD, and does not show any valuable relationship with exercise-induced functional abnormalities.

Background: Body image distortion is a core symptom of eating disorders. Functional magnetic resonance imaging (fMRI) studies on body image processing, described different patterns of neural response, mainly involving the inferior and superior parietal lobules, and the dorsolateral prefrontal cortex (DLPFC), with conflicting results.Methods: The neural response to the view of their own body pictures (normal size and distorted) was evaluated in 18 female anorexia nervosa (AN) restricting type patients, and in 19 healthy female subjects (HC) using fMRI. Clinical assessment was performed by means of the structured clinical interview for DSM-IV and self-reported questionnaires.Results: In response to the body image distortion, patients and controls showed an inverse pattern of activation, with the widest extent of activation in the oversize condition in AN, while in the undersize condition in HC. AN and HC showed a similar pattern of neural response to the view of their own body, with an increased activation in the extrastriate body area, superior and inferior parietal lobule and prefrontal areas, although the extent of activation in HC was more limited as compared with AN patients. Increased activity in AN patients, compared with HC, was observed in the DLPFC in response to the oversized body picture and a significant correlation was found in AN patients between DLPFC activation and eating disorder psychopathology.Conclusions: Our findings suggest the existence of a continuum from normalcy to pathology in neural response to body image, and confirm the clinical relevance of body image distortion in AN, reinforcing the key role of attentive, executive and self-evaluation networks in AN visual processing of own distorted body image.