Moderated Poster Session 4 Monday 4 May 2015 , 15 : 30 – 16 : 30 Room : Moderated

218 Figure. Abstract 219 Figure.219 Figure. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected]. European Heart Journal Cardiovascular Imaging Abstract Supplements – volume 16 supplement 1 May 2015 doi:10.1093/ehjci/jev050 Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/16/suppl_1/i35/2399740 by guest on 06 March 2018 Conclusions: HA and HA/rTIMP-3 therapy prevented LV wall thinning and reduces loss of function in MI, and decreased MMP activation and increased perfusion as assessed with SPECT imaging. 220 Quantification cardiac amyloid by cardiac computed tomography T. Treibel1, S. Bandula2, M. Fontana1, SK. White1, JA. Gilbertson3, SA. Punwani2, JD. Gillmore3, PN. Hawkins3, SA. Taylor2, JC. Moon1 The Heart Hospital, University College London Hospital Trust, London, United Kingdom; Centre for Medical Imaging, University College London Hospitals, London, United Kingdom; National Amyloidosis Centre, Royal Free Campus, University College London, London, United Kingdom Purpose: To develop Dynamic Equilibrium Computer Tomography (DynEQ-CT) to diagnose and quantify cardiac amyloidosis by measuring the myocardial Extracellular Volume, ECVct. Cardiac involvement determines outcome in patients with systemic amyloidosis. There is major unmet need for quantification of cardiac amyloid burden, which is currently only met in part through semi-quantitative DPD bone scintigraphy or Cardiovascular Magnetic Resonance (CMR), which measures ECVcmr. Other accessible tests are needed. Methods: Twenty-six patients (21 male, 64+14 years) with a biopsy proven systemic amyloidosis (ATTR n1⁄418; AL n1⁄48) were compared with twenty-seven patients (19 male, 68+8 years) with severe aortic stenosis (AS). Patients underwent echocardiography, bone scintigraphy, NT-pro-BNP, Troponin measurement and CMR. DynEQ-CT was performed using a prospectively gated cardiac scan prior to and after (5 and 15 minutes) a standard Iodixanol (1 ml/kg) bolus to measure ECVct; an additional 1 minute scan was added to aid cardiac wall segmentation. ECVct was compared to the reference ECVcmr and conventional amyloid measures: DPD bone scintigraphy and clinical markers of cardiac amyloid severity (NT-pro-BNP, Troponin, LVEF, LV mass, LA and RA area). Results: ECVct and ECVcmr results were well correlated (r2 1⁄4 0.85 vs r2 1⁄4 0.74 for 5 and 15 minutes post bolus respectively). ECVct was higher in amyloidosis than AS (0.54+0.11 vs 0.28+0.04, p,0.001) with no overlap. ECVct tracked clinical markers of cardiac amyloid severity (NT-pro-BNP, Troponin, LVEF, LV mass, LA area, 6-minute-walk test), and DPD bone scintigraphy amyloid burden (p,0.001). Conclusion: Dynamic Equilibrium CT, a 5 minute contrast-enhanced gated cardiac CT, has potential for non-invasive diagnosis and quantification of cardiac amyloidosis. 221 Simultaneous multi-isotope imaging for leukocyte tracking using dedicated cardiac CZT SPECT: A new approach to reveal foci of endocarditis F. Caobelli1, T. Wollenweber1, C. Kuehn2, U. Bavendiek3, C. Schuetze4, L. Geworski4, J. Bauersachs3, A. Haverich2, FM. Bengel1 Hannover Medical School, Nuclear Medicine, Hannover, Germany; Hannover Medical School, Cardiotoracic Surgery, Hannover, Germany; Hannover Medical School, Clinical Cardiology, Hannover, Germany; Hannover Medical School, Medical Physics, Hannover, Germany Objectives: Owing to its high energy resolution, cadmium-zinc-telluride (CZT) SPECT facilitates simultaneous multi isotope molecular imaging. Integration of an In-111 labeled leukocyte signal with myocardial contours derived from a Tc-99m-sestamibi perfusion image provides complementary anatomical localization of cells relative to valve plane. This may help in the evaluation of patients with suspected endocarditis. We performed feasibility studies in phantoms and humans. Methods: Images were acquired using a CZTcamera (GE Discovery 530c) operated in list mode. To determine the effect of radionuclide crosstalk, an anthropomorphic thorax phantom was filled with constant Tc-99m activity (34 kBq/ml) in the heart insert and variable In-111 activity in the defect (7–466 kBq/ml). Human feasibility studies were performed in 18 patients with suspected infection of native valves or implants. Simultaneous In-111 leukocyte/Tc-99m perfusion CZT imaging was compared with standard In-111 leukocyte planar imaging and SPECT/CTat 24 hrs. All studies were evaluated for image quality and reader confidence on a 5 point scale. Results: In phantom studies, Tc-99m images were unaffected by In-111 downscatter for In-111 activity concentrations up to 2.5 times that of Tc-99m. No crosstalk from Tc-99m up into the lower peak window of In-111 was identified. In clinical studies, co-localization of In-111 leukocytes with myocardial perfusion images aided localization of inflammatory foci and improved reader confidence (80% of studies were read as definitely normal or abnormal, vs 70% for standard SPECT/CT and 11% for planar images). Image quality scores were significantly higher for CZT-dual isotope over conventional In-111 SPECT/ CT (4.1+0.7 vs 3.0+0.6; p1⁄40.02) and planar images (1.3+0.5; p1⁄40.01). Conclusions: Simultaneous multi-isotope imaging with In-111 and Tc-99m is feasible using cardiac CZT SPECT. This novel approach may improve anatomic localization in leukocyte tracking and aid in the diagnosis of endocarditis. 222 Quantitative assessment of coronary plaques in patients with acute coronary syndrome without persistent segment STelevation by multidetector computed tomography N. Barysheva, IN. Merkulova, MS. Shabanova, SA. Gaman, TN. Veselova, MA. Shariya Russian Cardiology Research and Production Complex, Emergency cardiology, Moscow, Russian Federation Purpose: To analyze features of atherosclerotic plaques in culprit and remote coronary lesions in patients with acute coronary syndrome without persistent segment STelevation (NSTE-ACS) by multidetector spiral computed tomography (MDCT). Methods: We enrolled 70 patients with NSTEACS (47 with unstable angina and 23 with myocardial infarction), who underwent 64-slices MDCT before coronary angiography. We evaluated plaque type (soft, mixed and calcified), minimum CT density (HU), contour, length as well as presence of spotty calcium, ring-like sign and positive remodeling in all culprit lesions (Figure 1) and in non-culprit segmens, if stenosis was .50%. Results: In culprit lesions (n1⁄470) compared to non-culprit lesions (n1⁄4144) frequency of soft plaques (60% vs.43%, p1⁄40.003), positive remodeling (70.2% vs. 54.3%,p1⁄40.03) and uneven contour (91.7% vs. 68.7%, p1⁄40.0002) was significantly higher. The minimum plaque density was significantly lower and length of plaque was significantly higher in the culprit coronary segments (40.1 +/225.3 HU vs 74.1 +/2116.8 HU, p1⁄40.02 and 16.8 +/213.4 mm vs 13.2 +/2 6.9 mm, p1⁄40.01, respectively). Receiver-operator characteristic curve analysis identified the optimal cutoff value of minimum plaque density and length for discrimination between culprit and non-culprit lesion as 40 Hounsfield units (HU) and 13.5 mm respectively. The prevalence of spotty calcium and ring-like sign was tended to be greater in culprit lesions, but statistical analysis did not show significant difference (p1⁄40.12 and p1⁄40.27 respectively). Conclusions: The most specific features of culprit lesions in patients with ACS include positive vascular remodeling, minimum CT-density ,40 HU, length .13.5 mm and presence of uneven contour. 223 Extent and prognostic significance of scar and inducible ischaemia following primary PCI for STEMI with multivessel disease: insights from the CvLPRIT Nuclear Substudy A D. Kelion1, M. Pakkal2, F. Chowdhury3, N. Nagaraj4, J. Birchall5, K. Dixon6, W. Banya7, G. Mccann8, A. Gershlick8 Oxford University Hospitals NHS Trust, Oxford Heart Centre, Oxford, United Kingdom; University Health Network, Toronto, Canada; Leeds General Infirmary, Leeds, United Kingdom; University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; Poole Hospital NHS Trust, Poole, United Kingdom; Imperial College London, London, United Kingdom; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom Introduction: In STEMI patients with multivessel disease, the randomised CvLPRITstudy showed that complete revascularisation reduced MACE at 12 months compared to primary PCI (PPCI) of the infarct-related artery (IRA) alone. CvLPRIT patients underwent MPS at 6-8 weeks, and we report the effect of revascularisation strategy on scintigraphic variables, and their association with subsequent cardiac events. Methods: CvLPRIT randomised STEMI patients from seven UK centres (2011–2013). Following IRA-only or complete revascularisation, patients received contemporary medical therapy. Stress-rest SPECT MPS was performed at 6-8 weeks, with semiquantitative analysis centrally. Summed scores were converted to %LV. Clinicians were blinded unless ischaemia exceeded 20%LV (0 patients), or MPS was indicated symptomatically. MACE at 9–12 months comprised death, recurrent MI, heart failure, or ischaemiadriven revascularisation. Abstract 220 Figure. Dynamic Equilibrium Computed Tomography Abstract 222 Figure 1. Culprit lesion i36 Moderated Poster Session 4 European Heart Journal Cardiovascular Imaging Abstract Supplements – volume 16 supplement 1 May 2015 Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/16/suppl_1/i35/2399740 by guest on 06 March 2018 Results: Randomised groups were comparable (Table). Patients with complete revascularisation had smaller infarcts than those with IRA-only PPCI. The extent of inducible ischamia was limited and similar between groups. 13/194 patients (6.7%) suffered MACE following MPS, but no scinitgraphic variable was predictive (eg ischaemia no event v event 1.5% v 2.9%, P1⁄40.75). Conclusions: Compared with IRA-only PPCI, complete revascularisation reduced infarct size but not the extent of inducible ischaemia at 6–8 weeks. Ischaemia was limited and did not predict MACE at 12 months. Abstract 223 Table. Characteristics of randomised groups223 Table. Characteristics of randomised groups Variable IRA only (n1⁄4101) Complete revasc (n1⁄4104) P Age (y) 62.7 (11.0) 62.6 (10.1) 0.91 Male (%) 84 (83%) 91 (88%) 0.38 IRA = LAD (%) 33 (33%) 34 (33%) 0.76 MACE pre MPS 9 (8%) 2 (2%) 0.06 Stress defect (%LV) 13.2 (7.4, 19.1) 13.2 (7.4, 16.2) 0.16 Rest defect (%LV) 10.3 (5.9, 17.7) 8.8 (4.4, 14.7) 0.05 Ischaemia (%LV) 0% 49 (49%) 48 (47%) 0.91 0.1–4.9% 30 (30%) 29 (28%) 5.0–9.9% 15 (15%) 18 (17%) ≥10% 6 (6%) 8 (8%) Resting EF 0.56 (0.11) 0.56 (0.11) 0.88 224 Microvascular obstruction and left ventricular thrombi after acute myocardial infarction are associated with an increased inflammatory response C. Rischpler1, RJ. Dirschinger2, S. Nicolosi1, H. Kossmann2, A. Meinicke1, F. Hanus2, K. Goetze3, KL. Laugwitz2, M. Schwaiger1, SG. Nekolla1 Technical University of Munich, Nuklearmedizinische Klinik, Munich, Germany; Technical University of Munich, I. Medizinische Klinik, Munich, Germany; Technical University of Munich, III. Medizinische Klinik, Munich, Germany Purpose:Recently, research has focusedon the inflammatory processesafter acute myocardial infarction (AMI). The aim of this study was to investigate the influence of the occurrence of left ventricular thrombi (LVT) and microvascular obstruction (MVO) after AMI on the F-18-FDG uptake in the heart as well as on the innate immune response. Methods: 32 patients with first STEMI were imaged 4.9 + 1.3 days after PCI by F-18-FDG PET/MRI. In order to suppress physiological F-18-FDG uptake of the myocardium, patients were prepared with a low-carbohydrate/high-fat diet the day prior to the scan, overnight fasting and heparin injection before F-18-FDG administration. The innate cellular response was assessed on several time points after AMI. Results: 5 (16%) patients had LVTand 10 (31%) patients showed MVO. Both the presence of LVT and MVO were associated with higher numbers of proinflammatory monocytes early after AMI (LVT: 0.98 + 0.50 G/L vs. 0.54 + 0.20 G/L, p,0.002; MVO: 0.79 + 0.40 G/L vs. 0.53 + 0.23 G/L, p,0.03). Furthermore, patients with LVT and/or MVO demonstrated a higher F-18-FDG uptake (SUVmean[lbm]) in the remote myocardium ((LVT: 0.88 + 0.23 vs. 0,70 + 0.14, p,0.02; MVO: 0.84 + 0.17 vs. 0.66 + 0.13, p,0.004), while there was no difference in the post-ischemic myocardium (LVT: 2.49 + 0.35 vs. 2.23 + 0.43, p1⁄4NS; MVO: 2.37 + 0.38 vs. 2.22 + 0.43, p1⁄4NS). Conclusions: Patients demonstrating MVO or LVT after AMI show higher numbers of proinflammatory monocytes in the peripheral blood. Furthermore, an increased F-18-FDG uptake of the remote myocardium can be observed in these patients, possibly indicating an increased migration of proinflammatory monocytes into the myocardium. Further studies in order to elucidate this finding are warranted. 225 Hybrid F-18-FDG PET/MRI after acute myocardial infarction: characterization of a novel biosignal C. Rischpler1, RJ. Dirschinger2, S. Nicolosi1, H. Kossmann2, A. Meinicke1, F. Hanus2, K. Goetze3, KL. Laugwitz2, M. Schwaiger1, SG. Nekolla1 Technical University of Munich, Nuklearmedizinische Klinik, Munich, Germany; Technical University of Munich, I. Medizinische Klinik, Munich, Germany; Technical University of Munich, III. Medizinische Klinik, Munich, Germany Purpose: Recent cardiovascular research has focused on inflammatory processes after myocardial infarction. Preclinical studies have demonstrated that the inflammatory response after acute myocardial infarction can be imaged using F-18-FDG PET/MRI. In this study we aimed to investigate F-18-FDG PET/MRI as a novel biosignal in postischemic myocardium and investigated its relationship with the innate immune response in patients after acute myocardial infarction. Methods: After percutaneous coronary intervention (PCI) 32 patients with first acute STEMI were prospectively enrolled and imaged 4.9 + 1.3 days later using hybrid F-18-FDG PET/MRI. Patients were prepared for the scan by a low-carbohydrate, high-fat diet on the day prior to the scan as well as by injection of unfractionated heparin before F-18-FDG injection. In 17 patients, Tc-99m-sestamibi SPECTwith tracer injection before PCI was additionally performed in order to assess the area at risk. Imaging results were correlated with the cellular innate immune response, which was measured at different time points after acute myocardial infarction. Results: In the postischemic myocardium an F-18-FDG signal was present in all patients. There was a substantial agreement (k1⁄40.64) between the F-18-FDG uptake and the LGE signal when compared on a segmental basis (AHA 17-segment-model). In the quantitative analysis, however, the F-18-FDG signal extent exceeded the LGE extent (29.3 + 13.7 %LV vs. 20.4 + 10.6 %LV, p,0.0001) but did not differ from the area at risk assessed by Tc-99m-sestamibi SPECT (25.3 + 10.3 %LV vs. 22.3 + 17.4 %LV; p1⁄4NS). The infarct size determined by LGE showed a positive correlation with inflammatory CD14high und CCR2+ monocytes in the peripheral blood (R1⁄40.60, p,0.001 and R1⁄40.57, p1⁄40.001, respectively). The F-18-FDG uptake was highest in areas with transmural LGE, but did not correlate with monocyte counts in the peripheral blood. Conclusions: Early after acute myocardial infarction hybrid PET/MRI demonstrated increased F-18-FDG uptake both in scarred and in post-ischemic non-scarred myocardium. This novel biosignal presumably represents a combination of postischemic viable myocardium and recruited monocytes. In order to clearly elucidate this phenomenon specific tracers targeting either postischemic myocardium or subsets of inflammatory cells are needed and may help to guide future immunomodulatory strategies after acute myocardial infarction. Abstract 224 Figure. F-18-FDG PET/MR LV-Thrombus Moderated Poster Session 4 i37 European Heart Journal Cardiovascular Imaging Abstract Supplements – volume 16 supplement 1 May 2015 Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/16/suppl_1/i35/2399740 by guest on 06 March 2018