LAUSR

My editor’s page will be excerpts from my plenary lecture given at the International Conference on Nuclear Cardiology and Cardiac CT, Vienna, Austria, on May 7, 2017. It was indeed a pleasure and an honor to address the audience of this meeting, which has a track record of [ 20 years bringing people from around the world to learn and share knowledge. The predictions are that in the United States by 2035, [ 123 million will have hypertension; [ 24 million will have coronary artery disease (CAD); [ 11 million will have had a stroke; [ 9 million will have heart failure; and[ 7 million will have atrial fibrillation. That adds to a projected increase in heart disease costs are to double from $555 billion in 2016 to $1.1 trillion in 2035! One would predict similar increases in both developed and developing countries although Sweden recently reported considerable declines in death from any cause, death from cardiovascular disease, death from coronary heart disease, and hospitalization for cardiovascular disease between 1998 and 2014 in both general population and in those with diabetes mellitus. This change and other changes (Table 1) imply that imaging in general, and nuclear imaging especially will continue to be a popular imaging modality for sometimes to come. It is very likely that positron emission tomography (PET) use and measurement of myocardial blood flow (MBF) will increase. A recent study may shed some light, women though having less severe CAD by coronary angiography than men, had worse outcome especially those with reduced coronary flow reserve ratio (ratio of hyperemic to rest MBF) measured by PET. Historically, the prominent physician from University of Paris wrote in 1902 ‘‘Another point to remember is that angina pectoris is, like gout, a disease of men, and not women. When it does manifest itself in females, as is occasionally the case, it is often so confused with the common and frequent pains in the left side, due to flatulence or other causes, to which that sex is especially prone, that its recognition may be a matter of some difficulty.’’ His views were probably shared until very recently by many physicians! Though MBF use will increase (Figure 1), it does not mean that all problems have been solved such variability in measurements. Kitkungvan et al reported test-retest methodological precision of global PET myocardial perfusion by serial rest performed within minutes apart is ± 10% while the day-to-different-day biological plus methodological variability was ± 21%. Further, the global myocardial perfusion at 8 minutes after 4 minutes dipyridamole infusion was 10% higher than at standard 4 minutes after dipyridamole. The editorial by Beanlands concluded ‘‘... ultimately the value of flow quantification must be shown in multicenter clinical trials.’’ Dilsizian et al concluded ‘‘...trust the quantitative analysis but verify it by visual analysis.’’ Clearly more studies are needed to address the variability and impact of using different hardware, software, stress agent, and protocol. In additions to the tracers in Figure 1 and other tracers to study cardiac metabolism and innervation, there are a host of newer tracers; a partial list is provided in Table 2 and many of these are presented in this meeting. What is encouraging in the new list is that these tracers will expand the use of nuclear imaging in other cardiac conditions such as acute coronary syndromes, myocarditis, chemotherapy-related cardiotoxicity, and valvular heart diseases. As we move forwards, it is equally important to remain grounded and acknowledge the achievements Reprint requests: Ami E. Iskandrian, MD, MACC, MASNC, Division of CV Diseases, Department of Medicine, University of Alabama at Birmingham, 318 LHRB/ 1900 University BLVD, Birmingham AL 35294; [email protected] J Nucl Cardiol 2018;25:1–5. 1071-3581/$34.00 Copyright 2017 American Society of Nuclear Cardiology.