Philip Hasbak’s research while affiliated with Copenhagen University Hospital and other places

Purpose To investigate the efficacy of pulmonary blood volume (PBV) as a marker of the cardiac hyperemic response to adenosine during myocardial perfusion imaging (MPI). Methods Forty healthy subjects underwent four consecutive Rubidium‐82 rest/adenosine‐stress MPI: two sessions were conducted without any caffeine consumption (baseline), while the remaining two sessions involved controlled caffeine consumption (arm 1: 100 and 300 mg; arm 2: 200 and 400 mg). We evaluate the ability of the stress‐to‐rest ratio of PBV (PBV ratio) to identify an adequate cardiac hyperemic response. The adequate hyperemic response was defined as a stress myocardial blood flow >2 mL/g/min and a corresponding myocardial flow reserve >68% of the maximum myocardial flow reserve obtained during the baseline scans. Results Based on 126 MPI sessions conducted in 40 subjects, the PBV ratio demonstrated a sensitivity of 78% and a specificity of 74% in detecting adequate cardiac hyperemia. The positive predictive value was 95%, while the negative predictive value was 36%. Conclusion The PBV ratio permits the identification of adequate hyperemic response with sensitivities and specificities comparable to existing markers.

IMPORTANCE Long-term use of anabolic androgenic steroids (AASs) is associated with a high risk of left ventricular hypertrophy, heart failure with reduced systolic function, and early sudden death, with the mechanism of progression being understudied. Early and persistent impaired myocardial microcirculation could be of clinical importance and a potential underlying mechanism of frequent and early cardiac disease among individuals with AAS use and a future potential target for intervention. OBJECTIVE To investigate coronary microcirculation by measuring myocardial flow reserve (MFR) in men with current and former AAS use compared with controls with no prior AAS use, using cardiac rubidium 82 (82Rb) positron emission tomography/computed tomography (PET/CT). DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included men involved in recreational strength training without established cardiovascular disease grouped according to their history of AAS use. The study was conducted November 24, 2021, to August 16, 2023. EXPOSURE Cardiac PET/CT with 82Rb was performed at rest and after adenosine-induced stress. MAIN OUTCOME AND MEASURE The primary outcome of this study was the MFR among the study groups; a secondary outcome was the coronary calcium score. By definition, impaired myocardial microcirculation was determined using a cutoff of MFR less than 2, and subclinically impaired microcirculation was determined using a cutoff of MFR less than 2.5. RESULTS A total of 90 men (32 with current AAS use, 31 with former AAS use, and 27 controls) were included. Mean (SD) age was 35.1 (8.7) years. Elapsed duration since AAS cessation was a geometric mean of 1.5 (95% CI, 0.9-2.5) years. Eighteen men (58.1%) with former use discontinued AAS use more than 1 year before enrollment. Impaired MFR was present in those with current (6 [18.8%]) and former (1 [3.2%]) use, whereas no impairment was observed among the controls (P = .02). Subclinically impaired MFR was higher among men with current (9 [28.1%]) and former (8 [25.8%]) AAS use than the controls (1 [3.7%]) (P = .02). In a multivariable logistic regression model among men with former AAS use, every doubling of the accumulated weekly duration of AAS use (log2) was independently associated with a factor 2 increase in the risk of impaired MFR less than 2.5 (odds ratio, 2.1; 95% CI, 1.03-4.35; P = .04). CONCLUSIONS AND RELEVANCE In this study, men with former AAS use displayed impaired MFR years after AAS cessation, suggesting impaired coronary microcirculation persists beyond active use

Background Infective endocarditis (IE) is a serious and fatal condition, with prosthetic valve endocarditis representing the worst prognosis. The recommended nuclear imaging modality 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) has limitations. In this case series, we present two patients with IE scanned with a novel PET tracer [64Cu]Cu-DOTATATE ([64Cu]Cu-[1,4,7,10-tetraazacyclododecane-N,N′,N″,N‴-tetra acetic acid]-d-Phe1, Tyr3-octreotate). Case summary An 84-year-old female patient (Patient 1) with a biological mitral valve prosthesis (MVP) was admitted acutely from the outpatient clinic. Transoesophageal echocardiography showed vegetations on the MVP. The patient underwent [64Cu]Cu-DOTATATE PET/CT, which showed uptake at the site of infection. The patient underwent surgical valve replacement. The post-operative period was without significant complications, and the patient was discharged home. In another case, a 72-year-old male patient (Patient 2) with a medical history of mild mitral valve stenosis, aortic valve stenosis, and gastrointestinal stromal tumour was admitted to the hospital for back and abdominal pain and subfebrile episodes. Transoesophageal echocardiography showed large vegetations in the native aortic valve. The patient underwent [64Cu]Cu-DOTATATE PET/CT, which showed no uptake at the site of the suspected infection. The patient underwent surgical valve replacement. The post-operative period was characterized by Candida albicans sternitis, and after prolonged hospitalization, the patient died of respiratory failure as a complication of sepsis. Discussion In conclusion, this is the first case series presenting two patients with definite IE (modified Duke criteria), who were scanned with the novel [64Cu]Cu-DOTATATE PET/CT. Patient 1, with endocarditis in the MVP, showed an uptake of the tracer, while Patient 2, with native aortic valve endocarditis, did not show any uptake.

Aims Patients with type 2 diabetes (T2D) have a high prevalence of diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF), which in turn leads to an increased risk of hospitalization and death. However, the factors of risk and their relative importance in leading to higher left ventricular filling pressures are still disputed. We sought to clarify the associations of a wide range of invasive and non‐invasive risk factors with cardiac filling pressures in high‐risk T2D patients. Methods and results Patients with T2D at high risk of cardiovascular events were prospectively enrolled in this study. Participants were thoroughly phenotyped including right heart catheterization at rest and during exercise, echocardiography, urinary excretion of albumin (UACR), and quantification of their myocardial blood flow rate (MFR) using cardiac ⁸²Rb‐PET/CT. Of the 37 patients included in the study, 22 (59%) patients met invasive criteria for HFpEF. Only 2 out of 39 variables emerged as independent factors associated with left ventricular filling pressure as assessed by pulmonary capillary wedge pressure (PCWP) at rest; history of hypertension (coefficient: 2.6 mmHg [0.3; 5.0], P = 0.030) and MFR (P = 0.026). We found a significant inverse association between MFR and PCWP with a coefficient of −2.3 mmHg (−4.3; −0.3) in PCWP per integer change of MFR. The MFR ranged from 1.18 to 3.68 in our study, which corresponds to a difference in PCWP of approximately 6 mmHg between patients with the lowest compared to the highest MFR. During exercise, only 2 variables emerged as borderline independent factors associated with PCWP: myocardial flow reserve (coefficient: −4.4 [−9.6; 0.8], P = 0.091) and beta‐blockers use (coefficient: 6.1 [−0.1; 12.4], P = 0.053). Conclusions In patients with type 2 diabetes without known HFpEF but risk factors for cardiovascular disease, myocardial blood flow rate was independently associated with PCWP at rest across the range from normal to abnormal left heart filling pressures. A clinically significant difference of 6 mmHg in PWCP was attributable to differences in MFR in patients with the lowest compared with the highest MFR values. This suggests that strategies than attenuate microvascular dysfunction could slow progression of increased left ventricular left heart filling pressures in patients at increased risk.

In patients with chronic obstructive pulmonary disease (COPD), pulmonary vascular dysfunction and destruction are observable before the onset of detectable emphysema, but it is unknown whether this is associated with central hypovolemia. We investigated if COPD patients have reduced pulmonary blood volume (PBV) evaluated by ⁸² Rb-positron emission tomography (PET) at rest and during adenosine-induced hyperemia. This single-center retrospective cohort study assessed 6301 ⁸² Rb-PET myocardial perfusion imaging (MPI) examinations performed over a 6-year period. We compared 77 COPD patients with 44 healthy kidney donors (controls). Cardiac output (Q̇) and mean ⁸² Rb bolus transit time (MBTT) were used to calculate PBV. Q̇ was similar at rest (COPD: 3649 ± 120 mL vs. control: 3891 ± 160 mL, p=0.368) but lower in COPD patients compared to controls during adenosine infusion (COPD: 5432 ± 124 mL vs. control: 6185 ± 161 mL, p < 0.050). MBTT was shorter in COPD patients compared to controls at rest (COPD: 8.7 ± 0.28 seconds vs. control: 11.4 ± 0.37 seconds, p < 0.001) and during adenosine infusion (COPD: 9.2 ± 0.28 seconds vs. control: 10.2 ± 0.37 seconds, p < 0.014). PBV was lower in COPD patients, even after adjustment for body surface area, sex, and age at rest (COPD: 530 (29) mL vs. 708 (38) mL, p < 0.001) and during adenosine infusion (COPD: 826 (29) mL vs. 1044 (38) mL, p<0.001). In conclusion, patients with COPD show evidence of central hypovolemia, but it remains to be determined whether this has any diagnostic or prognostic impact.

Type I interferon induced differences in exercise adaptations of aerobic capacity and fatigue in systemic lupus erythematosus-Protocol for a randomised controlled single-centre trial Protocol for a HIIT exercise trial illuminating exercise as intervention for aerobic capacity and fatigue, differentiating SLE patients on their type 1 IFN-signature.

Diabetes affects the kidneys, and the presence of albuminuria reflects widespread vascular damage and is a risk factor for cardiovascular disease (CVD). Still, the pathophysiological association between albuminuria and CVD remains incompletely understood. Recent advances in noninvasive imaging enable functional assessment of coronary artery pathology and present an opportunity to explore the association between albuminuria and CVD. In this cross-sectional study, we evaluated the presence of subclinical coronary artery pathology in people with type 2 diabetes, free of overt CVD. Using multimodal imaging, we assessed the coronary microcalcification activity (18F-sodium fluoride positron emission tomography/computed tomography [PET/CT], plaque inflammation [64Cu-DOTATATE PET/CT], and myocardial flow reserve [82Rb PET/CT]). The study population consisted of 90 participants, stratified by albuminuria; 60 had historic or current albuminuria (urine albumin-to-creatinine ratio [UACR] ≥30 mg/g]), and 30 had normoalbuminuria (UACR <30 mg/g). We demonstrated that any albuminuria (historic or current) was associated with a more severe phenotype, in particular, higher levels of microcalcifications and impaired myocardial microvascular function; however, coronary inflammation activity was similar in people with and without albuminuria. Our findings establish a potential underlying mechanism connecting cardiovascular and kidney diseases and could indicate the initial stages of the cardiorenal syndrome. Article Highlights