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At least 1,603 records · Page 89
All sourcesNASA NTRSDOE OSTI
DOE OSTI2022

Direct uranium enrichment assay in gaseous uranium hexafluoride with laser induced breakdown spectroscopy

A set of eleven U atomic emission lines, between 421.099 and 421.460 nm, were characterized for direct enrichment assay of gaseous UF 6 samples with laser induced breakdown spectroscopy (LIBS). Several iterative, multivariate nonlinear spectral-fitting algorithms were evaluated for their efficacies to extract the enrichment information from the measured LIBS spectra. Furthermore, wavelength-dependent weight factors, which take into consideration of the spectral-line position in the fitting model, the determined isotopic ratio, and the isotopic shift of the emission line, are essential for the spectral-fitting model to function adequately. The analytical accuracies and precision were typically within 0.5% in absolute [ 235 U/( 235 U + 238 U)] ratios.

38 RADIATION CHEMISTRY, RADIOCHEMISTRY, AND NUCLEA↗
DOE OSTI2018

Mapping ecoregions under climate change: a case study from the biological ‘crossroads’ of three continents, Turkey

Context: Besides climate change vulnerability, most ecosystems are under threat from a history of improper land-use and conservation policies, yet there is little existing long-term ecological research infrastructure in Turkey. In regions with no ecological networks across large landscapes, ecoregion concept offers opportunities for characterizing the landscape under changing climate.Objectives: Aim is to develop contemporary and future quantitative ecoregions for Turkey based on climate model outputs, to identify climate change-sensitive areas of biodiversity and conservation significance, and to provide a framework for a comprehensive ecological observatory network design.Methods: Using Multivariate Spatio-Temporal Clustering and climate data contemporary and projected future distributions of Turkey’s ecoregions are delineated at several division levels.Results: Turkey’s contemporary ecoregions generally show a northward shift by the end of this century and the lengthening of the growing season across the country, especially eastward and northward. The increase in growing season length, along with the shift in precipitation seasonality and increasing growing season precipitation, shape future conditions within the climate change-sensitive areas. Apart from transboundary ecological and socioeconomic significance, these potentially vulnerable ecosystems also constitute the majority of Turkey’s biodiversity hotspots.Conclusions: Our study marks the first ‘ecoregionalization’ study for Turkey based on both contemporary and future climate scenarios. For countries like Turkey, where large-scale ecological networks have not been established, using such quantitative methodology for delineation of optimal ecoclimatic regions, and for mapping environments at risk from climate change provides an invaluable perspective for conservation planning strategies, and a framework for a comprehensive ecological observatory network design.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2024

Calculation of machine precision second order derivatives using dual-complex numbers

It is well known that both complex and dual numbers can be employed to obtain machine precision first-order derivatives; however, neither, on their own, can compute machine precision 2nd order derivatives. To address this limitation, it is demonstrated in this paper that combined dual-complex numbers can be used to compute machine precision 1st and 2nd order derivatives. The dual-complex approach is simpler than utilizing multicomplex or hyper-dual numbers as existing dual libraries can be used as is or easily augmented to accept complex numbers, and the complexity of developing, integrating, and deploying multicomplex or hyper-dual libraries is avoided. The efficacy of this approach is demonstrated for both univariate and multivariate functions. Finally, source code examples using the Python, Julia, and Mathematica languages are provided as supplemental material.

97 MATHEMATICS AND COMPUTING↗
DOE OSTI2024

Enhancing the Range and Reliability of the Spacer Layer Imaging Method

The spacer layer imaging method (SLIM) is widely used to measure the thickness of additive and lubricant films, in lubricant development and evaluation, and for fundamental research into elastohydrodynamic lubrication and tribofilm formation mechanisms. The film thickness measurement, as implemented on several popular tribometers, provides powerful, non-destructive in-situ mapping of film topography with nanometre-scale height sensitivity. However, the results can be highly sensitive to experimental procedure, machine condition, and image analysis, in some cases reporting unphysical film thickness trends. The prevailing image analysis techniques make it challenging to interrogate these errors, often hiding their multivariate nonlinear behaviour from the user by spatial averaging. Herein, several common ‘silent errors’ in the SLIM measurement, including colour matching to incorrect fringe orders, and colour drift due to the optical properties of the system or film itself, are discussed, with examples. A robust suite of novel a priori and a posteriori methods to address these issues, and to improve the accuracy and reliability of the measurement, are also presented, including a novel, computationally inexpensive circle-finding algorithm for automated image processing. In combination, these methods allow reliable mapping of films up to at least 800 nm in thickness, representing a significant milestone for the utility of SLIM applied to elastohydrodynamic contact.

EHL film geometry↗
DOE OSTI2018

Problem of Identification of Phase Transformation Models Used in Simulations of Steels Processing

Accuracy of phase transformation models depends on the correctness of coefficients evaluation, adequate to the investigated material. Dilatometric tests combined with the inverse analysis are used to perform identification. Since the problem is nonlinear, analytical approach is not possible and the inverse solution is transferred into the optimization task. It leads to difficulties typical for optimization of multivariable function such as local minima and lack of proof of the uniqueness. The problem of the effectiveness and uniqueness of the inverse algorithms used for identification of phase transformation models for steels was investigated for two models. The first was a modified JMAK (Johnson–Mehl–Avrami–Kolmogorov) equation. The second was an upgrade of the Leblond equation, in which second-order derivative of the volume fraction with respect to time was introduced. In classical identification, the result for one transformation depends on the coefficients for the remaining transformations and optimization has to be performed several times until the compatibility between transformations is reached. To avoid encountered problems, complex optimization simultaneously for all coefficients in the models was performed. This approach was based on nature-inspired optimization techniques. Models with identified coefficients for various steels were validated in simulations of industrial processes of laminar cooling and continuous annealing of strips.

36 MATERIALS SCIENCE↗
DOE OSTI2024

Data-Driven Insights into the Structural Essence of Plasticity in High-Entropy Alloys

The heterogeneous mechanical response of a crystalline alloy with multiple principal elements was investigated using molecular dynamics simulations. The local configuration of the alloy in its quiescent state was characterized by the variables derived from the gyration tensor and the atomic electronegativity. A multivariate analysis identified the geometric and chemical factors that influenced the atomic packing variations. Further, upon straining, the non-affine displacement exhibited spatial heterogeneity. A statistical correlation was established between the local yield events and the specific features of the local configuration. Our findings, validated by the performance metrics analysis, provided a structural criterion for the instability mechanisms in high-entropy alloys (HEAs) and enhanced the understanding of their plasticity.

36 MATERIALS SCIENCE↗
DOE OSTI2019

The roles of PTEN, cMET, and p16 in resistance to cetuximab in head and neck squamous cell carcinoma

There is no established biomarker for cetuximab efficacy in recurrent head and neck squamous cell carcinoma (HNSCC). The aim of the present study was to evaluate the prognostic and predictive impact of PTEN, cMET, and p16 expression in recurrent HNSCC. In this retrospective study, 112 patients with recurrent HNSCC received chemotherapy (CT) alone (n = 37) or chemotherapy with cetuximab (n = 75). PTEN, cMET, and p16 protein expression were evaluated by immunohistochemistry. The median overall survival (mOS) for the patients treated with cetuximab + CT versus CT alone was 11.4 months and 7.0 months, (p = 0.949). The median progression-free survival (mPFS) was 6.2 months versus 3.0 months (p = 0.154). Patients with PTEN loss exhibited a mOS of 5.8 months versus 10.5 months (p = 0.002) and a mPFS of 3.2 months versus 4.7 months (p = 0.019). A multivariate analysis identified an independent association between PTEN loss and OS (HR 2.27; 95% confidence 95% CI 1.27–4.08; p = 0.006) and with PFS (HR 1.85; 95% CI 1.09–2.99; p = 0.022). A negative prognostic impact of PTEN loss was observed in the patients treated with cetuximab + CT, and not in the CT only group. Expression of cMET and p16 showed no impact on OS or PFS. The present findings confirm that PTEN is a prognostic factor for metastatic HNSCC and they support further studies of PTEN expression to evaluate its predictive value to cetuximab response.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Characteristics and impact of programmed death-ligand 1 expression, CD8+ tumor-infiltrating lymphocytes, and p16 status in head and neck squamous cell carcinoma

Background: No predictive biomarker of immune checkpoint inhibitors in head and neck squamous cell carcinoma (HNSCC) has been well established. The impact of programmed death-ligand 1 (PD-L1) expression, CD8+ tumor-infiltrating lymphocytes (TILs), and p16 status in HNSCC is unclear and may vary according to ethnicity. Methods: HNSCC patients treated between 2007 and 2013 were reviewed. Archival tissues were retrieved for PD-L1, CD8+ TILs, and p16 analyses. PD-L1 expression was evaluated by using the validated SP142 assay on the VENTANA platform. CD8+ TILs were defined by using semiquantitative scoring. Results: A total of 203 patients were analyzed. PD-L1 expression was observed in 80% of patients and was significantly associated with older age (P < 0.001). A high CD8+ TIL score (≥ 6) was significantly associated with never-smoking (P = 0.020), oral cavity cancer (P < 0.001), and stage M0 at presentation (P = 0.025). The p16 status was positive in 12% of patients. Patients with a high TIL score had a significantly longer OS (P = 0.032). Patients with PD-L1 expression of 1–49% and ≥ 50% were associated with a significantly shorter OS compared with those with PD-L1 < 1% (P = 0.027 and P = 0.011, respectively). Multivariate analysis showed that PD-L1 ≥ 50% was significantly associated with a poor OS. (HR 2.98 [95% CI 1.2–7.39]; P = 0.019.) Conclusions: A high prevalence of PD-L1 expression was observed in HNSCC using the validated SP142 assay. PD-L1 expression was associated with older age, while highly PD-L1 expression (≥ 50%) was an independent prognostic factor for poor OS in anti-PD1/PD-L1 untreated HNSCC patients.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Factors that impact the outcomes in testicular germ cell tumors in low–middle-income countries

Germ cell tumors (GCTs) are one of the most common tumors in adolescents and young adults. There is paucity of data on GCT from low–middle-income countries (LMIC). The present study was conducted to assess the demographic features, clinical manifestations, pathology, and outcomes of GCT patients treated at our center. Patients with testicular GCT above the age of 18 years, treated at our center from 2001 to 2015 were included in the study. Data were extracted retrospectively from the case records. Event-free survival (EFS) and overall survival (OS) were calculated using the Kaplan–Meier method and the variables were compared using the log-rank test. The study included 421 patients among whom 128 (30%) had a histological diagnosis of seminoma and 293 (70%) had non-seminomatous germ cell tumor (NSGCT). Metastatic disease at presentation was observed in 83/128 (65%) with seminoma and 254/293 (87%) with NSGCT. According to the International Germ Cell Cancer Collaborative Group (IGCCCG) risk stratification for metastatic disease, good- and intermediate-risk seminoma were observed in 55/83 (66%) and 28/83 (34%) patients, respectively, and good-, intermediate-, and poor-risk NSGCT were observed in 82/254 (32%), 76/254 (30%), and 96/254 (38%) patients, respectively. The median follow-up was 32.3 months (range 0.03–200 months). The 3-year OS for the entire cohort was 80.3%. The 3-year OS for seminoma was 91.4%, and for NSGCT was 75.3%. Factors significantly associated with inferior EFS and OS on multivariate analysis included poor performance status, scrotal orchidectomy, carboplatin-based regimen, NSGCT histology, and treatment default. Patients with testicular GCT in India present in an advanced stage and higher IGCCCG risk compared to Western data. Factors unique to LMIC like treatment default, bulky disease, dose compromise, and scrotal orchidectomy have a negative impact on the outcome.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Correlation between the magnitude of best tumor response and patient survival in nivolumab therapy for metastatic renal cell carcinoma

The correlation between the magnitudes of best tumor response (bTR) and patient survival in immune checkpoint inhibitor therapy for metastatic renal cell carcinoma (mRCC) remains unclear. In this article, we retrospectively investigated the prognostic association of the magnitude of bTR in nivolumab therapy for mRCC. Fifty-five patients treated with nivolumab after failure of at least one molecular-targeted therapy were evaluated. Assessment of the magnitude of bTR was based on the Response Evaluation Criteria in Solid Tumors (RECIST) v.1.1. Endpoints were progression-free survival (PFS) and overall survival (OS) after the initiation of nivolumab therapy. In regard to the magnitude of bTR, complete response, partial response, stable disease, and progressive disease were observed in three (5.46%), 15 (27.3%), 19 (34.5%), and 18 (32.7%) patients, respectively. PFS and OS were significantly correlated with the magnitude of bTR (median PFS: not reached (N.R.) [95% confidence interval (CI) 16.8–N.R.] vs. 13.0 [8.38–56.0] vs. 5.95 [4.27–7.30] vs. 1.92 [0.53–3.91] months, p < 0.0001; OS: N.R. [N.R.–N.R.] vs. N.R. [21.4–N.R.] vs. 23.3 [23.3–N.R.] vs. 7.36 [1.41–N.R.] months, p < 0.0001). In addition, multivariate analyses show that the magnitude of bTR was an independent factor for PFS (p < 0.0001) and OS (p = 0.0010). In conclusion, this retrospective study shows the significant correlation between the magnitude of bTR and patient survival in nivolumab therapy for mRCC. The magnitude of bTR can be an effective surrogate marker for survival.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Altered fibrin clot properties in advanced lung cancer: strong impact of cigarette smoking

Background: Dense fibrin networks resistant to lysis have been reported in patients at high risk of thromboembolism. Little is known about fibrin clot properties in cancer. We investigated fibrin clot properties and their determinants in patients with inoperable lung cancer. Methods: We enrolled 150 patients with advanced lung cancer prior to therapy and 90 control subjects matched by age, sex, cardiovascular disease, and diabetes. Plasma clot permeability (K{sub s}), turbidimetric analysis of clot formation, clot lysis time (CLT), microparticle-associated tissue factor (MP-TF) activity, thrombin generation, and serum cotinine levels were determined. Results: Lung cancer patients, compared with controls, formed at a faster rate (− 8.1% lag phase) denser plasma fibrin networks (− 27.2% K{sub s}) that displayed impaired lysis (+ 26.5% CLT), along with 19.5% higher MP-TF activity and 100% higher peak thrombin generated, also after adjustment for potential confounders. Cotinine levels were associated with fibrin maximum absorbance (r = 0.20, p = 0.016) and K{sub s} (r = − 0.50, p < 0.0001) in cancer patients. On multivariate regression analysis, an increase in cotinine levels was a predictor of low K{sub s} (the lower quartile, < 5.8 × 10{sup −9} cm{sup 2}; odds ratio = 1.21 per 10 ng/ml, 95% confidence interval 1.02–1.46), but not CLT. Conclusion: Advanced lung cancer is associated with the prothrombotic plasma clot phenotype largely driven by smoking.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Individualized treatment of head neck squamous cell carcinoma patients aged 70 or older with radiotherapy alone or associated to cisplatin or cetuximab: impact of weekly radiation dose on loco-regional control

The purpose of this study is to evaluate if, in elderly HNC patients, loco-regional control (LRC) is influenced by average weekly radiation dose (AWD). From 2009 to 2017, 150 consecutive HNC elderly patients were analyzed. AWD was calculated by dividing total dose in Gray by overall treatment time in weeks. Patients were divided in 2 groups: Group 1 (70–75 years) and Group 2 (> 75 years). Primary endpoint was LRC; secondary endpoints were overall survival (OS) and compliance to treatment. The median age was 76 years (range 70–92), the distribution of patients by age was 72 and 78 patients in Group 1 and in Group 2, respectively; overall median follow-up was 23 months. Optimal cut-off of AWD for LRC was 9.236 (p = 0.018). Median OS was 73 months. In univariate survival analysis low PS (p = 0.005), T3–T4 (p = 0.021), Stage III–IV (p = 0.046) and AWD{sup Low} (< 9.236) (p = 0.018) were significantly associated with lower LRC; low PS (p < 0.001) and Group 2 (p = 0.006) were also associated with lower OS. Considering patients treated with radiotherapy alone AWD{sup Low} was significantly associated with lower LRC (p = 0.04) whereas among patient treated with chemoradiotherapy AWD did not affected LRC (p = 0.18). The multivariate analysis confirmed the significant value of PS for the prediction of LRC and OS (p = 0.035 and p < 0.001, respectively). In elderly patients an AWD of > 9.236 Gy was found to be beneficial for RT alone regimen. When radiotherapy alone is indicated in elderly patients an effort should be made to maintain an increased AWD in order to improve LRC.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Influence of ABCB1 polymorphisms on the pharmacokinetics and toxicity of lenalidomide in patients with multiple myeloma

Individual diversity in plasma concentrations of lenalidomide occurs despite dosage modifications based on creatinine clearance (CCr), which can lead to unexpected toxicity. We have previously identified a cutoff value of area under the concentration–time curve (AUC{sub 0–24}) for lenalidomide to avoid severe toxicity. Here, we investigated the association between ABCB1 polymorphisms and pharmacokinetics of lenalidomide in patients with multiple myeloma (MM) treated with lenalidomide and dexamethasone. Plasma concentrations of lenalidomide were analyzed using liquid chromatography–tandem mass spectrometry. Genotyping for ABCB1 1236C>T, 2677G>A/T, and 3435C>T polymorphisms was performed, and the effects of ABCB1 polymorphisms on AUC{sub 0–24} for lenalidomide were compared in 36 patients with MM who were administered lenalidomide according to the drug label based on CCr. Genotyping analysis showed that although there were no differences in AUC{sub 0–24} in 1236C>T and 2677G>A/T polymorphisms. AUC{sub 0–24} was significantly higher in patients with the T allele of 3435C>T (n = 15) than in those without (n = 21) (median 6324.6 ng h/mL vs. 2857.4 ng h/mL, p = 0.028). The AUC{sub 0–24} value exceeded the aforementioned cutoff value in 95% of the patients with the T allele of 3435C>T but in 60% with C/C genotype (p = 0.013). Multivariate logistic analysis confirmed the significance of T allele of ABCB1 3435C>T as a factor due to which the AUC{sub 0–24} cutoff value was exceeded (hazard ratio of 15.0, p = 0.019). We show that lenalidomide pharmacokinetics is influenced by the ABCB1 3435C>T polymorphism, which could be useful to individualize dosage design and reduce unexpected toxicity.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

High total bilirubin level is a significant risk factor for severe neutropenia in patients receiving irinotecan-based chemotherapy

Irinotecan is effective for the treatment of metastatic colorectal cancer (mCRC) and advanced pancreatic cancer (aPC). However, these treatments are often limited due to the incidence of severe neutropenia. We identified risk factors for severe neutropenia in patients with mCRC or aPC, receiving irinotecan-based chemotherapy regimens. The study selected 104 patients (mCRC: 53 and aPC: 51) who received irinotecan-based chemotherapy between January 2014 and May 2018 and who were included in the present study. The initial dose of irinotecan was 150 mg/m{sup 2} in all patients, and patients with a lower initial dose of irinotecan were excluded. Severe neutropenia (grade ≥ 3) occurred in 56 patients (53.8%). Multivariable Cox proportional hazards analysis indicated that modified FOLFIRINOX (mFOLFIRINOX) and serum total bilirubin (T-Bil) were significant risk factors for severe neutropenia. Moreover, with receiver-operating characteristic (ROC) curve analysis, the cutoff for T-Bil was found to be 0.7 mg/dL. Among patients treated with mFOLFIRINOX therapy, the incidence of severe neutropenia was significantly higher in patients with high level of T-Bil (> 0.7 mg/dL) than in those without it (93.8% vs 55.0%, P = 0.006). A chemotherapy regimen (modified FOLFIRINOX therapy) and T-Bil > 0.7 mg/dL were significant risk factors for severe neutropenia in patients receiving 150 mg/m{sup 2} irinotecan.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2017

An assessment of the safety, hemodynamic response, and diagnostic accuracy of commonly used vasodilator stressors in patients with severe aortic stenosis

Background: Increasing numbers of patients are undergoing transcatheter aortic valve replacement, which often involves assessment of coronary artery disease ischemic burden. The safety and diagnostic accuracy of vasodilator stress agents in patients with severe aortic stenosis (AS) undergoing SPECT myocardial perfusion imaging (MPI) has not been established. Methods: Patients with severe AS (valve area <1 cm{sup 2}) on echocardiography who underwent vasodilator stress SPECT MPI at two centers were identified. Patients with aortic valve intervention prior to MPI or who underwent concurrent exercise during stress testing were excluded. AS patients were matched to controls without AS based on age, gender, BMI, ejection fraction, and stress agent. Symptoms, serious adverse events, hemodynamic response, and correlation to invasive angiography were assessed. Results: A total of 95 cases were identified with 45% undergoing regadenoson, 31% dipyridamole, and 24% adenosine stress. A significant change in systolic blood pressure (BP), cases vs controls, was observed with adenosine [−17.9 ± 20.1 vs −2.6 ± 24.9 P = .03)], with a trend toward significance with regadenoson [−16.8 ± 20.3 vs −9.4 ± 17.9 (P = .08)] and dipyridamole [−17.8 ± 20.6 vs -9.0 ± 12.1 (P = .05)]. The change in heart rate was significantly different only for adenosine [5.3 ± 16.8 vs 14.2 ± 10.8 (P = .04)]. Overall, 45% of cases vs 24% of controls (P = .004) had a >20 mmHg decrease in systolic BP. Age, BMI, and resting systolic BP were related to a >20 mmHg decrease in systolic BP on univariate analysis, although only higher resting systolic BP was a predictor on multivariate analysis. In 33 patients who underwent angiography, the sensitivity, specificity, and diagnostic accuracy of vasodilator stress MPI was 77%, 69%, and 73%, respectively. No serious adverse events occurred in the severe AS patients. Conclusion: Severe AS patients are more likely to have a hemodynamically significant decrease in systolic BP with vasodilator stress. There were no serious adverse events in this severe AS cohort with good diagnostic performance of MPI compared to angiography.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Prognostic study of cardiac events in Japanese patients with chronic kidney disease using ECG-gated myocardial Perfusion imaging: Final 3-year report of the J-ACCESS 3 study

Background: Myocardial perfusion imaging (MPI) is considered useful for risk stratification among patients with chronic kidney disease (CKD), without renal deterioration by contrast media. Methods and Results: The Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS 3) is a multicenter, prospective cohort study investigating the ability of MPI to predict cardiac events in 529 CKD patients without a definitive coronary artery disease. All patients were assessed by stress and rest MPI with {sup 99m}Tc-tetrofosmin and data were analyzed using a defect scoring method and QGS software. Major cardiac events were analyzed for 3 years after registration. The mean eGFR was 29.0 ± 12.8 (mL/minute/1.73 m{sup 2}). The mean summed stress/rest/difference (SSS, SRS, SDS) scores were 1.9 ± 3.8, 1.1 ± 3.0, and 0.8 ± 1.8, respectively. A total of 60 cardiac events (three cardiac deaths, six sudden deaths, five nonfatal myocardial infarctions, 46 hospitalization cases for heart failure) occurred. The event-free survival rate was lower among patients with kidney dysfunction, higher SSS, and higher CRP values. Multivariate Cox regression analysis independently associated SSS ≥8, eGFR <15 (mL/minute/1.73 m{sup 2}), and CRP ≥0.3 (mg/dL) with cardiac events. Conclusions: Together with eGFR and CRP, MPI can predict cardiac events in patients with CKD.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Prognostic value of left ventricular dyssynchrony evaluated by gated myocardial perfusion imaging in patients with chronic kidney disease and normal perfusion defect scores

Background: This study aimed to investigate whether indices of left ventricular (LV) dyssynchrony by gated myocardial perfusion SPECT (GMPS) could be useful to predict prognosis in chronic kidney disease (CKD) patients with normal perfusion defect scores. Methods: One hundred and sixty-seven CKD patients with normal perfusion defect scores on adenosine-stress {sup 201}Tl GMPS and no previous history of overt heart diseases were enrolled. Phase standard deviation (PSD) and bandwidth (BW) were automatically calculated from GMPS. The major adverse cardiac events (MACEs) for a mean of 560 days were defined as sudden cardiac death, fatal arrhythmias, and acute coronary syndrome requiring urgent coronary revascularization. Patients were divided into two groups according to the presence or absence of MACEs. Results: The MACEs occurred in 12 patients (7.1%). Patients who experienced MACEs showed significantly higher PSD and wider BW than those who did not. In the Kaplan-Meier event-free survival analysis, cardiac event rate was significantly higher in the high-PSD and wide-BW group (n = 81) than in the low-PSD and narrow-BW group (n = 71) (P = .002). The multivariate regression analysis revealed that the PSD was associated with MACEs (odds ratio 1.33, 95% confidence interval 1.05-1.69, P = .01). Conclusion: The LV dyssynchrony indices from GMPS may be novel prognostic predictors in CKD patients with normal perfusion defect scores.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Interactions between myocardial sympathetic denervation and left ventricular mechanical dyssynchrony: A CZT analysis

Background: A correlation between left ventricular (LV) dyssynchrony (LVD) and impaired myocardial sympathetic tone has been hypothesized. We sought to assess the interactions between regional LV sympathetic innervation, perfusion, and mechanical dyssynchrony. Methods: Eighty-three patients underwent evaluation of LV perfusion and sympathetic innervation on {sup 99m}Tc-tetrofosmin/{sup 123}I-metaiodobenzylguanidine ({sup 123}I-MIBG) imaging. The summed rest score and summed {sup 123}I-MIBG score (SS-MIBG) were computed. The extent of “innervation/perfusion” mismatch was defined as the number of denervated LV segments with relatively preserved perfusion. LVD was evaluated on phase analysis and the wall with latest mechanical activation identified. Results: LVD was revealed in 36 (43%) patients. Patients with LVD had more abnormal values of SRS (21 ± 9 vs 10 ± 8, P < 0.001) and SS-MIBG (29 ± 9 vs 17 ± 11, P < 0.001) than those without LVD. The presence of LVD also clustered with a higher burden of “innervation/perfusion” mismatch (P = 0.019). On per-wall analysis, LV walls with delayed mechanical activation showed a higher burden of “innervation/perfusion” mismatch (2.3 ± 1.4 segments) than normally contracting walls (1.3 ± 1.2 segments; P < 0.001). On multivariate analysis, the extent of “innervation/perfusion” mismatch was the only predictor of delayed mechanical activation (P = 0.029). Conclusions: Patients with LVD show an elevated burden of “innervation/perfusion” mismatch that is concentrated at the level of the most dyssynchronous walls.

62 RADIOLOGY AND NUCLEAR MEDICINE↗