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Nayfeh M, Ahmed AI, Al-Mallah MH. Unveiling the hidden link: deciphering the interplay between plaque characteristics and nuclear myocardial perfusion imaging. J Nucl Cardiol 2023; 30:1851-1855. [PMID: 37264216 DOI: 10.1007/s12350-023-03299-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023]
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Al-Mallah MH. The heartbeat of tomorrow: welcoming the next generation of cardiologists. J Nucl Cardiol 2023; 30:2255-2257. [PMID: 37605059 DOI: 10.1007/s12350-023-03367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
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Cohen YA, Shetty M, Castillo M, Al-Mallah MH, Calnon DA, Einstein AJ. Thallium-201 Use in Medicare Patients From 2010-2021 and Implications of Potential Cessation of its Production. JACC Cardiovasc Imaging 2023; 16:1356-1358. [PMID: 37178078 DOI: 10.1016/j.jcmg.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/15/2023]
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Jonas R, Patel T, Crabtree TR, Jennings RS, Heo R, Park HB, Marques H, Chang HJ, Stuijfzand WJ, van Rosendael AR, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Shin SH, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Al-Mallah MH, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson RC, Jang JJ, Ridner M, Rowan C, Avelar E, Généreux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Bax JJ, Choi AD, Earls JP, Hoffmann U, Min JK, Villines TC. Relation of Gender to Atherosclerotic Plaque Characteristics by Differing Angiographic Stenosis Severity. Am J Cardiol 2023; 204:276-283. [PMID: 37562193 DOI: 10.1016/j.amjcard.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/24/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023]
Abstract
It is unknown whether gender influences the atherosclerotic plaque characteristics (APCs) of lesions of varying angiographic stenosis severity. This study evaluated the imaging data of 303 symptomatic patients from the derivation arm of the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia) trial, all of whom underwent coronary computed tomographic angiography and clinically indicated nonemergent invasive coronary angiography upon study enrollment. Index tests were interpreted by 2 blinded core laboratories, one of which performed quantitative coronary computed tomographic angiography using an artificial intelligence application to characterize and quantify APCs, including percent atheroma volume (PAV), low-density noncalcified plaque (LD-NCP), noncalcified plaque (NCP), calcified plaque (CP), lesion length, positive arterial remodeling, and high-risk plaque (a combination of LD-NCP and positive remodeling ≥1.10); the other classified lesions as obstructive (≥50% diameter stenosis) or nonobstructive (<50% diameter stenosis) based on quantitative invasive coronary angiography. The relation between APCs and angiographic stenosis was further examined by gender. The mean age of the study cohort was 64.4 ± 10.2 years (29.0% female). In patients with obstructive disease, men had more LD-NCP PAV (0.5 ± 0.4 vs 0.3 ± 0.8, p = 0.03) and women had more CP PAV (11.7 ± 1.6 vs 8.0 ± 0.8, p = 0.04). Obstructive lesions had more NCP PAV compared with their nonobstructive lesions in both genders, however, obstructive lesions in women also demonstrated greater LD-NCP PAV (0.4 ± 0.5 vs 1.0 ± 1.8, p = 0.03), and CP PAV (17.4 ± 16.5 vs 25.9 ± 18.7, p = 0.03) than nonobstructive lesions. Comparing the composition of obstructive lesions by gender, women had more CP PAV (26.3 ± 3.4 vs 15.8 ± 1.5, p = 0.005) whereas men had more NCP PAV (33.0 ± 1.6 vs 26.7 ± 2.5, p = 0.04). Men had more LD-NCP PAV in nonobstructive lesions compared with women (1.2 ± 0.2 vs 0.6 ± 0.2, p = 0.02). In conclusion, there are gender-specific differences in plaque composition based on stenosis severity.
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El Bizri A, Al-Mallah MH. Planning interventions in chronic total occlusions: A comprehensive approach. Atherosclerosis 2023; 381:117212. [PMID: 37604739 DOI: 10.1016/j.atherosclerosis.2023.117212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023]
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Ehrman JK, Keteyian SJ, Johansen MC, Blaha MJ, Al-Mallah MH, Brawner CA. Improved cardiorespiratory fitness is associated with lower incident ischemic stroke risk: Henry Ford FIT project. J Stroke Cerebrovasc Dis 2023; 32:107240. [PMID: 37393688 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Change in cardiorespiratory fitness (CRF) modulates vascular disease risk; however, it's unclear if this adds further prognostic information, particularly for ischemic stroke. The objective of this analysis is to describe the association between the change in CRF over time and subsequent incident ischemic stroke. METHODS This is a retrospective, longitudinal, observational cohort study of 9,646 patients (age=55±11 years; 41% women; 25% black) who completed 2 clinically indicated exercise tests (> 12 months apart) and were free of any stroke at the time of test 2. CRF was expressed as metabolic-equivalents-of-task (METs). Incident ischemic stroke was identified using ICD codes. The adjusted hazard ratio (aHR) was determined for risk of ischemic stroke associated with change in CRF. RESULTS Mean time between tests was 3.7 years (IQR, 2.2, 6.0). During a median of 5.0 years (IQR, 2.7, 7.6 y) of follow-up, there were 873 (9.1%) ischemic stroke events. Each 1 MET increase between tests was associated with a 9% lower ischemic stroke risk (aHR 0.91 [0.88-0.94]; n = 9.646). There was an interaction effect by baseline CRF category, but not for sex or race. A sensitivity analysis which removed those who experienced an incident diagnosis known to be associated with an increased risk of ischemic vascular disease, validated our primary findings (aHR 0.91 [0.88, 0.95]; n= 6,943). CONCLUSIONS Improvement in CRF over time is independently and inversely associated with a lower risk of ischemic stroke. Encouragement of regular exercise focused on improving CRF may reduce ischemic stroke risk.
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Al-Mallah MH. The journey to exceptional imaging: Three steps we all must take. J Nucl Cardiol 2023; 30:1749-1750. [PMID: 37382874 DOI: 10.1007/s12350-023-03323-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
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Saad JM, Ahmed AI, Han Y, El Nihum LI, Alahdab F, Nabi F, Al-Mallah MH. Splenic switch-off in regadenoson 82Rb-PET myocardial perfusion imaging: assessment of clinical utility. J Nucl Cardiol 2023; 30:1484-1496. [PMID: 36607537 DOI: 10.1007/s12350-022-03158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/05/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Splenic switch-off (SSO) is a phenomenon describing a decrease in splenic radiotracer uptake after vasodilatory stress. We aimed to assess the diagnostic utility of regadenoson-induced SSO. METHODS We included consecutive patients who had clinically indicated Regadenoson Rb-82 PET-MPI for suspected CAD. This derivation cohort (no perfusion defects and myocardial flow reserves (MFR) ≥ 2) was used to calculate the splenic response ratio (SRR). The validation cohort was defined as patients who underwent both PET-MPI studies and invasive coronary angiography (ICA). RESULTS The derivation cohort (n = 100, 57.4 ± 11.6 years, 77% female) showed a decrease in splenic uptake from rest to stress (79.9 ± 16.8 kBq⋅mL vs 69.1 ± 16.2 kBq⋅mL, P < .001). From the validation cohort (n = 315, 66.3 ± 10.4 years, 67% male), 28% (via SRR = 0.88) and 15% (visually) were classified as splenic non-responders. MFR was lower in non-responders (SRR; 1.55 ± 0.65 vs 1.76 ± 0.78, P = .02 and visually; 1.18 ± 0.33 vs 1.79 ± 0.77, P < .001). Based on ICA, non-responders were more likely to note obstructive epicardial disease with normal PET scans especially in patients with MFR < 1.5 (SRR; 61% vs 34% P = .05 and visually; 68% vs 33%, P = .01). CONCLUSION Lack of splenic response based on visual or quantitative assessment of SSO may be used to identify an inadequate vasodilatory response.
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Nayfeh M, Ahmed AI, Al Rifai M, Alahdab F, Nagueh SF, Chamsi-Pasha MA, Mahmarian JJ, Chang SM, Zoghbi WA, Al-Mallah MH. Temporal trends in the use of cardiac computerized tomography angiography and transesophageal echocardiography for left atrial appendage thrombus detection. J Cardiovasc Comput Tomogr 2023; 17:289-290. [PMID: 37061438 DOI: 10.1016/j.jcct.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/17/2023]
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Al-Mallah MH. Artificial intelligence in nuclear cardiology: your crucial role in transforming potential into reality. J Nucl Cardiol 2023; 30:1293-1296. [PMID: 37156962 DOI: 10.1007/s12350-023-03276-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Ahmed AI, Al-Mallah MH. Reply to SPECT and STE: Which one is better in incremental prognostic value over CCTA. Int J Cardiol 2023; 378:164-165. [PMID: 36863422 DOI: 10.1016/j.ijcard.2023.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
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Al Rifai M, Kanaya AM, Kandula NR, Patel J, Al-Mallah MH, Budoff M, Cainzos-Achirica M, Criqui MH, Virani SS. Association of Coronary Artery Calcium Density and Volume With Predicted Atherosclerotic Cardiovascular Disease Risk and Cardiometabolic Risk Factors in South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. Curr Probl Cardiol 2023; 48:101105. [PMID: 34999157 PMCID: PMC9259756 DOI: 10.1016/j.cpcardiol.2022.101105] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 02/07/2023]
Abstract
Individuals of South Asian (SA) ancestry are predisposed to a higher risk of atherosclerotic cardiovascular disease (ASCVD). Coronary artery calcium (CAC) volume and density can identify coronary plaque characteristics unique to SA that may provide important prognostic information to identify high risk individuals beyond traditional CAC scores. We used data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA). CAC density and volume were assessed according to established protocols. ASCVD risk was estimated using the pooled cohort equations (PCE). Multivariable-adjusted linear regression models were used to study the association between the PCE and advanced CAC measures, and between cardiovascular risk factors and CAC density and volume. Our analyses included 1,155 participants (mean age 57 (SD 9) years, 52% men) with information on advanced CAC measures. After multivariable-adjustment, the PCE was associated with both CAC density (β 0.24, 95% CI 0.12,0.35) and CAC volume (β 0.43, 95% CI 0.38,0.48). High-density lipoprotein cholesterol was directly associated with CAC density while waist circumference was inversely associated with it. Body mass index, hypertension status, statin use, diabetes, and HOMA-IR were all directly associated with CAC volume. Estimated ASCVD risk was associated with both CAC volume and density. Different cardiometabolic risk factors are associated with CAC density and volume. Future longitudinal studies are required to demonstrate the interrelationship of advanced CAC measures and cardiovascular risk factors with incident ASCVD outcomes.
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Al-Mallah MH. 30 years of innovation: are you ready for a challenge? J Nucl Cardiol 2023; 30:908-910. [PMID: 36849634 DOI: 10.1007/s12350-023-03230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Nayfeh M, Ahmed AI, Alahdab F, Nabi F, Chang SM, Mahmarian JJ, Chamsi-Pasha MA, Malahfji M, Rifai MA, Al-Mallah MH. TEMPORAL TRENDS IN THE US OF CARDIAC CT FOR DIAGNOSIS OF LEFT ATRIAL APPENDAGE THROMBUS; THE IMPACT OF COVID-19 PANDEMIC. J Am Coll Cardiol 2023. [PMCID: PMC9982906 DOI: 10.1016/s0735-1097(23)01929-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Ahmed AI, Saad JM, Han Y, Alahdab F, Malahfji M, Nabi F, Mahmarian JJ, Cooke JP, Zoghbi WA, Al-Mallah MH. CORONARY MICROVASCULAR DYSFUNCTION AND PRIOR COVID-19 INFECTION: DO VARIANTS MATTER? J Am Coll Cardiol 2023. [PMCID: PMC9982885 DOI: 10.1016/s0735-1097(23)01914-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Ahmed AI, Saad JM, Han Y, Alahdab F, Malahfji M, Nabi F, Mahmarian JJ, Cooke JP, Zoghbi WA, Al-Mallah MH. CORONARY MICROVASCULAR DYSFUNCTION IN PATIENTS WITH PRIOR COVID-19 INFECTION AND PERSISTENT SYMPTOMS: IMPACT OF DURATION SINCE THE INFECTION. J Am Coll Cardiol 2023. [PMCID: PMC9982875 DOI: 10.1016/s0735-1097(23)01913-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Nayfeh M, Rifai MA, Alfawara MS, Alahdab F, Al-Mallah MH. CHALLENGES IN THE MANAGEMENT OF PATIENTS WITH ANOMALOUS ORIGIN OF THE LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY PRESENTING IN ADULTHOOD. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03279-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Alahdab F, Shawi RE, Ahmed AI, Al-Mallah MH. PATIENT-LEVEL EXPLAINABLE MACHINE LEARNING TO PREDICT MAJOR ADVERSE CARDIOVASCULAR EVENTS FROM SPECT MPI AND CCTA IMAGING. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01930-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Nayfeh M, Al Rifai M, Alahdab F, Alfawara MS, Ahmed AI, Saad JM, Han Y, Al-Mallah MH. PLAQUE BURDEN VERSUS STENOSIS AS PREDICTORS OF MAJOR ADVERSE CARDIAC EVENTS IN PATIENTS WITH CORONARY ATHEROSCLEROSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01601-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Saad JM, Ahmed AI, Alahdab F, Rifai MA, Han Y, Alfawara MS, Kassi M, Trachtenberg B, Al-Mallah MH. CARDIAC SCINTIGRAPHY ATRIAL UPTAKE AND HEART FAILURE ADMISSIONS IN ATTR-CARDIAC AMYLOIDOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01912-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Saad JM, Ahmed AI, Alahdab F, Rifai MA, Han Y, Alfawara MS, Kassi M, Trachtenberg B, Al-Mallah MH. PROGNOSTIC VALUE OF LOW QRS VOLTAGE IN PATIENTS WITH TRANSTHYRETIN CARDIAC AMYLOIDOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01176-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Rifai MA, Ahmed AI, Alahdab F, Nabi F, Mahmarian JJ, Soliman A, Alfawara MS, Saad JM, Al-Mallah MH. PROGNOSTIC VALUE OF MYOCARDIAL FLOW RESERVE BY BODY MASS INDEX. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Rifai MA, Ahmed AI, Saad JM, Alahdab F, Nabi F, Al-Mallah MH. PROGNOSTIC UTILITY OF MYOCARDIAL FLOW RESERVE IN PATIENTS WITH PRIOR CORONARY ARTERY BYPASS GRAFTS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Ahmed AI, Saad JM, Alahdab F, Rifai MA, Han Y, Nayfeh M, Al-Mallah MH. PROGNOSTIC VALUE OF POSITRON EMISSION TOMOGRAPHY-DERIVED MYOCARDIAL FLOW RESERVE: SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01940-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Alfawara MS, Rifai MA, Ahmed AI, Saad JM, Han Y, Alahdab F, Nayfeh M, Al-Mallah MH. TRUST BUT VERIFY: IMPACT OF POSITRON EMISSION TOMOGRAPHY/CT MISREGISTRATION ON MYOCARDIAL BLOOD FLOW ASSESSMENT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03747-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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