1
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Kono T, Uetani T, Inoue K, Nagai T, Nishimura K, Suzuki J, Tanabe Y, Kido T, Kurata A, Mochizuki T, Ogimoto A, Okura T, Higaki J, Yamaguchi O, Ikeda S. Diagnostic accuracy of stress myocardial computed tomography perfusion imaging to detect myocardial ischemia: a comparison with coronary flow velocity reserve derived from transthoracic Doppler echocardiography. J Cardiol 2020; 76:251-258. [PMID: 32354493 DOI: 10.1016/j.jjcc.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Our aim was to evaluate the ability of adenosine triphosphate (ATP)-stress myocardial computed tomography perfusion (CTP) imaging to detect myocardial ischemia in the left anterior descending artery (LAD) territory, and to compare this method with coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography (TTDE). METHODS ATP-stress CTP and CFVR were performed in 50 patients with stable angina pectoris. Myocardial ischemia assessed from CTP imaging was defined as qualitative visual perfusion defects and reduced myocardial blood flow (MBF) based on quantitative assessment. A cut-off value of CFVR of 2.0 was used. RESULTS The mean CFVR was 1.9 ± 0.6 in ischemic regions by CTP, whereas it was 2.9 ± 0.8 in non-ischemic regions (p < 0.001). CTP imaging could accurately predict CFVR <2.0 with 84.0% diagnostic accuracy (94.7% sensitivity, 77.4% specificity, 72.0% positive predictive value, and 96.0% negative predictive value). When receiver operating characteristic curve analysis of the MBF data was performed to detect CFVR <2.0, the area under the curve was 0.89, and the optimal MBF cut-off value was 1.43 mL/g/min. CONCLUSIONS This study suggests that qualitative and quantitative assessment of ATP-stress CTP exhibits a good correlation with CFVR for evaluation of myocardial ischemia.
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Affiliation(s)
- Tamami Kono
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan.
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takayuki Nagai
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kazuhisa Nishimura
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jun Suzuki
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | | | - Takafumi Okura
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jitsuo Higaki
- Department of Cardiology, South Matsuyama Hospital, Matsuyama, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
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Gewirtz H, Iskandrian AE, Morgan C, Schelbert HR. Positron-Emission Tomography Quantitative Measurements of Myocardial Blood Flow. JACC Cardiovasc Imaging 2019; 12:1864-1867. [DOI: 10.1016/j.jcmg.2019.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/05/2019] [Accepted: 03/22/2019] [Indexed: 12/17/2022]
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3
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Gewirtz H. Coronary circulation: Pressure/flow parameters for assessment of ischemic heart disease. J Nucl Cardiol 2019; 26:459-470. [PMID: 29637523 DOI: 10.1007/s12350-018-1270-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/23/2018] [Indexed: 01/10/2023]
Abstract
Both invasive and non-invasive parameters have been reported for assessment of the physiological status of the coronary circulation. Fractional flow reserve and coronary (or myocardial) flow reserve may be obtained by invasive or non-invasive means. These metrics of coronary stenosis severity have achieved wide clinical acceptance for guiding revascularization decisions and risk stratification. Other indices are obtained invasively (e.g., instantaneous wave-free ratio, iFR; hyperemic stenosis resistance) or non-invasively (e.g., PET absolute myocardial blood flow (mL/min/g)) and have been used for the same purposes. Both iFR, and whole-cycle distal coronary to aortic mean pressure (Pd/Pa) are measured under basal condition and used for assessment of hemodynamic stenosis severity as is index of basal stenosis resistance (BSR). These metrics typically are dichotomized at an empirically derived cut point into "normal" and "abnormal" categories for purposes of clinical decision making and data analysis. Once dichotomized the indices do not always point in the same direction and so confusion may arise. This review, therefore, will present basic principles relevant to understanding commonly employed metrics of the physiological status of the coronary circulation, potential strengths and weaknesses, and hopefully an improved appreciation of the clinical information provided by each.
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Affiliation(s)
- Henry Gewirtz
- Department of Medicine (Cardiology Division), Harvard Medical School, Massachusetts General Hospital, Boston, MA, 02114, USA.
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Fayssal IA, Moukalled F, Alam S, Isma'eel H. An Outflow Boundary Condition Model for Noninvasive Prediction of Fractional Flow Reserve in Diseased Coronary Arteries. J Biomech Eng 2018; 140:2659642. [DOI: 10.1115/1.4038250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Indexed: 12/28/2022]
Abstract
This paper reports on a new boundary condition formulation to model the total coronary myocardial flow and resistance characteristics of the myocardial vascular bed for any specific patient when considered for noninvasive diagnosis of ischemia. The developed boundary condition model gives an implicit representation of the downstream truncated coronary bed. Further, it is based on incorporating patient-specific physiological parameters that can be noninvasively extracted to account for blood flow demand to the myocardium at rest and hyperemic conditions. The model is coupled to a steady three-dimensional (3D) collocated pressure-based finite volume flow solver and used to characterize the “functional significance” of a patient diseased coronary artery segment without the need for predicting the hemodynamics of the entire arterial system. Predictions generated with this boundary condition provide a deep understanding of the inherent challenges behind noninvasive image-based diagnostic techniques when applied to human diseased coronary arteries. The overall numerical method and formulated boundary condition model are validated via two computational-based procedures and benchmarked with available measured data. The newly developed boundary condition is used via a designed computational methodology to (a) confirm the need for incorporating patient-specific physiological parameters when modeling the downstream coronary resistance, (b) explain the discrepancies presented in the literature between measured and computed fractional flow reserve (FFRCT), and (c) discuss the current limitations and future challenges in shifting to noninvasive assessment of ischemia.
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Affiliation(s)
- Iyad A. Fayssal
- Computational Mechanics Laboratory, Mechanical Engineering Department, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
| | - Fadl Moukalled
- Professor Mechanical Engineering Department, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
| | - Samir Alam
- Professor Department of Internal Medicine, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
| | - Hussain Isma'eel
- Associate Professor Department of Internal Medicine, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
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Gewirtz H. PET measurements of myocardial blood flow post myocardial infarction: Relationship to invasive and cardiac magnetic resonance studies and potential clinical applications. J Nucl Cardiol 2017; 24:1883-1892. [PMID: 28577226 DOI: 10.1007/s12350-017-0930-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023]
Abstract
This review focuses on clinical studies concerning assessment of coronary microvascular and conduit vessel function primarily in the context of acute and sub acute myocardial infarction (MI). The ability of quantitative PET measurements of myocardial blood flow (MBF) to delineate underlying pathophysiology and assist in clinical decision making in this setting is discussed. Likewise, considered are physiological metrics fractional flow reserve, coronary flow reserve, index of microvascular resistance (FFR, CFR, IMR) obtained from invasive studies performed in the cardiac catheterization laboratory, typically at the time of PCI for MI. The role both of invasive studies and cardiac magnetic resonance (CMR) imaging in assessing microvascular function, a key determinant of prognosis, is reviewed. The interface between quantitative PET MBF measurements and underlying pathophysiology, as demonstrated both by invasive and CMR methodology, is discussed in the context of optimal interpretation of the quantitative PET MBF exam and its potential clinical applications.
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Affiliation(s)
- Henry Gewirtz
- Department of Medicine, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Yawkey 5E, 55 Fruit St, Boston, MA, 02114, USA.
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Visualization of the improvement of myocardial perfusion after coronary intervention using motorized fractional flow reserve pullback curve. Cardiovasc Interv Ther 2016; 33:99-108. [PMID: 27943219 PMCID: PMC5880845 DOI: 10.1007/s12928-016-0448-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/07/2016] [Indexed: 01/10/2023]
Abstract
This study aimed to evaluate the feasibility and utility of using motorized pullback of the pressure guidewire to provide a graphic assessment and prediction of the benefits of coronary intervention. Fractional flow reserve (FFR) measurements were performed with motorized pullback imaging in 20 patients who underwent successful percutaneous coronary intervention (PCI) of the left anterior descending artery. Physiological lesion length (PLL) was calculated using frame counts to determine stent length. FFR area was calculated by integrating the FFR values recorded during pullback tracing (FFRarea). The percentage increase in FFR area (%FFRarea) was defined as the ratio of the difference between the pre- and post-intervention FFRarea to the total frame count. The average FFR values were enhanced following PCI, from 0.64 to 0.82, and the median value of the difference between pre- and post-interventional FFR values (D-FFR) and %FFRarea were 0.13 and 10.6%, respectively. The %FFRarea demonstrated a significant positive correlation with D-FFR (R2, 0.61; p < 0.01). PLL tended to be longer and the %FFRarea was smaller in lesions with a gradual pressure-drop pattern than those with an abrupt pressure-drop pattern (35.37 vs. 20.40 mm, p = 0.07; 5.78 vs. 16.21%, p < 0.05, respectively). Motorized pullback tracing was able to identify the extent and location of stenosis and help in appropriate stent implantation, in addition to visualizing and quantifying the improvement in FFR following PCI.
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Integration of Quantitative Positron Emission Tomography Absolute Myocardial Blood Flow Measurements in the Clinical Management of Coronary Artery Disease. Circulation 2016; 133:2180-96. [DOI: 10.1161/circulationaha.115.018089] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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8
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Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT: Theoretical Models and Current Implementation. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1734190. [PMID: 27088083 PMCID: PMC4806267 DOI: 10.1155/2016/1734190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/11/2016] [Indexed: 01/21/2023]
Abstract
Technological advances in magnetic resonance imaging (MRI) and computed tomography (CT), including higher spatial and temporal resolution, have made the prospect of performing absolute myocardial perfusion quantification possible, previously only achievable with positron emission tomography (PET). This could facilitate integration of myocardial perfusion biomarkers into the current workup for coronary artery disease (CAD), as MRI and CT systems are more widely available than PET scanners. Cardiac PET scanning remains expensive and is restricted by the requirement of a nearby cyclotron. Clinical evidence is needed to demonstrate that MRI and CT have similar accuracy for myocardial perfusion quantification as PET. However, lack of standardization of acquisition protocols and tracer kinetic model selection complicates comparison between different studies and modalities. The aim of this overview is to provide insight into the different tracer kinetic models for quantitative myocardial perfusion analysis and to address typical implementation issues in MRI and CT. We compare different models based on their theoretical derivations and present the respective consequences for MRI and CT acquisition parameters, highlighting the interplay between tracer kinetic modeling and acquisition settings.
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9
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Gewirtz H. Functional Versus Anatomic Imaging of CAD: Lessons Learned from Recent Clinical Trials. Curr Cardiol Rep 2015; 18:4. [DOI: 10.1007/s11886-015-0686-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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From Physiology of the Coronary Circulation to Myocardial Perfusion Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-014-9313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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11
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Klein R, Hung GU, Wu TC, Huang WS, Li D, deKemp RA, Hsu B. Feasibility and operator variability of myocardial blood flow and reserve measurements with ⁹⁹mTc-sestamibi quantitative dynamic SPECT/CT imaging. J Nucl Cardiol 2014; 21:1075-88. [PMID: 25280761 DOI: 10.1007/s12350-014-9971-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 07/14/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE Myocardial blood flow (MBF) quantification with dynamic SPECT could lead to widespread utilization of MBF imaging in clinical practice with little cost increase over current standard SPECT myocardial perfusion imaging. This work evaluates the feasibility and operator-dependent variability of MBF and flow reserve measurements with (99m)Tc-sestamibi (MIBI) dynamic SPECT imaging using a standard dual-head SPECT camera. METHODS Twenty-eight patients underwent dipyridamole-stress and rest imaging with dynamic SPECT/CT acquisition. Quantitative images were iteratively reconstructed with all physical corrections and then myocardial and arterial blood regions of interest (ROI) were defined semi-automatically. A compartmental model was fitted to these ROI-sampled time-activity-curves, and flow-dependent MIBI extraction correction was applied to derive regional MBF values. Myocardial flow reserve (MFR) was estimated as stress/rest MBF ratio. MBF and MFR in low and high risk populations were evaluated for ability to detect disease. Images were each processed twice (≥7 days apart) by one expert and one novice operator to evaluate intra- and inter-operator variability of MBF and MFR measurement in the three coronary artery vascular territories. RESULTS Mean rest flow, stress flow, and MFR values were 0.83, 1.82 mL·minute(-1)·g(-1), and 2.45, respectively. For stress/rest MFR, the inter-operator reproducibility was r(2) = 0.86 with RPC = 1.1. Stress MBF and MFR were significantly reduced (P < .05) in high risk (n = 9) vs low risk populations (n = 19), indicating ability to detect disease. For expert and novice operators very good intra-operator correlations of r(2) = 0.98 and 0.95 (n = 168, P < .001) were observed for combined rest and stress regional flow values. Bland-Altman reproducibility coefficients (RPC) were 0.25 and 0.47 mL·minute(-1)·g(-1) for the expert and novice operators, respectively (P < .001). Inter-operator correlation was r(2) = 0.91 and Bland-Altman RPC = 0.58 mL·minute(-1)·g(-1) (n = 336). CONCLUSIONS MBF and reserve measurements using (99m)Tc-sestamibi on a traditional, two-headed camera with fast rotation and with quantitative dynamic SPECT appears to be feasible, warranting further investigation.
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Affiliation(s)
- Ran Klein
- University of Ottawa Heart Institute, Cardiac PET Centre, 40 Ruskin St., Ottawa, ON, K1Y 4W7, Canada,
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12
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Schwab F, Ingrisch M, Marcus R, Bamberg F, Hildebrandt K, Adrion C, Gliemi C, Nikolaou K, Reiser M, Theisen D. Tracer kinetic modeling in myocardial perfusion quantification using MRI. Magn Reson Med 2014; 73:1206-15. [DOI: 10.1002/mrm.25212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 02/04/2014] [Accepted: 02/18/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Felix Schwab
- Josef Lissner Laboratory for Biomedical Imaging; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
- Munich Heart Alliance; Munich Germany
| | - Michael Ingrisch
- Josef Lissner Laboratory for Biomedical Imaging; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - Roy Marcus
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - Fabian Bamberg
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
- Munich Heart Alliance; Munich Germany
| | - Kristof Hildebrandt
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - Christine Adrion
- Chair of Biometry and Bioinformatics; Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig-Maximilians-University; Munich Germany
| | | | - Konstantin Nikolaou
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - Maximilian Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
- Munich Heart Alliance; Munich Germany
| | - Daniel Theisen
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
- Munich Heart Alliance; Munich Germany
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Gould KL, Johnson NP, Bateman TM, Beanlands RS, Bengel FM, Bober R, Camici PG, Cerqueira MD, Chow BJW, Di Carli MF, Dorbala S, Gewirtz H, Gropler RJ, Kaufmann PA, Knaapen P, Knuuti J, Merhige ME, Rentrop KP, Ruddy TD, Schelbert HR, Schindler TH, Schwaiger M, Sdringola S, Vitarello J, Williams KA, Gordon D, Dilsizian V, Narula J. Anatomic versus physiologic assessment of coronary artery disease. Role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making. J Am Coll Cardiol 2013; 62:1639-1653. [PMID: 23954338 DOI: 10.1016/j.jacc.2013.07.076] [Citation(s) in RCA: 408] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/01/2013] [Accepted: 07/24/2013] [Indexed: 12/22/2022]
Abstract
Angiographic severity of coronary artery stenosis has historically been the primary guide to revascularization or medical management of coronary artery disease. However, physiologic severity defined by coronary pressure and/or flow has resurged into clinical prominence as a potential, fundamental change from anatomically to physiologically guided management. This review addresses clinical coronary physiology-pressure and flow-as clinical tools for treating patients. We clarify the basic concepts that hold true for whatever technology measures coronary physiology directly and reliably, here focusing on positron emission tomography and its interplay with intracoronary measurements.
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Affiliation(s)
- K Lance Gould
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School at Houston, Houston, Texas.
| | - Nils P Johnson
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - Timothy M Bateman
- Mid America Heart Institute, Cardiovascular Consultants PA, and the University of Missouri-Kansas City, Kansas City, Missouri
| | - Rob S Beanlands
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Frank M Bengel
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Paolo G Camici
- Vita-Salute University San Raffaele and San Raffaele Scientific Institute, Milan, Italy
| | - Manuel D Cerqueira
- Department of Molecular & Functional Imaging, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Benjamin J W Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Division of Cardiovascular Medicine, and Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Division of Cardiovascular Medicine, and Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Henry Gewirtz
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert J Gropler
- Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Philipp A Kaufmann
- Cardiac Imaging and Zurich Center for Integrative Human Physiology, University Hospital Zurich, Zurich, Switzerland
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | | | | | - Terrence D Ruddy
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California
| | - Thomas H Schindler
- Department of Specialties in Medicine, Division of Cardiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Markus Schwaiger
- Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, München, Germany
| | - Stefano Sdringola
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - John Vitarello
- Cardiovascular Specialists of Frederick, Frederick, Maryland
| | - Kim A Williams
- Division of Cardiovascular Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Donald Gordon
- Cardiovascular Associates of the Southeast, Birmingham, Alabama
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jagat Narula
- Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
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Beer-induced angina pectoris. J Cardiol Cases 2013; 8:e54-e56. [DOI: 10.1016/j.jccase.2013.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 03/06/2013] [Accepted: 04/05/2013] [Indexed: 11/21/2022] Open
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