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Pontone G, Weir-McCall JR, Baggiano A, Del Torto A, Fusini L, Guglielmo M, Muscogiuri G, Guaricci AI, Andreini D, Patel M, Nieman K, Akasaka T, Rogers C, Nørgaard BL, Bax J, Raff GL, Chinnaiyan K, Berman D, Fairbairn T, Koweek LH, Leipsic J. Determinants of Rejection Rate for Coronary CT Angiography Fractional Flow Reserve Analysis. Radiology 2019; 292:597-605. [PMID: 31335283 DOI: 10.1148/radiol.2019182673] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Coronary artery fractional flow reserve (FFR) derived from CT angiography (FFTCT) enables functional assessment of coronary stenosis. Prior clinical trials showed 13%-33% of coronary CT angiography studies had insufficient quality for quantitative analysis with FFRCT. Purpose To determine the rejection rate of FFRCT analysis and to determine factors associated with technically unsuccessful calculation of FFRCT. Materials and Methods Prospectively acquired coronary CT angiography scans submitted as part of the Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care (ADVANCE) registry (https://ClinicalTrials.gov: NCT02499679) and coronary CT angiography series submitted for clinical analysis were included. The primary outcome was the FFRCT rejection rate (defined as an inability to perform quantitative analysis with FFRCT). Factors that were associated with FFRCT rejection rate were assessed with multiple linear regression. Results In the ADVANCE registry, FFRCT rejection rate due to inadequate image quality was 2.9% (80 of 2778 patients; 95% confidence interval [CI]: 2.1%, 3.2%). In the 10 621 consecutive patients who underwent clinical analysis, the FFRCT rejection rate was 8.4% (n = 892; 95% CI: 6.2%, 7.2%; P < .001 vs the ADVANCE cohort). The main reason for the inability to perform FFRCT analysis was the presence of motion artifacts (63 of 80 [78%] and 729 of 892 [64%] in the ADVANCE and clinical cohorts, respectively). At multivariable analysis, section thickness in the ADVANCE (odds ratio [OR], 1.04; 95% CI: 1.001, 1.09; P = .045) and clinical (OR, 1.03; 95% CI: 1.02, 1.04; P < .001) cohorts and heart rate in the ADVANCE (OR, 1.05; 95% CI: 1.02, 1.08; P < .001) and clinical (OR, 1.06; 95% CI: 1.05, 1.07; P < .001) cohorts were independent predictors of rejection. Conclusion The rates for technically unsuccessful CT-derived fractional flow reserve in the ADVANCE registry and in a large clinical cohort were 2.9% and 8.4%, respectively. Thinner CT section thickness and lower patient heart rate may increase rates of completion of CT fractional flow reserve analysis. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Sakuma in this issue.
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Affiliation(s)
- Gianluca Pontone
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Jonathan R Weir-McCall
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Andrea Baggiano
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Alberico Del Torto
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Laura Fusini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Marco Guglielmo
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Giuseppe Muscogiuri
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Andrea Igoren Guaricci
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Daniele Andreini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Manesh Patel
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Koen Nieman
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Takashi Akasaka
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Campbell Rogers
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Bjarne L Nørgaard
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Jeroen Bax
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Gilbert L Raff
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Kavitha Chinnaiyan
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Daniel Berman
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Timothy Fairbairn
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Lynne Hurwitz Koweek
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Jonathon Leipsic
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
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