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Chen MY, Rochitte CE, Arbab-Zadeh A, Dewey M, George RT, Miller JM, Niinuma H, Yoshioka K, Kitagawa K, Sakuma H, Laham R, Vavere AL, Cerci RJ, Mehra VC, Nomura C, Kofoed KF, Jinzaki M, Kuribayashi S, Scholte AJ, Laule M, Tan SY, Hoe J, Paul N, Rybicki FJ, Brinker JA, Arai AE, Matheson MB, Cox C, Clouse ME, Di Carli MF, Lima JAC. Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging versus Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events: The CORE320 Multicenter Study. Radiology 2017; 284:55-65. [PMID: 28290782 DOI: 10.1148/radiol.2017161565] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial perfusion imaging. Materials and Methods This study was approved by all institutional review boards, and written informed consent was obtained. Between November 2009 and July 2011, 381 participants clinically referred for ICA and aged 45-85 years were enrolled in the Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) prospective multicenter diagnostic study. All images were analyzed in blinded independent core laboratories, and a panel of physicians adjudicated all adverse events. MACE was defined as revascularization (>30 days after index ICA), myocardial infarction, or cardiac death; hospitalization for chest pain or congestive heart failure; or arrhythmia. Late MACE was defined similarly, except for patients who underwent revascularization within the first 182 days after ICA, who were excluded. Comparisons of 2-year survival (time to MACE) used standard Kaplan-Meier curves and restricted mean survival times bootstrapped with 2000 replicates. Results An MACE (49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia) occurred in 51 of 379 patients (13.5%). The 2-year MACE-free rates for combined CT angiography and CT perfusion findings were 94% negative for coronary artery disease (CAD) versus 82% positive for CAD and were similar to combined ICA and single photon emission CT findings (93% negative for CAD vs 77% positive for CAD, P < .001 for both). Event-free rates for CT angiography and CT perfusion versus ICA and single photon emission CT for either positive or negative results were not significantly different for MACE or late MACE (P > .05 for all). The area under the receiver operating characteristic curve (AUC) for combined CT angiography and CT perfusion (AUC = 68; 95% confidence interval [CI]: 62, 75) was similar (P = .36) to that for combined ICA and single photon emission CT (AUC = 71; 95% CI: 65, 79) in the identification of MACE at 2-year follow-up. Conclusion Combined CT angiography and CT perfusion enables similar prediction of 2-year MACE, late MACE, and event-free survival similar to that enabled by ICA and single photon emission CT. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Marcus Y Chen
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Carlos E Rochitte
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Armin Arbab-Zadeh
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Marc Dewey
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Richard T George
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Julie M Miller
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Hiroyuki Niinuma
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Kunihiro Yoshioka
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Kakuya Kitagawa
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Hajime Sakuma
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Roger Laham
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Andrea L Vavere
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Rodrigo J Cerci
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Vishal C Mehra
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Cesar Nomura
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Klaus F Kofoed
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Masahiro Jinzaki
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Sachio Kuribayashi
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Arthur J Scholte
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Michael Laule
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Swee Yaw Tan
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - John Hoe
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Narinder Paul
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Frank J Rybicki
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Jeffrey A Brinker
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Andrew E Arai
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Matthew B Matheson
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Christopher Cox
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Melvin E Clouse
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Marcelo F Di Carli
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - João A C Lima
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
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Arbab-Zadeh A, Di Carli MF, Cerci R, George RT, Chen MY, Dewey M, Niinuma H, Vavere AL, Betoko A, Plotkin M, Cox C, Clouse ME, Arai AE, Rochitte CE, Lima JAC, Brinker J, Miller JM. Accuracy of Computed Tomographic Angiography and Single-Photon Emission Computed Tomography-Acquired Myocardial Perfusion Imaging for the Diagnosis of Coronary Artery Disease. Circ Cardiovasc Imaging 2016; 8:e003533. [PMID: 26467105 DOI: 10.1161/circimaging.115.003533] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Establishing the diagnosis of coronary artery disease (CAD) in symptomatic patients allows appropriately allocating preventative measures. Single-photon emission computed tomography (CT)-acquired myocardial perfusion imaging (SPECT-MPI) is frequently used for the evaluation of CAD, but coronary CT angiography (CTA) has emerged as a valid alternative. METHODS AND RESULTS We compared the accuracy of SPECT-MPI and CTA for the diagnosis of CAD in 391 symptomatic patients who were prospectively enrolled in a multicenter study after clinical referral for cardiac catheterization. The area under the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of CTA and SPECT-MPI for identifying patients with CAD defined as the presence of ≥1 coronary artery with ≥50% lumen stenosis by quantitative coronary angiography. Sensitivity to identify patients with CAD was greater for CTA than SPECT-MPI (0.92 versus 0.62, respectively; P<0.001), resulting in greater overall accuracy (area under the receiver operating characteristic curve, 0.91 [95% confidence interval, 0.88-0.94] versus 0.69 [0.64-0.74]; P<0.001). Results were similar in patients without previous history of CAD (area under the receiver operating characteristic curve, 0.92 [0.89-0.96] versus 0.67 [0.61-0.73]; P<0.001) and also for the secondary end points of ≥70% stenosis and multivessel disease, as well as subgroups, except for patients with a calcium score of ≥400 and those with high-risk anatomy in whom the overall accuracy was similar because CTA's superior sensitivity was offset by lower specificity in these settings. Radiation doses were 3.9 mSv for CTA and 9.8 for SPECT-MPI (P<0.001). CONCLUSIONS CTA is more accurate than SPECT-MPI for the diagnosis of CAD as defined by conventional angiography and may be underused for this purpose in symptomatic patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00934037.
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Affiliation(s)
- Armin Arbab-Zadeh
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Marcelo F Di Carli
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
| | - Rodrigo Cerci
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Richard T George
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Marcus Y Chen
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Marc Dewey
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Hiroyuki Niinuma
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Andrea L Vavere
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Aisha Betoko
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Michail Plotkin
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Christopher Cox
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Melvin E Clouse
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Andrew E Arai
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Carlos E Rochitte
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Joao A C Lima
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Jeffrey Brinker
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Julie M Miller
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
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