1
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Madsen KT, Nørgaard BL, Øvrehus KA, Jensen JM, Parner E, Grove EL, Mortensen MB, Fairbairn TA, Nieman K, Patel MR, Rogers C, Mullen S, Mickley H, Thomsen KK, Bøtker HE, Leipsic J, Sand NPR. Coronary computed tomography angiography derived fractional flow reserve and risk of recurrent angina: A 3-year follow-up study. J Cardiovasc Comput Tomogr 2024; 18:243-250. [PMID: 38246785 DOI: 10.1016/j.jcct.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND The association between coronary computed tomography angiography (CTA) derived fractional flow reserve (FFRCT) and risk of recurrent angina in patients with new onset stable angina pectoris (SAP) and stenosis by CTA is uncertain. METHODS Multicenter 3-year follow-up study of patients presenting with symptoms suggestive of new onset SAP who underwent first-line CTA evaluation and subsequent standard-of-care treatment. All patients had at least one ≥30 % coronary stenosis. A per-patient lowest FFRCT-value ≤0.80 represented an abnormal test result. Patients with FFRCT ≤0.80 who underwent revascularization were categorized according to completeness of revascularization: 1) Completely revascularized (CR-FFRCT), all vessels with FFRCT ≤0.80 revascularized; or 2) incompletely revascularized (IR-FFRCT) ≥1 vessels with FFRCT ≤0.80 non-revascularized. Recurrent angina was evaluated using the Seattle Angina Questionnaire. RESULTS Amongst 769 patients (619 [80 %] stenosis ≥50 %, 510 [66 %] FFRCT ≤0.80), 174 (23 %) reported recurrent angina at follow-up. An FFRCT ≤0.80 vs > 0.80 associated to increased risk of recurrent angina, relative risk (RR): 1.82; 95 % CI: 1.31-2.52, p < 0.001. Risk of recurrent angina in CR-FFRCT (n = 135) was similar to patients with FFRCT >0.80, 13 % vs 15 %, RR: 0.93; 95 % CI: 0.62-1.40, p = 0.72, while IR-FFRCT (n = 90) and non-revascularized patients with FFRCT ≤0.80 (n = 285) had increased risk, 37 % vs 15 % RR: 2.50; 95 % CI: 1.68-3.73, p < 0.001 and 30 % vs 15 %, RR: 2.03; 95 % CI: 1.44-2.87, p < 0.001, respectively. Use of antianginal medication was similar across study groups. CONCLUSION In patients with SAP and coronary stenosis by CTA undergoing standard-of-care guided treatment, FFRCT provides information regarding risk of recurrent angina.
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Affiliation(s)
| | - Bjarne Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Jesper Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Erik Parner
- Department of Public Health, Section for Biostatistics, Aarhus University, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Timothy A Fairbairn
- Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | | | | | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathon Leipsic
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
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2
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Mehdipoor G, Redfors B, Chen S, Gkargkoulas F, Zhang Z, Patel MR, Granger CB, Ohman EM, Maehara A, Eitel I, Ben-Yehuda O, de Waha-Thiele S, Thiele H, Stone GW. Hypertension, microvascular obstruction and infarct size in patients with STEMI undergoing PCI: Pooled analysis from 7 cardiac magnetic resonance imaging studies. Am Heart J 2024; 271:148-155. [PMID: 38430992 DOI: 10.1016/j.ahj.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Mortality after ST-segment elevation myocardial infarction (STEMI) is increased in patients with hypertension. The mechanisms underlying this association are uncertain. We sought to investigate whether patients with STEMI and prior hypertension have greater microvascular obstruction (MVO) and infarct size (IS) compared with those without hypertension. METHODS We pooled individual patient data from 7 randomized trials of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) in whom cardiac magnetic resonance imaging was performed within 1 month after reperfusion. The associations between hypertension and MVO, IS, and mortality were assessed in multivariable adjusted models. RESULTS Among 2174 patients (61.3 ± 12.6 years, 76% male), 1196 (55.0%) had hypertension. Patients with hypertension were older, more frequently diabetic and had more extensive coronary artery disease than those without hypertension. MVO and IS measured as percent LV mass were not significantly different in patients with and without hypertension (adjusted differences 0.1, 95% CI -0.3 to 0.6, P = .61 and -0.2, 95% CI -1.5 to 1.2, P = .80, respectively). Hypertension was associated with a higher unadjusted risk of 1-year death (hazard ratio [HR] 2.28, 95% CI 1.44-3.60, P < .001), but was not independently associated with higher mortality after multivariable adjustment (adjusted HR 1.04, 95% CI 0.60-1.79, P = .90). CONCLUSION In this large-scale individual patient data pooled analysis, hypertension was not associated with larger IS or MVO after primary PCI for STEMI.
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Affiliation(s)
- Ghazaleh Mehdipoor
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Fotios Gkargkoulas
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | | | | | | | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - Ingo Eitel
- University Heart Center Lübeck and The German Center for Cardiovascular Research, Lübeck, Germany
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - Suzanne de Waha-Thiele
- University Heart Center Lübeck and The German Center for Cardiovascular Research, Lübeck, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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3
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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. J Am Coll Cardiol 2024; 83:1579-1613. [PMID: 38493389 DOI: 10.1016/j.jacc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
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4
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Rymer JA, Patel MR. Health-Related Quality of Life Instruments in Chronic Limb-Threatening Ischemia: Evolution of Defining Quality of Life in a Complex Disease State. Circulation 2024; 149:1254-1257. [PMID: 38620090 DOI: 10.1161/circulationaha.123.067812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Jennifer A Rymer
- Division of Cardiology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, NC
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, NC
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5
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Rogers RK, Herold J, Govsyeyev N, Iezzi R, Morrison J, Hogan SE, Nehler M, Bricker R, Andring B, Bergmark B, Cavender M, Malgor E, Jacobs D, Young MN, Capell W, Yčas JW, Anand SS, Berkowitz SD, Debus ES, Haskell LP, Muehlhofer E, Patel MR, Hess CN, Bauersachs RM, Anderson V, Bonaca MP. Methods, design, and initial results of an angiographic core lab from VOYAGER-PAD. Vasc Med 2024; 29:143-152. [PMID: 38493348 PMCID: PMC11010567 DOI: 10.1177/1358863x241228542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
Background: Anatomy is critical in risk stratification and therapeutic decision making in coronary disease. The relationship between anatomy and outcomes is not well described in PAD. We sought to develop an angiographic core lab within the VOYAGER-PAD trial. The current report describes the methods of creating this core lab, its study population, and baseline anatomic variables. Methods: Patients undergoing lower-extremity revascularization for symptomatic PAD were randomized in VOYAGER-PAD. The median follow up was 2.25 years. Events were adjudicated by a blinded Clinical Endpoint Committee. Angiograms were collected from study participants; those with available angiograms formed this core lab cohort. Angiograms were scored for anatomic and flow characteristics by trained reviewers blinded to treatment. Ten percent of angiograms were evaluated independently by two reviewers; inter-rater agreement was assessed. Clinical characteristics and the treatment effect of rivaroxaban were compared between the core lab cohort and noncore lab participants. Anatomic data by segment were analyzed. Results: Of 6564 participants randomized in VOYAGER-PAD, catheter-based angiograms from 1666 patients were obtained for this core lab. Anatomic and flow characteristics were collected across 16 anatomic segments by 15 reviewers. Concordance between reviewers for anatomic and flow variables across segments was 90.5% (24,417/26,968). Clinical characteristics were similar between patients in the core lab and those not included. The effect of rivaroxaban on the primary efficacy and safety outcomes was also similar. Conclusions: The VOYAGER-PAD angiographic core lab provides an opportunity to correlate PAD anatomy with independently adjudicated outcomes and provide insights into therapy for PAD. (ClinicalTrials.gov Identifier: NCT02504216).
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Affiliation(s)
- R Kevin Rogers
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | - Joerg Herold
- Department of Angiology, Darmstadt Hospital, Darmstadt, Germany
| | - Nicholas Govsyeyev
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | - Roberto Iezzi
- Department of Radiology, Agostino Gemelli University Hospital, IRCCS, Catholic University, Rome, Italy
| | - Justin Morrison
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Shea E Hogan
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | - Mark Nehler
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | - Rory Bricker
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Brian Bergmark
- Thrombolysis in Myocardial Infarction Study Group, Brigham and Women’s Hospital, Boston, MA, USA
| | - Matt Cavender
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Emily Malgor
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Donald Jacobs
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael N Young
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Warren Capell
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | | | - Sonia S Anand
- Vascular Medicine, McMaster University, Hamilton, ON, Canada
| | - Scott D Berkowitz
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | | | | | | | - Manesh R Patel
- Division of Cardiology, Duke Medical Center, Durham, NC, USA
| | - Connie N Hess
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | | | | | - Marc P Bonaca
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
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6
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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2024; 17:e000129. [PMID: 38484039 DOI: 10.1161/hcq.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Affiliation(s)
- Hani Jneid
- ACC/AHA Joint Committee on Clinical Data Standards liaison
- Society for Cardiovascular Angiography and Interventions representative
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7
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Holmes KR, Gulsin GS, Fairbairn TA, Hurwitz-Koweek L, Matsuo H, Nørgaard BL, Jensen JM, Sand NPR, Nieman K, Bax JJ, Pontone G, Chinnaiyan KM, Rabbat MG, Amano T, Kawasaki T, Akasaka T, Kitabata H, Rogers C, Patel MR, Payne GW, Leipsic JA, Sellers SL. Impact of Smoking on Coronary Volume-to-Myocardial Mass Ratio: An ADVANCE Registry Substudy. Radiol Cardiothorac Imaging 2024; 6:e220197. [PMID: 38483246 PMCID: PMC11056751 DOI: 10.1148/ryct.220197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/30/2023] [Accepted: 01/26/2024] [Indexed: 04/19/2024]
Abstract
Purpose To examine the relationship between smoking status and coronary volume-to-myocardial mass ratio (V/M) among individuals with coronary artery disease (CAD) undergoing CT fractional flow reserve (CT-FFR) analysis. Materials and Methods In this secondary analysis, participants from the ADVANCE registry evaluated for suspected CAD from July 15, 2015, to October 20, 2017, who were found to have coronary stenosis of 30% or greater at coronary CT angiography (CCTA) were included if they had known smoking status and underwent CT-FFR and V/M analysis. CCTA images were segmented to calculate coronary volume and myocardial mass. V/M was compared between smoking groups, and predictors of low V/M were determined. Results The sample for analysis included 503 current smokers, 1060 former smokers, and 1311 never-smokers (2874 participants; 1906 male participants). After adjustment for demographic and clinical factors, former smokers had greater coronary volume than never-smokers (former smokers, 3021.7 mm3 ± 934.0 [SD]; never-smokers, 2967.6 mm3 ± 978.0; P = .002), while current smokers had increased myocardial mass compared with never-smokers (current smokers, 127.8 g ± 32.9; never-smokers, 118.0 g ± 32.5; P = .02). However, both current and former smokers had lower V/M than never-smokers (current smokers, 24.1 mm3/g ± 7.9; former smokers, 24.9 mm3/g ± 7.1; never-smokers, 25.8 mm3/g ± 7.4; P < .001 [unadjusted] and P = .002 [unadjusted], respectively). Current smoking status (odds ratio [OR], 0.74 [95% CI: 0.59, 0.93]; P = .009), former smoking status (OR, 0.81 [95% CI: 0.68, 0.97]; P = .02), stenosis of 50% or greater (OR, 0.62 [95% CI: 0.52, 0.74]; P < .001), and diabetes (OR, 0.67 [95% CI: 0.56, 0.82]; P < .001) were independent predictors of low V/M. Conclusion Both current and former smoking status were independently associated with low V/M. Keywords: CT Angiography, Cardiac, Heart, Ischemia/Infarction Clinical trial registration no. NCT02499679 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Kenneth R. Holmes
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Gaurav S. Gulsin
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Timothy A. Fairbairn
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Lynne Hurwitz-Koweek
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Hitoshi Matsuo
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Bjarne L. Nørgaard
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jesper M. Jensen
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Niels-Peter Rønnow Sand
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Koen Nieman
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jeroen J. Bax
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Gianluca Pontone
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Kavitha M. Chinnaiyan
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Mark G. Rabbat
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Tetsuya Amano
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Tomohiro Kawasaki
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Takashi Akasaka
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Hironori Kitabata
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Campbell Rogers
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Manesh R. Patel
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Geoffrey W. Payne
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jonathon A. Leipsic
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Stephanie L. Sellers
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
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Patel SM, Braunwald E, Steffel J, Boriani G, Palazzolo MG, Antman EM, Bohula EA, Carnicelli AP, Connolly SJ, Eikelboom JW, Gencer B, Granger CB, Morrow DA, Patel MR, Wallentin L, Ruff CT, Giugliano RP. Efficacy and Safety of Non-Vitamin-K Antagonist Oral Anticoagulants Versus Warfarin Across the Spectrum of Body Mass Index and Body Weight: An Individual Patient Data Meta-Analysis of 4 Randomized Clinical Trials of Patients With Atrial Fibrillation. Circulation 2024; 149:932-943. [PMID: 38264923 DOI: 10.1161/circulationaha.123.066279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND The efficacy and safety of non-vitamin-K antagonist oral anticoagulants (NOACs) across the spectrum of body mass index (BMI) and body weight (BW) remain uncertain. METHODS We analyzed data from COMBINE AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation), which pooled patient-level data from the 4 pivotal randomized trials of NOAC versus warfarin in patients with atrial fibrillation. The primary efficacy and safety outcomes were stroke or systemic embolic events (stroke/SEE) and major bleeding, respectively; secondary outcomes were ischemic stroke/SEE, intracranial hemorrhage, death, and the net clinical outcome (stroke/SEE, major bleeding, or death). Each outcome was examined across BMI and BW. Because few patients had a BMI <18.5 kg/m2 (n=598), the primary analyses were restricted to those with a BMI ≥18.5 kg/m2. RESULTS Among 58 464 patients, the median BMI was 28.3 (interquartile range, 25.2-32.2) kg/m2, and the median BW was 81.0 (interquartile range, 70.0-94.3) kg. The event probability of stroke/SEE was lower at a higher BMI irrespective of treatment, whereas the probability of major bleeding was lower at a higher BMI with warfarin but relatively unchanged across BMI with NOACs. NOACs reduced stroke/SEE overall (adjusted hazard ratio [HRadj], 0.80 [95% CI, 0.73-0.88]; P<0.001), with a generally consistent effect across BMI (Ptrend across HRs, 0.48). NOACs also reduced major bleeding overall (HRadj, 0.88 [95% CI, 0.82-0.94]; P<0.001), but with attenuation of the benefit at a higher BMI (trend test across BMI [Ptrend], 0.003). The overall treatment effects of NOACs versus warfarin for secondary outcomes were consistent across BMI, with the exception of the net clinical outcome and death. While these outcomes were overall reduced with NOACs (net clinical outcome, HRadj, 0.91 [95% CI, 0.87-0.95]; P<0.001; death, HRadj, 0.91 [95% CI, 0.86-0.97]; P=0.003), these benefits were attenuated at higher BMI (Ptrend, 0.001 and 0.08, respectively). All findings were qualitatively similar when analyzed across BW. CONCLUSIONS The treatment effect of NOACs versus warfarin in atrial fibrillation is generally consistent for stroke/SEE across the spectrum of BMI and BW, whereas the reduction in major bleeding is attenuated in those with higher BMI or BW. Death and the net clinical outcome are overall reduced with NOACs over warfarin, although there remain uncertainties for these outcomes at a very high BMI and BW.
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Affiliation(s)
- Siddharth M Patel
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.)
| | - Eugene Braunwald
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.)
| | - Jan Steffel
- Hirslanden Clinic, Zurich, Switzerland and University of Zurich, Switzerland (J.S.)
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Italy (G.B.)
| | - Michael G Palazzolo
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.)
| | - Elliott M Antman
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.)
| | - Erin A Bohula
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.)
| | - Anthony P Carnicelli
- Cardiology Division, Department of Internal Medicine, Medical University of South Carolina, Charleston (A.P.C.)
| | - Stuart J Connolly
- Department of Medicine, McMaster University, Hamilton, Canada (S.J.C., J.W.E.)
| | - John W Eikelboom
- Department of Medicine, McMaster University, Hamilton, Canada (S.J.C., J.W.E.)
| | - Baris Gencer
- Division of Cardiology, Geneva University Hospitals, Switzerland (B.G.)
- University of Bern Institute of Primary Health Care (BIHAM), Switzerland (B.G.)
| | - Christopher B Granger
- Duke Clinical Research Institute, Division of Cardiology, Duke University, Durham, NC (C.B.G., M.R.P.)
| | - David A Morrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.)
| | - Manesh R Patel
- Duke Clinical Research Institute, Division of Cardiology, Duke University, Durham, NC (C.B.G., M.R.P.)
| | - Lars Wallentin
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Sweden (L.W.)
| | - Christian T Ruff
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.)
| | - Robert P Giugliano
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.P., E.B., M.G.P., E.M.A., E.A.B., D.A.M., C.T.R., R.P.G.)
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9
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Dundas J, Leipsic J, Fairbairn T, Ng N, Sussman V, Guez I, Rosenblatt R, Hurwitz Koweek LM, Douglas PS, Rabbat M, Pontone G, Chinnaiyan K, de Bruyne B, Bax JJ, Amano T, Nieman K, Rogers C, Kitabata H, Sand NPR, Kawasaki T, Mullen S, Huey W, Matsuo H, Patel MR, Norgaard BL, Ahmadi A, Tzimas G. Interaction of AI-Enabled Quantitative Coronary Plaque Volumes on Coronary CT Angiography, FFR CT, and Clinical Outcomes: A Retrospective Analysis of the ADVANCE Registry. Circ Cardiovasc Imaging 2024; 17:e016143. [PMID: 38469689 DOI: 10.1161/circimaging.123.016143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/12/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND Luminal stenosis, computed tomography-derived fractional-flow reserve (FFRCT), and high-risk plaque features on coronary computed tomography angiography are all known to be associated with adverse clinical outcomes. The interactions between these variables, patient outcomes, and quantitative plaque volumes have not been previously described. METHODS Patients with coronary computed tomography angiography (n=4430) and one-year outcome data from the international ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) registry underwent artificial intelligence-enabled quantitative coronary plaque analysis. Optimal cutoffs for coronary total plaque volume and each plaque subtype were derived using receiver-operator characteristic curve analysis. The resulting plaque volumes were adjusted for age, sex, hypertension, smoking status, type 2 diabetes, hyperlipidemia, luminal stenosis, distal FFRCT, and translesional delta-FFRCT. Median plaque volumes and optimal cutoffs for these adjusted variables were compared with major adverse cardiac events, late revascularization, a composite of the two, and cardiovascular death and myocardial infarction. RESULTS At one year, 55 patients (1.2%) had experienced major adverse cardiac events, and 123 (2.8%) had undergone late revascularization (>90 days). Following adjustment for age, sex, risk factors, stenosis, and FFRCT, total plaque volume above the receiver-operator characteristic curve-derived optimal cutoff (total plaque volume >564 mm3) was associated with the major adverse cardiac event/late revascularization composite (adjusted hazard ratio, 1.515 [95% CI, 1.093-2.099]; P=0.0126), and both components. Total percent atheroma volume greater than the optimal cutoff was associated with both major adverse cardiac event/late revascularization (total percent atheroma volume >24.4%; hazard ratio, 2.046 [95% CI, 1.474-2.839]; P<0.0001) and cardiovascular death/myocardial infarction (total percent atheroma volume >37.17%, hazard ratio, 4.53 [95% CI, 1.943-10.576]; P=0.0005). Calcified, noncalcified, and low-attenuation percentage atheroma volumes above the optimal cutoff were associated with all adverse outcomes, although this relationship was not maintained for cardiovascular death/myocardial infarction in analyses stratified by median plaque volumes. CONCLUSIONS Analysis of the ADVANCE registry using artificial intelligence-enabled quantitative plaque analysis shows that total plaque volume is associated with one-year adverse clinical events, with incremental predictive value over luminal stenosis or abnormal physiology by FFRCT. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02499679.
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Affiliation(s)
- James Dundas
- Department of Cardiology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, United Kingdom (J.D.)
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
| | | | - Nicholas Ng
- HeartFlow Inc, Mountain View, CA (N.N., C.R., S.M., W.H.)
| | - Vida Sussman
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
| | - Ilana Guez
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
| | - Rachael Rosenblatt
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
| | - Lynne M Hurwitz Koweek
- Duke Clinical Research Institute, Duke University, Durham, NC (L.M.H.K., P.S.D., M.R.P.)
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University, Durham, NC (L.M.H.K., P.S.D., M.R.P.)
| | - Mark Rabbat
- Loyola University Medical Center, Maywood, IL (M.R.)
| | | | | | | | - Jeroen J Bax
- Leiden University Medical Centre, the Netherlands (J.J.B.)
| | | | - Koen Nieman
- Stanford University Medical Centre, CA (K.N.)
| | | | | | | | | | - Sarah Mullen
- HeartFlow Inc, Mountain View, CA (N.N., C.R., S.M., W.H.)
| | - Whitney Huey
- HeartFlow Inc, Mountain View, CA (N.N., C.R., S.M., W.H.)
| | | | - Manesh R Patel
- Duke Clinical Research Institute, Duke University, Durham, NC (L.M.H.K., P.S.D., M.R.P.)
| | | | | | - Georgios Tzimas
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.D., J.L., V.S., I.G., R.R., G.T.)
- Division of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland (G.T.)
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10
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Anand SS, Aboyans V, Bosch J, Debus S, Gay A, Patel MR, Vogtländer K, Welsh RC, Zeymer U, Fox KAA. Identifying the highest risk vascular patients: Insights from the XATOA registry. Am Heart J 2024; 269:191-200. [PMID: 38218425 DOI: 10.1016/j.ahj.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Patients with coronary and peripheral artery disease (PAD) have a residual risk of major adverse cardiovascular and limb events despite standards of care. Among patients with coronary artery disease (CAD) and/or PAD selected for low dose rivaroxaban (2.5 mg BID) and aspirin, we sought to determine the highest risk vascular patients. METHODS Xarelto pluc Acetylsalicylic acid: Treatment patterns and Outcomes in patients with Atherosclerosis (XATOA) is a single-arm registry of CAD and/or PAD patients. All participants were initiated on low dose rivaroxaban (2.5 mg BID) and aspirin. We report the incidence risk of major adverse cardiovascular events (MACE) or major adverse limb events (MALE) and major bleeding. A classification and regression tree analysis determined independent subgroups. RESULTS Between November 2018 and May 2020, 5,808 participants were enrolled in XATOA; 5,532 were included in the full analysis. The median follow-up (interquartile range) was 462 (371-577) days. The incidence risk per 100 patient-years of MACE or MALE was highest among participants with polyvascular disease (2 or more vascular beds affected, n = 2,889). The incidence risk was 9.16 versus 2.48 per 100 patient-years in polyvascular and nonpolyvascular patients respectively. Other subgroups of high-risk patients included participants 75 years or older, with a history of diabetes, heart failure, or chronic renal insufficiency (CRI). Rates of major bleeding were low overall. A classification and regression tree analysis showed that polyvascular disease was the most dominant factor separating higher from lower risk participants, and this was heightened with CRI or diabetes. CONCLUSION Patients with polyvascular disease represent a substantial subset of patients in clinical practice and should be prioritized to receive maximal medical therapy including low dose rivaroxaban (2.5 mg BID) and aspirin.
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Affiliation(s)
- Sonia S Anand
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and Inserm 1094/IRD270, Limoges University, Limoges, France
| | - Jackie Bosch
- Population Health Research Institute, Hamilton, Ontario, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Robert C Welsh
- Mazankowski Alberta Heart Insitute and University of Alberta, Edmonton, Alberta, Canada
| | - Uwe Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh United Kingdom
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11
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Rymer JA, Ng N, Takagi H, Koweek LM, Douglas PS, De Bruyne B, Norgaard BL, Patel MR, Leipsic JA, Daubert MA. Anatomic and Functional Discordance Among Patients With Nonobstructive Coronary Disease. JACC Cardiovasc Imaging 2024:S1936-878X(24)00037-8. [PMID: 38456878 DOI: 10.1016/j.jcmg.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 03/09/2024]
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12
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Hogan SE, Debus ES, Nehler MR, Patel MR, Anand SS, Muehlhofer E, Haskell LP, Berkowitz SD, Bauersachs RM, Bonaca MP. Unplanned Index Limb Revascularization With Rivaroxaban Versus Placebo in Patients With Critical Limb-Threatening Ischemia After Endovascular and Surgical Treatment: Insights From VOYAGER PAD. Circulation 2024; 149:635-637. [PMID: 38377256 DOI: 10.1161/circulationaha.123.065330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Shea E Hogan
- CPC Clinical Research, Aurora, CO (S.E.H., M.R.N., S.D.B., M.P.B.)
- Denver Health, CO (S.E.H.)
- Department of Medicine, University of Colorado, Aurora (S.E.H., S.D.B., M.P.B.)
| | | | - Mark R Nehler
- CPC Clinical Research, Aurora, CO (S.E.H., M.R.N., S.D.B., M.P.B.)
- Department of Surgery, University of Colorado, Aurora (M.R.N.)
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University, Durham, NC (M.R.P.)
| | - Sonia S Anand
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Canada (S.S.A.)
| | | | | | - Scott D Berkowitz
- CPC Clinical Research, Aurora, CO (S.E.H., M.R.N., S.D.B., M.P.B.)
- Department of Medicine, University of Colorado, Aurora (S.E.H., S.D.B., M.P.B.)
| | - Rupert M Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt, Germany (R.M.B.)
- Center for Thrombosis and Hemostasis, University of Mainz, Germany (R.M.B.)
| | - Marc P Bonaca
- Department of Medicine, University of Colorado, Aurora (S.E.H., S.D.B., M.P.B.)
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13
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Eikelboom JW, Mundl H, Alexander JH, Caso V, Connolly SJ, Coppolecchia R, Gebel M, Hart RG, Holberg G, Keller L, Patel MR, Piccini JP, Rao SV, Shoamanesh A, Tamm M, Viethen T, Yassen A, Bonaca MP. Bleeding Outcomes in Patients Treated With Asundexian in Phase II Trials. J Am Coll Cardiol 2024; 83:669-678. [PMID: 38325992 DOI: 10.1016/j.jacc.2023.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Phase II trials of asundexian were underpowered to detect important differences in bleeding. OBJECTIVES The goal of this study was to obtain best estimates of effects of asundexian vs active control/placebo on major and clinically relevant nonmajor (CRNM) and all bleeding, describe most common sites of bleeding, and explore association between asundexian exposure and bleeding. METHODS We performed a pooled analysis of 3 phase II trials of asundexian in patients with atrial fibrillation (AF), recent acute myocardial infarction (AMI), or stroke. Bleeding was defined according to the International Society on Thrombosis and Hemostasis (ISTH) criteria. RESULTS In patients with AF (n = 755), both asundexian 20 mg and 50 mg once daily vs apixaban had fewer major/CRNM events (3 of 249; incidence rate [IR] per 100 patient-years 5.47 vs 1 of 254 [IR: not calculable] vs 6 of 250 [IR: 11.10]) and all bleeding (12 of 249 [IR: 22.26] vs 10 of 254 [IR: 18.21] vs 26 of 250 [IR: 50.56]). In patients with recent AMI or stroke (n = 3,409), asundexian 10 mg, 20 mg, and 50 mg once daily compared with placebo had similar rates of major/CRNM events (44 of 840 [IR: 7.55] vs 42 of 843 [IR: 7.04] vs 56 of 845 [IR: 9.63] vs 41 of 851 [IR: 6.99]) and all bleeding (107 of 840 [IR: 19.57] vs 123 of 843 [IR: 22.45] vs 130 of 845 [IR: 24.19] vs 129 of 851 [IR: 23.84]). Most common sites of major/CRNM bleeding with asundexian were gastrointestinal, respiratory, urogenital, and skin. There was no significant association between asundexian exposure and major/CRNM bleeding. CONCLUSIONS Analyses of phase II trials involving >500 bleeds highlight the potential for improved safety of asundexian compared with apixaban and similar safety compared with placebo. Further evidence on the efficacy of asundexian awaits the results of ongoing phase III trials.
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Affiliation(s)
- John W Eikelboom
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | | | - John H Alexander
- Duke Clinical Research Institute and Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Valeria Caso
- Santa Maria della Misericordia Hospital, University of Perugia Stroke Unit, Perugia, Italy
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Robert G Hart
- Population Health Research Institute, Hamilton, Ontario, Canada
| | | | | | - Manesh R Patel
- Duke Clinical Research Institute and Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Jonathan P Piccini
- Duke Clinical Research Institute and Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Sunil V Rao
- New York University Langone Health System, New York, New York, USA
| | - Ashkan Shoamanesh
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Marc P Bonaca
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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14
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Farber A, Menard MT, Bonaca MP, Bradbury A, Conte MS, Debus ES, Eldrup N, Goodney P, Gupta PC, Hinchliffe RJ, Houlind KC, Kolh P, Kum SWC, Nordanstig J, Parikh SA, Patel MR, Patrone L, Sillesen H, Strong MB, Varcoe RL, Vega de Ceniga M, Venermo MA, Rosenfield K. BEST-CLI International Collaborative: planning a better future for patients with chronic limb-threatening ischaemia globally. Br J Surg 2024; 111:znad413. [PMID: 38294083 PMCID: PMC10828928 DOI: 10.1093/bjs/znad413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc P Bonaca
- Division of Cardiovascular Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Andrew Bradbury
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, SanFrancisco, California, USA
| | - E Sebastian Debus
- Department for Vascular Medicine, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Philip Goodney
- Heart and Vascular Center, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Prem C Gupta
- Department of Vascular and Endovascular Surgery, Care Hospital, Banjara Hills, Hyderabad, India
| | | | - Kim C Houlind
- Department of Vascular Surgery, Kolding Hospital, Kolding, Denmark
- University of Southern Denmark, Kolding, Denmark
| | - Philippe Kolh
- Department of Biomedical and Preclinical Sciences, University of Liège, Liège, Belgium
- GIGA Cardiovascular Sciences, University of Liège, Liège, Belgium
| | | | - Joakim Nordanstig
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Manesh R Patel
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Lorenzo Patrone
- West London Vascular and Interventional Centre, London North West University NHS Trust, London, UK
| | | | - Michael B Strong
- Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital and Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Melina Vega de Ceniga
- Department of Angiology and Vascular Surgery, Hospital Universitario de Galdako-Usansolo, Galdakao, Spain
- University of the Basque Country (UPV/EHU), Leioa, Spain
- Research Institute BioBizkaia, Barakaldo, Spain
| | - Maarit A Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kenneth Rosenfield
- Section of Vascular Medicine and Intervention Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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15
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Norgren L, Weiss N, Nikol S, Lantis JC, Patel MR, Hinchliffe RJ, Reinecke H, Volk HD, Reinke P, Fadini GP, Ofir R, Rothenstein D, Halevy N, Karagjozov M, Rundback JH. PACE: randomized, controlled, multicentre, multinational, phase III study of PLX-PAD for critical limb ischaemia in patients unsuitable for revascularization: randomized clinical trial. Br J Surg 2024; 111:znad437. [PMID: 38294084 PMCID: PMC10828925 DOI: 10.1093/bjs/znad437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Revascularization is the primary treatment modality for chronic limb-threatening ischaemia (CLTI), but is not feasible in all patients. PLX-PAD is an off-the-shelf, placental-derived, mesenchymal stromal cell-like cell therapy. This study aimed to evaluate whether PLX-PAD would increase amputation-free survival in people with CLTI who were not candidates for revascularization. METHODS People with CLTI and minor tissue loss (Rutherford 5) who were unsuitable for revascularization were entered into a randomized, parallel-group, placebo-controlled, multinational, blinded, trial, in which PLX-PAD was compared with placebo (2 : 1 randomization), with 30 intramuscular injections (0.5 ml each) into the index leg on days 0 and 60. Planned follow-up was 12-36 months, and included vital status, amputations, lesion size, pain and quality-of-life assessments, haemodynamic parameters, and adverse events. RESULTS Of 213 patients enrolled, 143 were randomized to PLX-PAD and 70 to placebo. Demographics and baseline characteristics were balanced. Most patients were Caucasian (96.2%), male (76.1%), and ambulatory (85.9%). Most patients (76.6%) reported at least one adverse event, which were mostly expected events in CLTI, such as skin ulcer or gangrene. The probability of major amputation or death was similar for placebo and PLX-PAD (33 and 28.6% respectively; HR 0.93, 95% c.i. 0.53 to 1.63; P = 0.788). Revascularization and complete wound healing rates were similar in the two groups. A post hoc analysis of a subpopulation of 121 patients with a baseline haemoglobin A1c level below 6.5% showed improved 12-month amputation-free survival (HR 0.46, 0.21 to 0.99; P = 0.048). CONCLUSION Although there was no evidence that PLX-PAD reduced amputation-free survival in the entire study population, benefit was observed in patients without diabetes mellitus or whose diabetes was well controlled; this requires confirmation in further studies. Trial registration: NCT03006770 (http://www.clinicaltrials.gov); 2015-005532-18 (EudraCT Clinical Trials register - Search for 2015-005532-18).
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Affiliation(s)
- Lars Norgren
- Department of Surgery, Örebro University and University Hospital, Örebro, Sweden
| | - Norbert Weiss
- University Centre for Vascular Medicine and Department of Medicine—Section Angiology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Sigrid Nikol
- Department of Clinical and Interventional Angiology, Asklepios Klinik St Georg, Hamburg, Germany
| | - John C Lantis
- Department of Surgery, Mt Sinai West Hospital, Icahn School of Medicine, New York, New York, USA
| | - Manesh R Patel
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Holger Reinecke
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
| | - Hans Dieter Volk
- Berlin Centre for Advanced Therapies (BeCAT) and Institute of Medical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Reinke
- Berlin Centre for Advanced Therapies (BeCAT) and Institute of Medical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Gian Paolo Fadini
- Department of Medicine, University of Padova, Padua, Italy and Veneto Institute of Molecular Medicine, Padua, Italy
| | | | | | | | - Mitko Karagjozov
- Department of Thoracic Vascular Surgery, Acibadem Sistina, Skopje, Macedonia
| | - John H Rundback
- Vascular and Interventional Radiology, Holy Name Medical Centre, Teaneck, New Jersey, USA
- Advanced Interventional and Vascular Services (AIVS), Teaneck, New Jersey, USA
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16
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Scierka LE, Peri-Okonny PA, Romain G, Cleman J, Spertus JA, Fitridge R, Secemsky E, Patel MR, Gosch KL, Mena-Hurtado C, Smolderen KG. Psychosocial and socioeconomic factors are most predictive of health status in patients with claudication. J Vasc Surg 2024:S0741-5214(24)00081-8. [PMID: 38266885 DOI: 10.1016/j.jvs.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND As a key treatment goal for patients with symptomatic peripheral artery disease (PAD), improving health status has also become an important end point for clinical trials and performance-based care. An understanding of patient factors associated with 1-year PAD health status is lacking in patients with PAD. METHODS The health status of 1073 consecutive patients with symptomatic PAD in the international multicenter PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry was measured at baseline and 1 year with the Peripheral Artery Questionnaire (PAQ). The association of 47 patient characteristics with 1-year PAQ scores was assessed using a random forest algorithm. Variables of clinical significance were retained and included in a hierarchical multivariable linear regression model predicting 1-year PAQ summary scores. RESULTS The mean age of patients was 67.7 ± 9.3 years, and 37% were female. Variables with the highest importance ranking in predicting 1-year PAQ summary score were baseline PAQ summary score, Patient Health Questionnaire-8 depression score, Generalized Anxiety Disorder-2 anxiety score, new onset symptom presentation, insurance status, current or prior diagnosis of depression, low social support, initial invasive treatment, duration of symptoms, and race. The addition of 19 clinical variables in an extended model marginally improved the explained variance in 1-year health status (from R2 0.312 to 0.335). CONCLUSIONS Patients' 1-year PAD-specific health status, as measured by the PAQ, can be predicted from 10 mostly psychosocial and socioeconomic patient characteristics including depression, anxiety, insurance status, social support, and symptoms. These characteristics should be validated and tested in other PAD cohorts so that this model can inform risk adjustment and prediction of PAD health status in comparative effectiveness research and performance-based care.
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Affiliation(s)
- Lindsey E Scierka
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT
| | - Poghni A Peri-Okonny
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT
| | - Gaelle Romain
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT
| | - Jacob Cleman
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO; Departments of Biomedical and Health Informatics and Internal Medicine, Section of Cardiovascular Disease, University of Missouri-Kansas City, Kansas City, MO
| | - Robert Fitridge
- Vascular Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Eric Secemsky
- Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT
| | - Kim G Smolderen
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT; Department of Psychiatry, Section of Psychology, Yale University, New Haven, CT.
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17
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Fudim M, Litwin SE, Borlaug BA, Mohan RC, Price MJ, Fail P, Zirakashvili T, Shaburishvili T, Goyal P, Hummel SL, Patel RB, Reddy VY, Burkhoff D, Patel MR, Somo SI, Shah SJ. Endovascular Ablation of the Right Greater Splanchnic Nerve in Heart Failure With Preserved Ejection Fraction: Rationale, Design and Lead-in Phase Results of the REBALANCE-HF Trial. J Card Fail 2024:S1071-9164(24)00002-2. [PMID: 38211934 DOI: 10.1016/j.cardfail.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Splanchnic vasoconstriction augments transfer of blood volume from the abdomen into the thorax, which may increase filling pressures and hemodynamic congestion in patients with noncompliant hearts. Therapeutic interruption of splanchnic nerve activity holds promise to reduce hemodynamic congestion in patients with heart failure with preserved ejection fraction (HFpEF). Here we describe (1) the rationale and design of the first sham-controlled, randomized clinical trial of splanchnic nerve ablation for HFpEF and (2) the 12-month results of the lead-in (open-label) trial's participants. METHODS REBALANCE-HF is a prospective, multicenter, randomized, double-blinded, sham-controlled clinical trial of endovascular, transcatheter, right-sided greater splanchnic nerve ablation for volume management (SAVM) in patients with HFpEF. The primary objectives are to evaluate the safety and efficacy of SAVM and identify responder characteristics to inform future studies. The trial consists of an open-label lead-in phase followed by the randomized, sham-controlled phase. The primary efficacy endpoint is the reduction in pulmonary capillary wedge pressure (PCWP) at 1-month follow-up compared to baseline during passive leg raise and 20W exercise. Secondary and exploratory endpoints include health status (Kansas City Cardiomyopathy Questionnaire), 6-minute walk test distance, New York Heart Association class, and NTproBNP levels at 3, 6 and 12 months. The primary safety endpoint is device- or procedure-related serious adverse events at the 1-month follow-up. RESULTS The lead-in phase of the study, which enrolled 26 patients with HFpEF who underwent SAVM, demonstrated favorable safety outcomes and reduction in exercise PCWP at 1 month post-procedure and improvements in all secondary endpoints at 6 and 12 months of follow-up. The randomized phase of the trial (n = 44 SAVM; n = 46 sham) has completed enrollment, and follow-up is ongoing. CONCLUSION REBALANCE-HF is the first sham-controlled randomized clinical trial of greater splanchnic nerve ablation in HFpEF. Initial 12-month open-label results are promising, and the results of the randomized portion of the trial will inform the design of a future pivotal clinical trial. SAVM may offer a promising therapeutic option for patients with HFpEF. TRIAL REGISTRATION NCT04592445.
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Affiliation(s)
- Marat Fudim
- Department of Medicine, Division of Cardiology, Duke University Medical Center Durham, NC, USA; Duke Clinical Research Institute, Division of Cardiology, Durham, NC, USA; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | | | | | | | - Peter Fail
- Cardiovascular Institute of the South, Houma, LA, USA
| | | | | | | | - Scott L Hummel
- University of Michigan and VA, Ann Arbor, Ann Arbor, MI, USA
| | - Ravi B Patel
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vivek Y Reddy
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Manesh R Patel
- Department of Medicine, Division of Cardiology, Duke University Medical Center Durham, NC, USA; Duke Clinical Research Institute, Division of Cardiology, Durham, NC, USA
| | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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18
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Petek BJ, Churchill TW, Moulson N, Kliethermes SA, Baggish AL, Drezner JA, Patel MR, Ackerman MJ, Kucera KL, Siebert DM, Salerno L, Suchsland MZ, Asif IM, Maleszewski JJ, Harmon KG. Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study. Circulation 2024; 149:80-90. [PMID: 37955565 PMCID: PMC10843024 DOI: 10.1161/circulationaha.123.065908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/24/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Understanding the incidence, causes, and trends of sudden cardiac death (SCD) among young competitive athletes is critical to inform preventive policies. METHODS This study included National Collegiate Athletic Association athlete deaths during a 20-year time frame (July 1, 2002, through June 30, 2022). Athlete deaths were identified through 4 separate independent databases and search strategies (National Collegiate Athletic Association resolutions list, Parent Heart Watch database and media reports, National Center for Catastrophic Sports Injury Research database, and insurance claims). Autopsy reports and medical history were reviewed by an expert panel to adjudicate causes of SCD. RESULTS A total of 143 SCD cases in National Collegiate Athletic Association athletes were identified from 1102 total deaths. The National Collegiate Athletic Association resolutions list identified 117 of 143 (82%), the Parent Heart Watch database or media reports identified 89 of 143 (62%), the National Center for Catastrophic Sports Injury Research database identified 63 of 143 (44%), and insurance claims identified 27 of 143 (19%) SCD cases. The overall incidence of SCD was 1:63 682 athlete-years (95% CI, 1:54 065-1:75 010). Incidence was higher in male athletes than in female athletes (1:43 348 [95% CI, 1:36 228-1:51 867] versus 1:164 504 [95% CI, 1:110 552-1:244 787] athlete-years, respectively) and Black athletes compared with White athletes (1:26 704 [1:20 417-1:34 925] versus 1:74 581 [1:60 247-1:92 326] athlete-years, respectively). The highest incidence of SCD was among Division I male basketball players (1:8188 [White, 1:5848; Black, 1:7696 athlete-years]). The incidence rate for SCD decreased over the study period (5-year incidence rate ratio, 0.71 [95% CI, 0.61-0.82]), whereas the rate of noncardiovascular deaths remained stable (5-year incidence rate ratio, 0.98 [95% CI, 0.94-1.04]). Autopsy-negative sudden unexplained death (19.5%) was the most common postmortem examination finding, followed by idiopathic left ventricular hypertrophy or possible cardiomyopathy (16.9%) and hypertrophic cardiomyopathy (12.7%), in cases with enough information for adjudication (118 of 143). Eight cases of death were attributable to myocarditis over the study period (1 case from January 1, 2020, through June 30, 2022), with none attributed to COVID-19 infection. SCD events were exertional in 50% of cases. Exertional SCD was more common among those with coronary artery anomalies (100%) and arrhythmogenic cardiomyopathy (83%). CONCLUSIONS The incidence of SCD in college athletes has decreased. Male sex, Black race, and basketball are associated with a higher incidence of SCD.
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Affiliation(s)
- Bradley J. Petek
- Sports Cardiology Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
| | - Timothy W. Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
| | - Nathaniel Moulson
- Division of Cardiology and Sports Cardiology BC, University of British Columbia, Vancouver, BC, Canada
| | | | - Aaron L. Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
- Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lusanne, Switzerland
- Institute for Sport Science, University of Lausanne (ISSUL), Lusanne, Switzerland
| | - Jonathan A. Drezner
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - Manesh R. Patel
- Division of Cardiology, Duke Heart Center, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Michael J. Ackerman
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, MN
- Department of Cardiovascular Medicine (Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic), Mayo Clinic, Rochester, MN
- Department of Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), Mayo Clinic
| | - Kristen L. Kucera
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David M. Siebert
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - Lauren Salerno
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - Monica Zigman Suchsland
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - Irfan M. Asif
- Family and Community Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | | | - Kimberly G. Harmon
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
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Matsumura M, Maehara A, Davis JE, Kumar G, Sharp A, Samady H, Seto AH, Cohen D, Patel MR, Ali ZA, Stone GW, Jeremias A. Changes in post-PCI physiology based on anatomical vessel location: a DEFINE PCI substudy. EUROINTERVENTION 2023; 19:e903-e912. [PMID: 38031488 PMCID: PMC10719742 DOI: 10.4244/eij-d-23-00517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/24/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anatomical vessel location affects post-percutaneous coronary intervention (PCI) physiology. AIMS We aimed to compare the post-PCI instantaneous wave-free ratio (iFR) in left anterior descending (LAD) versus non-LAD vessels and to identify the factors associated with a suboptimal post-PCI iFR. METHODS DEFINE PCI was a multicentre, prospective, observational study in which a blinded post-PCI iFR pullback was used to assess residual ischaemia following angiographically successful PCI. RESULTS Pre- and post-PCI iFR recordings of 311 LAD and 195 non-LAD vessels were compared. Though pre-PCI iFR in the LAD vessels (median 0.82 [0.63, 0.86]) were higher compared with those in non-LAD vessels (median 0.72 [0.49, 0.84]; p<0.0001), post-PCI iFR were lower in the LAD vessels (median 0.92 [0.88, 0.94] vs 0.98 [0.95, 1.00]; p<0.0001). The prevalence of a suboptimal post-PCI iFR of <0.95 was higher in the LAD vessels (77.8% vs 22.6%; p<0.0001). While the overall frequency of residual physiological diffuse disease (31.4% vs 38.6%; p=0.26) and residual focal disease in the non-stented segment (49.6% vs 50.0%; p=0.99) were similar in both groups, residual focal disease within the stented segment was more common in LAD versus non-LAD vessels (53.7% vs 27.3%; p=0.0009). Improvement in iFR from pre- to post-PCI was associated with angina relief regardless of vessel location. CONCLUSIONS After angiographically successful PCI, post-PCI iFR is lower in the LAD compared with non-LAD vessels, resulting in a higher prevalence of suboptimal post-PCI iFR in LAD vessels. This difference is, in part, due to a greater frequency of a residual focal pressure gradient within the stented segment which may be amenable to more aggressive PCI.
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Affiliation(s)
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Justin E Davis
- Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
| | | | - Andrew Sharp
- Royal Devon & Exeter NHS Foundation Trust, Exeter, United Kingdom
| | | | | | - David Cohen
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
| | | | - Ziad A Ali
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allen Jeremias
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
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20
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Rymer J, Anand SS, Sebastian Debus E, Haskell LP, Hess CN, Jones WS, Muehlhofer E, Berkowitz SD, Bauersachs RM, Bonaca MP, Patel MR. Rivaroxaban Plus Aspirin Versus Aspirin Alone After Endovascular Revascularization for Symptomatic PAD: Insights From VOYAGER PAD. Circulation 2023; 148:1919-1928. [PMID: 37850397 DOI: 10.1161/circulationaha.122.063806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 09/25/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Rivaroxaban plus aspirin compared with aspirin alone reduced major cardiac and ischemic limb events after lower extremity revascularization (LER) in the VOYAGER PAD (Vascular Outcomes Study of ASA Along With Rivaroxaban in Endovascular or Surgical Limb Revascularization for Peripheral Artery Disease) trial. The effect has not been described in patients undergoing endovascular LER. METHODS The VOYAGER PAD trial randomized 6564 patients with symptomatic peripheral artery disease to a double-blinded treatment with 2.5 mg of rivaroxaban BID or matching placebo and 100 mg of aspirin daily. The primary efficacy outcome was a composite of acute limb ischemia, major amputation of a vascular pathogenesis, myocardial infarction, ischemic stroke, or cardiovascular death. The principal safety end point was Thrombolysis in Myocardial Infarction major bleeding. A prespecified subgroup of patients who underwent endovascular revascularization was included. RESULTS Endovascular LER occurred in 4379 (66.7%) patients and surgical LER in 2185 (33.3%). Over a 3-year follow-up, rivaroxaban reduced the risk of the primary outcome by 15% (hazard ratio [HR], 0.85 [95% CI, 0.76-0.96]) with an absolute risk reduction of 0.92% at 6 months and 1.04% at 3 years and a consistent benefit in those receiving endovascular (HR, 0.89 [95% CI, 0.76-1.03]) or surgical LER (HR, 0.81 [95% CI, 0.67-0.98]; P interaction=0.43). For endovascular-treated patients, rivaroxaban reduced the risk of acute limb ischemia or major amputation of a vascular pathogenesis by 30% (HR, 0.70 [95% CI, 0.54-0.90]; P=0.005) with an absolute risk reduction of 1.0% at 6 months and 2.0% at 3 years compared with aspirin alone. Among endovascular-treated patients, the median duration of concomitant dual antiplatelet therapy with clopidogrel treatment was 31 days (interquartile range, 30-58). There was a consistent benefit for rivaroxaban regardless of background clopidogrel. Thrombolysis in Myocardial Infarction major bleeding was significantly higher for the rivaroxaban and aspirin group for the endovascular cohort (HR, 1.66 [95% CI, 1.06-2.59]) with an absolute risk increase of 0.9% at 3 years with no increase in intracranial or fatal bleeding observed (HR, 0.86 [95% CI, 0.40-1.87]; P=0.71). Mortality with rivaroxaban was higher in the endovascular-treated patients (HR, 1.24 [95% CI, 1.02-1.52]), although this finding was isolated to specific regions. CONCLUSIONS Rivaroxaban added to aspirin or dual antiplatelet therapy after LER for peripheral artery disease reduces ischemic risk and increases major bleeding without an increased risk of intracranial or fatal bleeding. These benefits are consistent in those treated with endovascular and surgical approaches with significant benefits for major adverse limb events. These data support the use of rivaroxaban in addition to aspirin or dual antiplatelet therapy after endovascular intervention for symptomatic peripheral artery disease.
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Affiliation(s)
- Jennifer Rymer
- Duke Clinical Research Institute, Division of Cardiology, Duke University, Durham, NC (J.R., W.S.J., M.R.P.)
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Canada (S.S.A.)
| | - E Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery-Angiology-Endovascular Therapy, University Heart & Vascular Center, University of Hamburg-Eppendorf, Hamburg, Germany (E.S.D., S.D.B., M.P.B.)
| | | | - Connie N Hess
- Colorado Prevention Center Clinical Research, Aurora (C.N.H.)
- Division of Cardiology (C.N.H.), Department of Medicine, University of Colorado School of Medicine, Aurora
| | - W Schuyler Jones
- Duke Clinical Research Institute, Division of Cardiology, Duke University, Durham, NC (J.R., W.S.J., M.R.P.)
| | - Eva Muehlhofer
- Bayer AG, Research & Development, Wuppertal, Germany (E.M.)
| | - Scott D Berkowitz
- Department of Vascular Medicine, Vascular Surgery-Angiology-Endovascular Therapy, University Heart & Vascular Center, University of Hamburg-Eppendorf, Hamburg, Germany (E.S.D., S.D.B., M.P.B.)
- Divisions of Cardiology and Hematology (S.D.B.), Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Rupert M Bauersachs
- CCB-Cardioangiologic Center Bethanien, Frankfurt and Center of Thrombosis and Hemostasis, University of Mainz, Germany (R.M.B.)
| | - Marc P Bonaca
- Department of Vascular Medicine, Vascular Surgery-Angiology-Endovascular Therapy, University Heart & Vascular Center, University of Hamburg-Eppendorf, Hamburg, Germany (E.S.D., S.D.B., M.P.B.)
| | - Manesh R Patel
- Duke Clinical Research Institute, Division of Cardiology, Duke University, Durham, NC (J.R., W.S.J., M.R.P.)
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21
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Klein CF, Petek BJ, Moulson N, Baggish AL, Churchill TW, Harmon KG, Kliethermes SA, Patel MR, Drezner JA. Non-COVID-19 cardiovascular pathology from return-to-play screening in college athletes after COVID-19. Heart 2023; 109:1851-1857. [PMID: 37460194 PMCID: PMC10792102 DOI: 10.1136/heartjnl-2023-322645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE Concerns for cardiac involvement after SARS-CoV-2 infection led to widespread cardiac testing in athletes. We examined incidental non-COVID-19 cardiovascular pathology in college athletes undergoing postinfection return-to-play screening. METHODS The Outcomes Registry for Cardiac Conditions in Athletes was a nationwide prospective multicentre observational cohort study that captured testing and outcomes data from 45 institutions (September 2020-June 2021). Athletes with an ECG and transthoracic echocardiogram (TTE) and no pre-existing conditions were included. Findings were defined as major (associated with sudden cardiac death or requiring intervention), minor (warrants surveillance), incidental (no follow-up needed) or uncertain significance (abnormal with subsequent normal testing). RESULTS Athletes with both ECG and TTE (n=2900, mean age 20±1, 32% female, 27% black) were included. 35 (1.2%) had ECG abnormalities. Of these, 2 (5.7%) had TTE abnormalities indicating cardiomyopathy (hypertrophic-1, dilated-1), and 1 with normal TTE had atrial fibrillation. Of 2865 (98.8%) athletes with a normal ECG, 54 (1.9%) had TTE abnormalities: 3 (5.6%) with aortic root dilatation ≥40 mm, 15 (27.8%) with minor abnormalities, 25 (46.3%) with incidental findings and 11 (20.4%) with findings of uncertain significance. Overall, 6 (0.2%) athletes had major conditions; however, coronary anatomy and aortic dimensions were inconsistently reported and pathology may have been missed. CONCLUSION Major non-COVID-19 cardiovascular pathology was identified in 1/500 college athletes undergoing return-to-play screening. In athletes without ECG abnormalities, TTE's added value was limited to pathological aortic root dilatation in 1/1000 athletes and minor abnormalities warranting surveillance in 1/160 athletes. Two-thirds of findings were incidental or of uncertain significance.
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Affiliation(s)
- Christian F Klein
- Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Bradley J Petek
- Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathaniel Moulson
- Centre for Cardiovascular Innovation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron L Baggish
- Cardiovascular Performance Program, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
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22
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Sullivan AE, Holder TA, Beckman JA, Green CL, Patel MR, Fortin TA, Jones WS. Utility of electrocardiographic findings in acute pulmonary embolism. Eur Heart J Open 2023; 3:oead121. [PMID: 38105922 PMCID: PMC10724117 DOI: 10.1093/ehjopen/oead121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Alexander E Sullivan
- Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave S, Suite 5468A, Nashville, TN 37232, USA
| | - Tara A Holder
- Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave S, Suite 5468A, Nashville, TN 37232, USA
- Department of Medicine, Division of Cardiology, Prisma Health, Greenville, SC 29605, USA
| | - Joshua A Beckman
- Division of Vascular Medicine, Department of Medicine, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Cynthia L Green
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27701, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27701, USA
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27701, USA
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Terry A Fortin
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - W Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27701, USA
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
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23
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Gulsin GS, Tzimas G, Holmes KR, Takagi H, Sellers SL, Blanke P, Koweek LMH, Nørgaard BL, Jensen J, Rabbat MG, Pontone G, Fairbairn TA, Chinnaiyan KM, Douglas PS, Huey W, Matsuo H, Sand NPR, Nieman K, Bax JJ, Amano T, Kawasaki T, Akasaka T, Rogers C, Berman DS, Patel MR, De Bruyne B, Mullen S, Leipsic JA. Impact of Coronary CT Angiography-derived Fractional Flow Reserve on Downstream Management and Clinical Outcomes in Individuals with and without Diabetes. Radiol Cardiothorac Imaging 2023; 5:e220276. [PMID: 37908552 PMCID: PMC10613926 DOI: 10.1148/ryct.220276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 06/21/2023] [Accepted: 09/01/2023] [Indexed: 11/02/2023]
Abstract
Purpose To compare the clinical use of coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) in individuals with and without diabetes mellitus (DM). Materials and Methods This secondary analysis included participants (enrolled July 2015 to October 2017) from the prospective, multicenter, international The Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care (ADVANCE) registry (ClinicalTrials.gov identifier, NCT02499679) who were evaluated for suspected coronary artery disease (CAD), with one or more coronary stenosis ≥30% on CCTA images, using CT-FFR. CCTA and CT-FFR findings, treatment strategies at 90 days, and clinical outcomes at 1-year follow-up were compared in participants with and without DM. Results The study included 4290 participants (mean age, 66 years ± 10 [SD]; 66% male participants; 22% participants with DM). Participants with DM had more obstructive CAD (one or more coronary stenosis ≥50%; 78.8% vs 70.6%, P < .001), multivessel CAD (three-vessel obstructive CAD; 18.9% vs 11.2%, P < .001), and proportionally more vessels with CT-FFR ≤ 0.8 (74.3% vs 64.6%, P < .001). Treatment reclassification by CT-FFR occurred in two-thirds of participants which was consistent regardless of the presence of DM. There was a similar graded increase in coronary revascularization with declining CT-FFR in both groups. At 1 year, presence of DM was associated with higher rates of major adverse cardiovascular events (hazard ratio, 2.2; 95% CI: 1.2, 4.1; P = .01). However, no between group differences were observed when stratified by stenosis severity (<50% or ≥50%) or CT-FFR positivity. Conclusion Both anatomic CCTA findings and CT-FFR demonstrated a more complex pattern of CAD in participants with versus without DM. Rates of treatment reclassification were similar regardless of the presence of DM, and DM was not an adverse prognostic indicator when adjusted for diameter stenosis and CT-FFR.Clinical trial registration no. NCT 02499679Keywords: Fractional Flow Reserve, CT Angiography, Diabetes Mellitus, Coronary Artery Disease Supplemental material is available for this article. See also the commentary by Ghoshhajra in this issue.© RSNA, 2023.
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Affiliation(s)
- Gaurav S. Gulsin
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Georgios Tzimas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Kenneth-Royce Holmes
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Hidenobu Takagi
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Stephanie L. Sellers
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Philipp Blanke
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Lynne M. H. Koweek
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Bjarne L. Nørgaard
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jesper Jensen
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Mark G. Rabbat
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Gianluca Pontone
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Timothy A. Fairbairn
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Kavitha M. Chinnaiyan
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Pamela S. Douglas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Whitney Huey
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Hitoshi Matsuo
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Niels P. R. Sand
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Koen Nieman
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jeroen J. Bax
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Tetsuya Amano
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Tomohiro Kawasaki
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Takashi Akasaka
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Campbell Rogers
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Daniel S. Berman
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Manesh R. Patel
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Bernard De Bruyne
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Sarah Mullen
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jonathon A. Leipsic
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
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24
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Udelson JE, Kelsey MD, Nanna MG, Fordyce CB, Yow E, Clare RM, Mark DB, Patel MR, Rogers C, Curzen N, Pontone G, Maurovich-Horvat P, De Bruyne B, Greenwood JP, Marinescu V, Leipsic J, Stone GW, Ben-Yehuda O, Berry C, Hogan SE, Redfors B, Ali ZA, Byrne RA, Kramer CM, Yeh RW, Martinez B, Mullen S, Huey W, Anstrom KJ, Al-Khalidi HR, Chiswell K, Vemulapalli S, Douglas PS. Deferred Testing in Stable Outpatients With Suspected Coronary Artery Disease: A Prespecified Secondary Analysis of the PRECISE Randomized Clinical Trial. JAMA Cardiol 2023; 8:915-924. [PMID: 37610768 PMCID: PMC10448368 DOI: 10.1001/jamacardio.2023.2614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/26/2023] [Indexed: 08/24/2023]
Abstract
Importance Guidelines recommend deferral of testing for symptomatic people with suspected coronary artery disease (CAD) and low pretest probability. To our knowledge, no randomized trial has prospectively evaluated such a strategy. Objective To assess process of care and health outcomes in people identified as minimal risk for CAD when testing is deferred. Design, Setting, and Participants This randomized, pragmatic effectiveness trial included prespecified subgroup analysis of the PRECISE trial at 65 North American and European sites. Participants identified as minimal risk by the validated PROMISE minimal risk score (PMRS) were included. Intervention Randomization to a precision strategy using the PMRS to assign those with minimal risk to deferred testing and others to coronary computed tomography angiography with selective computed tomography-derived fractional flow reserve, or to usual testing (stress testing or catheterization with PMRS masked). Randomization was stratified by PMRS risk. Main Outcome Composite of all-cause death, nonfatal myocardial infarction (MI), or catheterization without obstructive CAD through 12 months. Results Among 2103 participants, 422 were identified as minimal risk (20%) and randomized to deferred testing (n = 214) or usual testing (n = 208). Mean age (SD) was 46 (8.6) years; 304 were women (72%). During follow-up, 138 of those randomized to deferred testing never had testing (64%), whereas 76 had a downstream test (36%) (at median [IQR] 48 [15-78] days) for worsening (30%), uncontrolled (10%), or new symptoms (6%), or changing clinician preference (19%) or participant preference (10%). Results were normal for 96% of these tests. The primary end point occurred in 2 deferred testing (0.9%) and 13 usual testing participants (6.3%) (hazard ratio, 0.15; 95% CI, 0.03-0.66; P = .01). No death or MI was observed in the deferred testing participants, while 1 noncardiovascular death and 1 MI occurred in the usual testing group. Two participants (0.9%) had catheterizations without obstructive CAD in the deferred testing group and 12 (5.8%) with usual testing (P = .02). At baseline, 70% of participants had frequent angina and there was similar reduction of frequent angina to less than 20% at 12 months in both groups. Conclusion and Relevance In symptomatic participants with suspected CAD, identification of minimal risk by the PMRS guided a strategy of initially deferred testing. The strategy was safe with no observed adverse outcome events, fewer catheterizations without obstructive CAD, and similar symptom relief compared with usual testing. Trial Registration ClinicalTrials.gov Identifier: NCT03702244.
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Affiliation(s)
- James E. Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Michelle D. Kelsey
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher B. Fordyce
- Division of Cardiology, Department of Medicine, and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Yow
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Robert M. Clare
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Manesh R. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | | | - Nick Curzen
- Faculty of Medicine, University of Southampton and Cardiothoracic Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino Instituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, and Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Onze Lieve Vrouwziekenhuis-Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Victor Marinescu
- Midwest Cardiovascular Institute, Chicago Medical School, Edward-Elmhurst Health, Naperville, Illinois
- Edward-Elmhurst Health, Naperville, Illinois
| | - Jonathon Leipsic
- Departments of Radiology and Medicine (Cardiology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom
| | - Shea E. Hogan
- CPC Clinical Research, and University of Colorado School of Medicine, Aurora
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ziad A. Ali
- St Francis Hospital & Heart Center, Roslyn, New York
| | - Robert A. Byrne
- Department of Cardiology and Cardiovascular Research Institute Dublin, Mater Private Network, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Beth Martinez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Hussein R. Al-Khalidi
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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25
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Douglas PS, Nanna MG, Kelsey MD, Yow E, Mark DB, Patel MR, Rogers C, Udelson JE, Fordyce CB, Curzen N, Pontone G, Maurovich-Horvat P, De Bruyne B, Greenwood JP, Marinescu V, Leipsic J, Stone GW, Ben-Yehuda O, Berry C, Hogan SE, Redfors B, Ali ZA, Byrne RA, Kramer CM, Yeh RW, Martinez B, Mullen S, Huey W, Anstrom KJ, Al-Khalidi HR, Vemulapalli S. Comparison of an Initial Risk-Based Testing Strategy vs Usual Testing in Stable Symptomatic Patients With Suspected Coronary Artery Disease: The PRECISE Randomized Clinical Trial. JAMA Cardiol 2023; 8:904-914. [PMID: 37610731 PMCID: PMC10448364 DOI: 10.1001/jamacardio.2023.2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/26/2023] [Indexed: 08/24/2023]
Abstract
Importance Trials showing equivalent or better outcomes with initial evaluation using coronary computed tomography angiography (cCTA) compared with stress testing in patients with stable chest pain have informed guidelines but raise questions about overtesting and excess catheterization. Objective To test a modified initial cCTA strategy designed to improve clinical efficiency vs usual testing (UT). Design, Setting, and Participants This was a pragmatic randomized clinical trial enrolling participants from December 3, 2018, to May 18, 2021, with a median of 11.8 months of follow-up. Patients from 65 North American and European sites with stable symptoms of suspected coronary artery disease (CAD) and no prior testing were randomly assigned 1:1 to precision strategy (PS) or UT. Interventions PS incorporated the Prospective Multicenter Imaging Study for the Evaluation of Chest Pain (PROMISE) minimal risk score to quantitatively select minimal-risk participants for deferred testing, assigning all others to cCTA with selective CT-derived fractional flow reserve (FFR-CT). UT included site-selected stress testing or catheterization. Site clinicians determined subsequent care. Main Outcomes and Measures Outcomes were clinical efficiency (invasive catheterization without obstructive CAD) and safety (death or nonfatal myocardial infarction [MI]) combined into a composite primary end point. Secondary end points included safety components of the primary outcome and medication use. Results A total of 2103 participants (mean [SD] age, 58.4 [11.5] years; 1056 male [50.2%]) were included in the study, and 422 [20.1%] were classified as minimal risk. The primary end point occurred in 44 of 1057 participants (4.2%) in the PS group and in 118 of 1046 participants (11.3%) in the UT group (hazard ratio [HR], 0.35; 95% CI, 0.25-0.50). Clinical efficiency was higher with PS, with lower rates of catheterization without obstructive disease (27 [2.6%]) vs UT participants (107 [10.2%]; HR, 0.24; 95% CI, 0.16-0.36). The safety composite of death/MI was similar (HR, 1.52; 95% CI, 0.73-3.15). Death occurred in 5 individuals (0.5%) in the PS group vs 7 (0.7%) in the UT group (HR, 0.71; 95% CI, 0.23-2.23), and nonfatal MI occurred in 13 individuals (1.2%) in the PS group vs 5 (0.5%) in the UT group (HR, 2.65; 95% CI, 0.96-7.36). Use of lipid-lowering (450 of 900 [50.0%] vs 365 of 873 [41.8%]) and antiplatelet (321 of 900 [35.7%] vs 237 of 873 [27.1%]) medications at 1 year was higher in the PS group compared with the UT group (both P < .001). Conclusions and Relevance An initial diagnostic approach to stable chest pain starting with quantitative risk stratification and deferred testing for minimal-risk patients and cCTA with selective FFR-CT in all others increased clinical efficiency relative to UT at 1 year. Additional randomized clinical trials are needed to verify these findings, including safety. Trial Registration ClinicalTrials.gov Identifier: NCT03702244.
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Affiliation(s)
- Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Michelle D. Kelsey
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Eric Yow
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Manesh R. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | | | - James E. Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Christopher B. Fordyce
- Division of Cardiology, Department of Medicine, Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Curzen
- Faculty of Medicine, University of Southampton, Cardiothoracic Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino Instituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Onze Lieve Vrouwziekenhuis Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, United Kingdom
| | - Victor Marinescu
- Midwest Cardiovascular Institute, Chicago Medical School, Edward-Elmhurst Health, Naperville, Illinois
| | - Jonathon Leipsic
- Departments of Radiology and Medicine (Cardiology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom
| | - Shea E. Hogan
- CPC Clinical Research, University of Colorado School of Medicine, Aurora
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ziad A. Ali
- St Francis Hospital & Heart Center, Roslyn, New York
| | - Robert A. Byrne
- Department of Cardiology, Cardiovascular Research Institute Dublin, Mater Private Network, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Beth Martinez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Hussein R. Al-Khalidi
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Wang SM, Hogg HDJ, Sangvai D, Patel MR, Weissler EH, Kellogg KC, Ratliff W, Balu S, Sendak M. Development and Integration of Machine Learning Algorithm to Identify Peripheral Arterial Disease: Multistakeholder Qualitative Study. JMIR Form Res 2023; 7:e43963. [PMID: 37733427 PMCID: PMC10557008 DOI: 10.2196/43963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/20/2023] [Accepted: 04/30/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Machine learning (ML)-driven clinical decision support (CDS) continues to draw wide interest and investment as a means of improving care quality and value, despite mixed real-world implementation outcomes. OBJECTIVE This study aimed to explore the factors that influence the integration of a peripheral arterial disease (PAD) identification algorithm to implement timely guideline-based care. METHODS A total of 12 semistructured interviews were conducted with individuals from 3 stakeholder groups during the first 4 weeks of integration of an ML-driven CDS. The stakeholder groups included technical, administrative, and clinical members of the team interacting with the ML-driven CDS. The ML-driven CDS identified patients with a high probability of having PAD, and these patients were then reviewed by an interdisciplinary team that developed a recommended action plan and sent recommendations to the patient's primary care provider. Pseudonymized transcripts were coded, and thematic analysis was conducted by a multidisciplinary research team. RESULTS Three themes were identified: positive factors translating in silico performance to real-world efficacy, organizational factors and data structure factors affecting clinical impact, and potential challenges to advancing equity. Our study found that the factors that led to successful translation of in silico algorithm performance to real-world impact were largely nontechnical, given adequate efficacy in retrospective validation, including strong clinical leadership, trustworthy workflows, early consideration of end-user needs, and ensuring that the CDS addresses an actionable problem. Negative factors of integration included failure to incorporate the on-the-ground context, the lack of feedback loops, and data silos limiting the ML-driven CDS. The success criteria for each stakeholder group were also characterized to better understand how teams work together to integrate ML-driven CDS and to understand the varying needs across stakeholder groups. CONCLUSIONS Longitudinal and multidisciplinary stakeholder engagement in the development and integration of ML-driven CDS underpins its effective translation into real-world care. Although previous studies have focused on the technical elements of ML-driven CDS, our study demonstrates the importance of including administrative and operational leaders as well as an early consideration of clinicians' needs. Seeing how different stakeholder groups have this more holistic perspective also permits more effective detection of context-driven health care inequities, which are uncovered or exacerbated via ML-driven CDS integration through structural and organizational challenges. Many of the solutions to these inequities lie outside the scope of ML and require coordinated systematic solutions for mitigation to help reduce disparities in the care of patients with PAD.
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Affiliation(s)
- Sabrina M Wang
- Duke University School of Medicine, Durham, NC, United States
| | - H D Jeffry Hogg
- Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Devdutta Sangvai
- Population Health Management, Duke Health, Durham, NC, United States
| | - Manesh R Patel
- Department of Cardiology, Duke University, Durham, NC, United States
| | - E Hope Weissler
- Department of Vascular Surgery, Duke University, Durham, NC, United States
| | | | - William Ratliff
- Duke Institute for Health Innovation, Durham, NC, United States
| | - Suresh Balu
- Duke Institute for Health Innovation, Durham, NC, United States
| | - Mark Sendak
- Duke Institute for Health Innovation, Durham, NC, United States
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Madsen KT, Nørgaard BL, Øvrehus KA, Jensen JM, Parner E, Grove EL, Fairbairn TA, Nieman K, Patel MR, Rogers C, Mullen S, Mickley H, Rohold A, Bøtker HE, Leipsic J, Sand NPR. Prognostic Value of Coronary CT Angiography-derived Fractional Flow Reserve on 3-year Outcomes in Patients with Stable Angina. Radiology 2023; 308:e230524. [PMID: 37698477 DOI: 10.1148/radiol.230524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background The prognostic value of coronary CT angiography (CTA)-derived fractional flow reserve (FFR) beyond 1-year outcomes and in patients with high levels of coronary artery calcium (CAC) is uncertain. Purpose To assess the prognostic value of coronary CTA-derived FFR test results on 3-year clinical outcomes in patients with coronary stenosis and among a subgroup of patients with high levels of CAC. Materials and Methods This study represents a 3-year follow-up of patients with new-onset stable angina pectoris who were consecutively enrolled in the Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care, known as ADVANCE (ClinicalTrials.gov: NCT02499679) registry, between December 2015 and October 2017 at three Danish sites. A high CAC was defined as an Agatston score of at least 400. A lesion-specific coronary CTA-derived FFR value of 2 cm with distal-to-stenosis value at or below 0.80 represented an abnormal test result. The primary end point was a composite of all-cause death and nonfatal spontaneous myocardial infarction. Event rates were estimated using the one-sample binomial model, and relative risk was compared between participants stratified by results of coronary CTA-derived FFR. Results This study included 900 participants: 523 participants with normal results (mean age, 64 years ± 9.6 [SD]; 318 male participants) and 377 with abnormal results from coronary CTA-derived FFR (mean age, 65 years ± 9.6; 264 male participants). The primary end point occurred in 11 of 523 (2.1%) and 25 of 377 (6.6%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 3.1; 95% CI: 1.6, 6.3; P < .001). In participants with high CAC, the primary end point occurred in four of 182 (2.2%) and 19 of 212 (9.0%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 4.1; 95% CI: 1.4, 11.8; P = .001). Conclusion In individuals with stable angina, a normal coronary CTA-derived FFR test result identified participants with a low 3-year risk of all-cause death or nonfatal spontaneous myocardial infarction, both in the overall cohort and in participants with high CAC scores. Clinical trial registration no. NCT02499679 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Sinitsyn in this issue.
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Affiliation(s)
- Kristian T Madsen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Bjarne L Nørgaard
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Kristian A Øvrehus
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jesper M Jensen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik Parner
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik L Grove
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Timothy A Fairbairn
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Koen Nieman
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Manesh R Patel
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Campbell Rogers
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Sarah Mullen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Mickley
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Allan Rohold
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Erik Bøtker
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jonathon Leipsic
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Niels Peter R Sand
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
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Cohen DJ, Patel MR. Evidence Generation for Novel Cardiovascular Devices-Putting the Horse Back in Front of the Cart. JAMA Cardiol 2023; 8:718-720. [PMID: 37342030 DOI: 10.1001/jamacardio.2023.1664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- David J Cohen
- Cardiovascular Research Foundation, New York, New York
- St Francis Hospital, Roslyn, New York
| | - Manesh R Patel
- Division of Cardiology and Duke Clinical Research Institute, Durham, North Carolina
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van Rosendael SE, van Rosendael AR, Kuneman JH, Patel MR, Nørgaard BL, Fairbairn TA, Nieman K, Akasaka T, Berman DS, Koweek LMH, Pontone G, Kawasaki T, Sand NPR, Jensen JM, Amano T, Poon M, Øvrehus KA, Sonck J, Rabbat MG, Rogers C, Matsuo H, Leipsic JA, Marsan NA, Jukema JW, Bax JJ, Saraste A, Knuuti J. Coronary Volume to Left Ventricular Mass Ratio in Patients With Hypertension. Am J Cardiol 2023; 199:100-109. [PMID: 37198076 DOI: 10.1016/j.amjcard.2023.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/22/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
The coronary vascular volume to left ventricular mass (V/M) ratio assessed by coronary computed tomography angiography (CCTA) is a promising new parameter to investigate the relation of coronary vasculature to the myocardium supplied. It is hypothesized that hypertension decreases the ratio between coronary volume and myocardial mass by way of myocardial hypertrophy, which could explain the detected abnormal myocardial perfusion reserve reported in patients with hypertension. Individuals enrolled in the multicenter ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) registry who underwent clinically indicated CCTA for analysis of suspected coronary artery disease with known hypertension status were included in current analysis. The V/M ratio was calculated from CCTA by segmenting the coronary artery luminal volume and left ventricular myocardial mass. In total, 2,378 subjects were included in this study, of whom 1,346 (56%) had hypertension. Left ventricular myocardial mass and coronary volume were higher in subjects with hypertension than normotensive patients (122.7 ± 32.8 g vs 120.0 ± 30.5 g, p = 0.039, and 3,105.0 ± 992.0 mm3 vs 2,965.6 ± 943.7 mm3, p <0.001, respectively). Subsequently, the V/M ratio was higher in patients with hypertension than those without (26.0 ± 7.6 mm3/g vs 25.3 ± 7.3 mm3/g, p = 0.024). After correcting for potential confounding factors, the coronary volume and ventricular mass remained higher in patients with hypertension (least square) mean difference estimate: 196.3 (95% confidence intervals [CI] 119.9 to 272.7) mm3, p <0.001, and 5.60 (95% CI 3.42 to 7.78) g, p <0.001, respectively), but the V/M ratio was not significantly different (least square mean difference estimate: 0.48 (95% CI -0.12 to 1.08) mm3/g, p = 0.116). In conclusion, our findings do not support the hypothesis that the abnormal perfusion reserve would be caused by reduced V/M ratio in patients with hypertension.
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Affiliation(s)
| | | | - Jurrien H Kuneman
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Timothy A Fairbairn
- Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Koen Nieman
- Department of Cardiovascular Medicine, Stanford University, Stanford, California; Department of Radiology, Stanford University, Stanford, California
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daniel S Berman
- Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Lynne M Hurwitz Koweek
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Michael Poon
- Department of Noninvasive Cardiac Imaging, Northwell Health, New York, New York
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, Illinois
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jonathon A Leipsic
- Department of Radiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Netherlands Heart Institute, Utrecht, The Netherlands; Turku PET Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Turku PET Center, Turku University Hospital and University of Turku, Turku, Finland.
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Kittipibul V, Ganesh A, Coburn A, Coyne BJ, Gray JM, Molinger J, Ray N, Podgoreanu M, McCartney SL, Mamoun N, Fitzhugh RC, Lurz P, Green CL, Hernandez AF, Patel MR, Fudim M. Splanchnic Nerve Modulation Effects on Surrogate Measures of Venous Capacitance. J Am Heart Assoc 2023:e028780. [PMID: 37449573 PMCID: PMC10382122 DOI: 10.1161/jaha.122.028780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Background Splanchnic nerve modulation (SNM) is an emerging procedure to reduce cardiac filling pressures in heart failure. Although the main contributor to reduction in cardiac preload is thought to be increased venous capacitance in the splanchnic circulation, supporting evidence is limited. We examined changes in venous capacitance surrogates pre- and post-SNM. Methods and Results This is a prespecified analysis of a prospective, open-label, single-arm interventional study evaluating the effects of percutaneous SNM with ropivacaine in chronic heart failure with elevated filling pressures at rest and with exercise. Patients underwent cardiopulmonary exercise testing with invasive hemodynamic assessment pre- and post-SNM. Blood pressure changes with modified Valsalva maneuver and hemoconcentration, pre- and post-SNM were compared using a repeated measures model. Inferior vena cava diameter and collapsibility (>50% decrease in size with inspiration), and presence of bendopnea pre- and post-SNM were also compared. Fifteen patients undergoing SNM (age 58 years, 47% women, 93% with left ventricular ejection fraction ≤35%) were included. After SNM, changes in systolic blood pressure during Valsalva (peak-to-trough) were greater (41 versus 48 mm Hg, P=0.025). Exercise-induced hemoconcentration was unchanged (0.63 versus 0.43 g/dL, P=0.115). Inferior vena cava diameter was reduced (1.59 versus 1.30 cm, P=0.034) with higher collapsibility (33% versus 73%, P=0.014). Bendopnea was less (47% versus 13%, P=0.025). Conclusions SNM resulted in increased venous capacitance, associated decreased cardiac preload, and decreased bendopnea. Minimally invasive measures of venous capacitance could serve as markers of successful SNM. Long-term effects of SNM on venous capacitance warrant further investigation for heart failure management. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03453151.
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Affiliation(s)
| | - Arun Ganesh
- Department of Anesthesiology Duke University Medical Center Durham NC
| | - Aubrie Coburn
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - Brian J Coyne
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - James Matthew Gray
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - Jeroen Molinger
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - Neil Ray
- Department of Anesthesiology Duke University Medical Center Durham NC
| | - Mihai Podgoreanu
- Department of Anesthesiology Duke University Medical Center Durham NC
| | | | - Negmeldeen Mamoun
- Department of Anesthesiology Duke University Medical Center Durham NC
| | | | - Philipp Lurz
- Heart Center Leipzig at University Leipzig Leipzig Germany
| | - Cynthia L Green
- Biostatistics and Bioinformatics Duke University Medical Center Durham NC
- Duke Clinical Research Institute Durham NC
| | - Adrian F Hernandez
- Division of Cardiology, Department of Medicine Duke University Durham NC
- Duke Clinical Research Institute Durham NC
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine Duke University Durham NC
- Duke Clinical Research Institute Durham NC
| | - Marat Fudim
- Division of Cardiology, Department of Medicine Duke University Durham NC
- Duke Clinical Research Institute Durham NC
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Nanna MG, Yow E, Vemulapalli S, Mark DB, Kelsey M, Patel MR, Al-Khalidi HR, Rogers C, Udelson JE, Douglas PS. Clinical and cost implications of deferred testing in low-risk patients with stable chest pain: a simulation using the PROMISE trial. Am Heart J 2023; 261:124-126. [PMID: 36828202 PMCID: PMC10903188 DOI: 10.1016/j.ahj.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 05/26/2023]
Abstract
Current guidelines recommend a deferred testing approach in low-risk patients presenting with stable chest pain. After simulating a deferred testing approach using the PROMISE Minimal Risk Score to identify 915 minimal risk participants with cost data from the PROMISE trial, a deferred testing strategy was associated with an adjusted cost savings of -$748.74 (95% CI: -1646.97, 158.06) per participant and 74.6% of samples had better clinical outcomes and lower mean cost. This supports the current guideline recommended deferred testing approach in low-risk patients with stable chest pain.
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Affiliation(s)
- Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT.
| | - Eric Yow
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Daniel B Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Michelle Kelsey
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - James E Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Moulson N, Petek BJ, Ackerman MJ, Churchill TW, Day SM, Kim JH, Kliethermes SA, Lampert R, Levine BD, Martinez MW, Patel MR, Phelan D, Harmon KG, Baggish AL, Drezner JA. Rationale and Design of the ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) Study. J Am Heart Assoc 2023; 12:e029052. [PMID: 37259981 PMCID: PMC10382007 DOI: 10.1161/jaha.122.029052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/13/2023] [Indexed: 06/02/2023]
Abstract
Background Clinical practice recommendations for participation in sports and exercise among young competitive athletes with cardiovascular conditions at risk for sudden death are based largely on expert consensus with a paucity of prospective outcomes data. Recent guidelines have taken a more permissive approach, using a shared decision-making model. However, the impact and outcomes of this strategy remain unknown. Methods The ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) study is a prospective, multicenter, longitudinal, observational cohort study designed to monitor clinical outcomes in athletes with potentially life-threatening cardiovascular conditions. The study will assess sports eligibility decision-making, exercise habits, psychosocial well-being, and long-term cardiovascular outcomes among young competitive athletes with cardiovascular conditions. Competitive athletes aged 18 to <35 years diagnosed with a confirmed cardiovascular condition or borderline finding with potential increased risk of major adverse cardiovascular events are eligible. Outcomes will be monitored for an initial 5-year follow-up period or until age 35, and metrics of psychosocial well-being and composite adverse cardiovascular events including arrhythmias, sudden cardiac arrest/sudden cardiac death, and evidence of disease progression will be compared among athletes who continue versus discontinue competitive sports participation. Conclusions The ORCCA study aims to assess the process and results of return to sport decision-making and to monitor major adverse cardiovascular events, exercise habits, and the psychosocial well-being among young competitive athletes diagnosed with confirmed cardiovascular conditions or borderline findings with potential increased risk of major adverse cardiovascular events. The results of this work will generate an evidence base to inform future guidelines.
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Affiliation(s)
- Nathaniel Moulson
- Division of Cardiology and Sports Cardiology BCUniversity of British ColumbiaVancouverBCUSA
| | - Bradley J. Petek
- Massachusetts General Hospital Division of CardiologyBostonMAUSA
- Cardiovascular Performance ProgramBostonMAUSA
| | - Michael J. Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric CardiologyWindland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics LaboratoryRochesterMNUSA
| | - Timothy W. Churchill
- Massachusetts General Hospital Division of CardiologyBostonMAUSA
- Cardiovascular Performance ProgramBostonMAUSA
| | - Sharlene M. Day
- Division of Cardiovascular MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Jonathan H. Kim
- Division of CardiologyEmory University School of MedicineAtlantaGAUSA
| | | | - Rachel Lampert
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of MedicineNew HavenCTUSA
| | - Benjamin D. Levine
- Division of CardiologyUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Matthew W. Martinez
- Department of Cardiovascular Medicine, Morristown Medical Center, Atlantic Health SystemMorristownNJUSA
| | - Manesh R. Patel
- Division of CardiologyDuke Heart Center, and Duke Clinical Research Institute, Duke University School of MedicineDurhamNCUSA
| | - Dermot Phelan
- Sports Cardiology CenterAtrium Health Sanger Heart & Vascular InstituteCharlotteNCUSA
| | - Kimberly G. Harmon
- Department of Family Medicine and Center for Sports CardiologyUniversity of WashingtonSeattleWAUSA
| | - Aaron L. Baggish
- Department of CardiologyLausanne University Hospital (CHUV)LausanneSwitzerland
- Institute for Sport Science, University of Lausanne (ISSUL)LausanneSwitzerland
| | - Jonathan A. Drezner
- Department of Family Medicine and Center for Sports CardiologyUniversity of WashingtonSeattleWAUSA
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33
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Harrington J, Carnicelli AP, Hua K, Wallentin L, Patel MR, Hohnloser SH, Giugliano RP, Fox KAA, Hijazi Z, Lopes RD, Pokorney SD, Hong H, Granger CB. Direct Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF. Circulation 2023; 147:1748-1757. [PMID: 37042255 PMCID: PMC10309661 DOI: 10.1161/circulationaha.122.062752] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND There is uncertainty surrounding the use of direct oral anticoagulants (DOACs) in patients with kidney dysfunction. METHODS Using the COMBINE AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation) database (data from RE-LY [Randomized Evaluation of Long-term Anticoagulation Therapy], ROCKET AF [Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation], ARISTOTLE [Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation], and ENGAGE AF-TIMI 48 [Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48]), we performed an individual patient-level network meta-analysis to evaluate the safety and efficacy of DOACs versus warfarin across continuous creatinine clearance (CrCl). A multivariable Cox model including treatment-by-CrCl interaction with random effects was fitted to estimate hazard ratios for paired treatment strategies (standard-dose DOAC, lower-dose DOAC, and warfarin). Outcomes included stroke and systemic embolism (S/SE), major bleeding, intracranial hemorrhage (ICH), and death. RESULTS Among 71 683 patients (mean age, 70.6±9.4 years; 37.3% female; median follow-up, 23.1 months), the mean CrCl was 75.5±30.5 mL/min. The incidence of S/SE, major bleeding, ICH, and death increased significantly with worsening kidney function. Across continuous CrCl values down to 25 mL/min, the hazard of major bleeding did not change for patients randomized to standard-dose DOACs compared with those randomized to warfarin (Pinteraction=0.61). Compared with warfarin, standard-dose DOAC use resulted in a significantly lower hazard of ICH at CrCl values <122 mL/min, with a trend for increased safety with DOAC as CrCl decreased (6.2% decrease in hazard ratio per 10-mL/min decrease in CrCl; Pinteraction=0.08). Compared with warfarin, standard-dose DOAC use resulted in a significantly lower hazard of S/SE with CrCl <87 mL/min, with a significant treatment-by-CrCl effect (4.8% decrease in hazard ratio per 10-mL/min decrease in CrCl; Pinteraction=0.01). The hazard of death was significantly lower with standard-dose DOACs for patients with CrCl <77 mL/min, with a trend toward increasing benefit with lower CrCl (2.1% decrease in hazard ratio per 10-mL/min decrease in CrCl; Pinteraction=0.08). Use of lower-dose rather than standard-dose DOACs was not associated with a significant difference in incident bleeding or ICH in patients with reduced kidney function but was associated with a higher incidence4 of death and S/SE. CONCLUSIONS Standard-dose DOACs are safer and more effective than warfarin down to a CrCl of at least 25 mL/min. Lower-dose DOACs do not significantly lower the incidence of bleeding or ICH compared with standard-dose DOACs but are associated with a higher incidence of S/SE and death. These findings support the use of standard-dose DOACs over warfarin in patients with kidney dysfunction.
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Affiliation(s)
- Josephine Harrington
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (J.H., M.R.P., R.D.L., S.D.P., C.B.G.)
- Duke Clinical Research Institute, Durham, NC (J.H., K.H., M.R.P., R.D.L., S.D.P., H.H., C.B.G.)
| | - Anthony P Carnicelli
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston (A.P.C.)
| | - Kaiyuan Hua
- Duke Clinical Research Institute, Durham, NC (J.H., K.H., M.R.P., R.D.L., S.D.P., H.H., C.B.G.)
| | - Lars Wallentin
- Uppsala Clinical Research Center (L.W.), Uppsala University, Sweden
- Department of Medical Sciences, Cardiology (L.W., Z.H.), Uppsala University, Sweden
| | - Manesh R Patel
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (J.H., M.R.P., R.D.L., S.D.P., C.B.G.)
- Duke Clinical Research Institute, Durham, NC (J.H., K.H., M.R.P., R.D.L., S.D.P., H.H., C.B.G.)
| | - Stefan H Hohnloser
- Department of Cardiology, JW Goethe University, Frankfurt, Germany (S.H.H.)
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.P.G.)
| | - Keith A A Fox
- Division of Medical and Radiological Sciences, University of Edinburgh, UK (K.A.A.F.)
| | - Ziad Hijazi
- Department of Medical Sciences, Cardiology (L.W., Z.H.), Uppsala University, Sweden
| | - Renato D Lopes
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (J.H., M.R.P., R.D.L., S.D.P., C.B.G.)
- Duke Clinical Research Institute, Durham, NC (J.H., K.H., M.R.P., R.D.L., S.D.P., H.H., C.B.G.)
| | - Sean D Pokorney
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (J.H., M.R.P., R.D.L., S.D.P., C.B.G.)
- Duke Clinical Research Institute, Durham, NC (J.H., K.H., M.R.P., R.D.L., S.D.P., H.H., C.B.G.)
| | - Hwanhee Hong
- Duke Clinical Research Institute, Durham, NC (J.H., K.H., M.R.P., R.D.L., S.D.P., H.H., C.B.G.)
| | - Christopher B Granger
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (J.H., M.R.P., R.D.L., S.D.P., C.B.G.)
- Duke Clinical Research Institute, Durham, NC (J.H., K.H., M.R.P., R.D.L., S.D.P., H.H., C.B.G.)
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Sullivan AE, Barbery CE, Holder T, Green CL, Patel MR, Thomas KL, Jones WS. Association of race and in-hospital outcomes following acute pulmonary embolism: A retrospective cohort study. Clin Cardiol 2023. [PMID: 37255216 DOI: 10.1002/clc.24055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Racial disparities in health care are well established, with Black patients frequently experiencing the most significant consequences of this inequality. Acute pulmonary embolism (PE) is increasing in incidence and an important cause of morbidity and mortality in the United States, but little is known about racial disparities in the inpatient setting. HYPOTHESIS Black and White patients admitted with acute PE will have different in-hospital outcomes. METHODS All PE patients from January 1, 2016 to June 30, 2017 were retrospectively identified using ICD-10 codes. Data were abstracted by manual chart review for all image-confirmed PEs. RESULTS A total of 782 patients with acute PE were identified, of which 319 (40.8%) were Black and 463 (59.2%) were White. Black patients had higher BMI (median [Q1-Q3]: 30.3 [25.4-36.6] vs. 29.3 [24.5-33.8] kg/m2 , p = .017), were younger (61 [48-74] vs. 67 [54-75] years, p = .001), and were more likely to have a history of heart failure (16.0 vs. 7.1%, p < .001), while White patients had higher rates of malignancy (46.9 vs. 34.5%, p = .001) and recent surgery (29.6 vs. 18.2%, p < .001). Black patients were more likely to receive systemic thrombolysis (3.1% vs. 1.1%, p = .040), while White patients had numerically higher rates of surgical embolectomy (0.3% vs. 1.1%, p = .41). No difference in inpatient mortality was observed; however, Black patients had longer hospital length of stay (5.0 [3-9] vs. 4.0 [2-9] days, p = .007) and were more likely to receive warfarin (23.5 vs. 12.1%, p < .001). CONCLUSIONS Similar in-hospital mortality rates were observed in Black and White patients following acute PE. However, Black patients had longer hospital stays, higher warfarin prescription, and fewer traditional PE-related risk factors.
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Affiliation(s)
- Alexander E Sullivan
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos E Barbery
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tara Holder
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cynthia L Green
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin L Thomas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - W Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
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35
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Benz AP, Hohnloser SH, Eikelboom JW, Carnicelli AP, Giugliano RP, Granger CB, Harrington J, Hijazi Z, Morrow DA, Patel MR, Seiffge DJ, Shoamanesh A, Wallentin L, Yi Q, Connolly SJ. Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation. Eur Heart J 2023; 44:1807-1814. [PMID: 37038327 PMCID: PMC10411934 DOI: 10.1093/eurheartj/ehad200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 04/12/2023] Open
Abstract
AIMS The prognosis of patients with atrial fibrillation (AF) and ischemic stroke while taking oral anticoagulation is poorly understood. This study aimed to characterize the outcomes of patients following a stroke event while on oral anticoagulation. METHODS AND RESULTS Individual participant data from five pivotal randomized trials of antithrombotic therapy in AF were used to assess the outcomes of patients with a post-randomization ischemic stroke while on study medication (warfarin, standard-, or lower-dose direct oral anticoagulant regimen) during trial follow-up. The primary outcome was recurrent ischemic stroke after the first post-randomization ischemic stroke. The primary analysis included 1163 patients with a first post-randomization ischemic stroke while on study medication (median age 73 years, 39.3% female, 35.4% history of stroke before trial enrollment). During a median continued follow-up of 337 days, 74 patients had a recurrent ischemic stroke [cumulative incidence at 1 year: 7.0%, 95% confidence interval (CI) 5.2%-8.7%]. The cumulative incidence of mortality at 3 months after stroke was 12.4% (95% CI 10.5%-14.4%). Consistent results for the incidence of recurrent ischemic stroke at 1 year were obtained in an analysis accounting for the competing risk of death (6.2%, 95% CI 4.8%-7.9%) and in a landmark analysis excluding the first 2 weeks after the index stroke and only including patients without permanent study drug discontinuation since then (6.8%, 95% CI 4.6%-8.9%). CONCLUSION Patients with AF and ischemic stroke while on oral anticoagulation are at increased risk of recurrent ischemic stroke and death. These patients currently have an unmet medical need.
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Affiliation(s)
- Alexander P Benz
- Population Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz 55131, Rhineland-Palatinate, Germany
| | | | - John W Eikelboom
- Population Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada
| | - Anthony P Carnicelli
- Duke Clinical Research Institute, Duke University, Durham, NC, United States
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Robert P Giugliano
- TIMI Study Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | | | | | - Ziad Hijazi
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - David A Morrow
- TIMI Study Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University, Durham, NC, United States
| | - David J Seiffge
- Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland
| | - Ashkan Shoamanesh
- Population Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Qilong Yi
- School of Epidemiology and Public Health, University of Ottawa, ON, Canada
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada
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Ninomiya K, Serruys PW, Kotoku N, Zhou J, Kageyama S, Masuda S, Revaiah PC, Wang B, He X, Tsai TY, Kageyama M, Sevestre E, Sharif F, Garg S, Akasaka T, Escaned J, Patel MR, Onuma Y. Anonymous Comparison of Various Angiography-Derived Fractional Flow Reserve Software With Pressure-Derived Physiological Assessment. JACC Cardiovasc Interv 2023:S1936-8798(23)00760-4. [PMID: 37191608 DOI: 10.1016/j.jcin.2023.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Software to compute angiography-derived fractional flow reserve (angio-FFR) have been validated against pressure wire-derived fractional flow reserve (PW-FFR) with an area under the receiver-operating characteristic curve (AUC) of 0.93 to 0.97. OBJECTIVES The aim of this study was to investigate diagnostic accuracies of 5 angio-FFR software/methods by an independent core lab in a prospective cohort of 390 vessels with carefully documented sites of PW-FFR and pressure wire-derived instantaneous wave-free ratio. METHODS One "matcher investigator" colocalized on angiography the sites of pressure wire measurement with angio-FFR measurements and provided the same 2 optimal angiographic views and frame selection to independent analysts who were blinded to invasive physiological results and results from other software. The results were anonymized and randomly presented. The AUC of each angio-FFR was compared with 2-dimensional quantitative coronary angiography (QCA) percent diameter stenosis (%DS) using a 2-tailed paired comparison of AUC. RESULTS All 5 software/methods yielded a high proportion of analyzable vessels (A: 100%, B: 100%, C: 92.1%, D: 99.5%, and E: 92.1%). The AUCs for predicting fractional flow reserve ≤0.8 for software A, B, C, D, E, and 2-dimensional QCA %DS were 0.75, 0.74, 0.74, 0.73, 0.73, and 0.65, respectively. The AUC for each angio-FFR was significantly greater than that for 2-dimensional QCA %DS. CONCLUSIONS This head-to-head comparison by an independent core lab demonstrated that the diagnostic accuracy of various angio-FFR software for predicting PW-FFR ≤0.80 was useful, with a higher discrimination compared with 2-dimensional QCA %DS; however, it did not reach the diagnostic accuracy previously reported in validation studies of various vendors. Therefore, the intrinsic clinical value of "angiography-derived fractional flow reserve" requires confirmation in large clinical trials.
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Affiliation(s)
- Kai Ninomiya
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Nozomi Kotoku
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Jinying Zhou
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Pruthvi C Revaiah
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Bo Wang
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Xingqiang He
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Tsung-Ying Tsai
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Momoko Kageyama
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Emelyne Sevestre
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Javier Escaned
- Hospital Clínico San Carlos Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Manesh R Patel
- Division of Cardiology and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
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Lowenstern A, Ng N, Takagi H, Rymer JA, Koweek LM, Douglas PS, Duran JM, Rabbat M, Pontone G, Fairbairn T, Chinnaiyan K, Berman DS, De Bruyne B, Bax JJ, Akasaka T, Amano T, Nieman K, Rogers C, Kitabata H, Sand NPR, Kawasaki T, Mullen S, Matsuo H, Norgaard BL, Patel MR, Leipsic J, Daubert MA. Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry. Circ Cardiovasc Imaging 2023; 16:e014850. [PMID: 37192296 DOI: 10.1161/circimaging.122.014850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 04/11/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND The relationship between body size and cardiovascular events is complex. This study utilized the ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) Registry to investigate the association between body mass index (BMI), coronary artery disease (CAD), and clinical outcomes. METHODS The ADVANCE registry enrolled patients undergoing evaluation for clinically suspected CAD who had >30% stenosis on cardiac computed tomography angiography. Patients were stratified by BMI: normal <25 kg/m2, overweight 25-29.9 kg/m2, and obese ≥30 kg/m2. Baseline characteristics, cardiac computed tomography angiography and computed tomography fractional flow reserve (FFRCT), were compared across BMI groups. Adjusted Cox proportional hazards models assessed the association between BMI and outcomes. RESULTS Among 5014 patients, 2166 (43.2%) had a normal BMI, 1883 (37.6%) were overweight, and 965 (19.2%) were obese. Patients with obesity were younger and more likely to have comorbidities, including diabetes and hypertension (all P<0.001), but were less likely to have obstructive coronary stenosis (65.2% obese, 72.2% overweight, and 73.2% normal BMI; P<0.001). However, the rate of hemodynamic significance, as indicated by a positive FFRCT, was similar across BMI categories (63.4% obese, 66.1% overweight, and 67.8% normal BMI; P=0.07). Additionally, patients with obesity had a lower coronary volume-to-myocardial mass ratio compared with patients who were overweight or had normal BMI (obese BMI, 23.7; overweight BMI, 24.8; and normal BMI, 26.3; P<0.001). After adjustment, the risk of major adverse cardiovascular events was similar regardless of BMI (all P>0.05). CONCLUSIONS Patients with obesity in the ADVANCE registry were less likely to have anatomically obstructive CAD by cardiac computed tomography angiography but had a similar degree of physiologically significant CAD by FFRCT and similar rates of adverse events. An exclusively anatomic assessment of CAD in patients with obesity may underestimate the burden of physiologically significant disease that is potentially due to a significantly lower volume-to-myocardial mass ratio.
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Affiliation(s)
| | - Nicholas Ng
- HeartFlow, Redwood City, CA (N.N., C.R., S.M., J.L.)
| | | | - Jennifer A Rymer
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
| | - Lynne M Koweek
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
| | - Pamela S Douglas
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
| | - Jessica M Duran
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
| | - Mark Rabbat
- Loyola University Medical Center, Maywood, IL (M.R.)
| | | | | | | | | | | | - Jeroen J Bax
- Leiden University Medical Center, the Netherlands (J.J.B.)
| | | | | | | | | | | | - Niels P R Sand
- University of Southern Denmark, Odense, Denmark (N.P.R.S.)
| | | | - Sarah Mullen
- HeartFlow, Redwood City, CA (N.N., C.R., S.M., J.L.)
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (H.M.)
| | | | - Manesh R Patel
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
| | - Jonathan Leipsic
- HeartFlow, Redwood City, CA (N.N., C.R., S.M., J.L.)
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Melissa A Daubert
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
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Bavishi A, Kliethermes SA, Petek B, Moulson N, Mellacheruvu P, Churchill TW, Harmon K, Patel MR, Baggish AL, Drezner JA, Mutharasan RK. Clinical spectrum of COVID-19 complications in young adults: combined analysis of the American Heart Association COVID-19 Cardiovascular Disease Registry and the Outcomes Registry for Cardiac Conditions in Athletes. BMJ Open 2023; 13:e069943. [PMID: 37045581 PMCID: PMC10105915 DOI: 10.1136/bmjopen-2022-069943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND While young adults 18-24 years old bear a significant proportion of COVID-19 diagnoses, the risk factors for hospitalisation and severe COVID-19 complications in this population are poorly understood. OBJECTIVE The objective of this study was to identify risk factors for hospitalisation and other COVID-19 complications across the health spectrum of young adults diagnosed with COVID-19 infection. STUDY DESIGN Retrospective cohort study. PARTICIPANTS Young adults (aged 18-24) with confirmed COVID-19 infection from the American Heart Association (AHA) COVID-19 Cardiovascular Disease Registry of hospitalised patients and the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) study of collegiate athletes. The AHA registry included 636 young adults from 152 hospitals. The ORCCA registry consisted of 3653 competitive college athletes from 42 colleges and universities. INTERVENTION None (exposure to COVID-19). PRIMARY AND SECONDARY OUTCOME MEASURES Main outcomes included hospitalisation, death, major adverse cardiovascular events (MACE) and other severe clinical events. RESULTS In comparison to the ORCCA registry, patients in the AHA registry were more likely to be female (59% vs 33%); had higher average body mass index (BMI) (32.4 vs 25.6); and had increased prevalence of diabetes (10% vs 0.4%), hypertension (7% vs 0.6%), chronic kidney disease (2% vs 0%) and asthma (14% vs 8%), all with p<0.01. There were eight (2%) deaths in the AHA hospitalised registry compared with zero in the ORCCA cohort. BMI was a statistically significant predictor of death in the hospitalised cohort (OR 1.05, 95% CI 1.00, 1.10). No significant predictors of MACE or other severe clinical events were identified. CONCLUSIONS The risk of cardiac events in young adults aged 18-24 diagnosed with COVID-19 infection is low. Patients who were hospitalised (AHA registry) were more likely to have pre-existing medical comorbidities and higher BMI than healthy collegiate athletes (ORCCA registry). Once hospitalised, elevated BMI is associated with increased mortality although other drivers of MACE and other severe clinical events remain unclear.
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Affiliation(s)
- Aakash Bavishi
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Bradley Petek
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathaniel Moulson
- Department of Cardiology, The University of British Columbia Library Vancouver Campus, Vancouver, British Columbia, Canada
| | - Pranav Mellacheruvu
- Department of Internal Medicine, Washington State University Elson S Floyd College of Medicine, Spokane, Washington, USA
| | - Timothy W Churchill
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimberly Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Manesh R Patel
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Aaron L Baggish
- Department of Sports Science, University of Lausanne, Lausanne, Switzerland
| | - Jonathan A Drezner
- Department of Family Medicine, Washington State University Spokane, Spokane, Washington, USA
| | - Raja Kannan Mutharasan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Fudim M, Parikh K, Ganesh A, Molinger J, Ray N, Coburn A, Coyne BJ, Swavely AG, Andrews J, Gray JM, Rao VN, Felker GM, Borges-Neto S, Hernandez AF, Patel MR. Splanchnic nerve block with botulinum toxin for therapy of chronic heart failure - mechanism of action (SPONGE-HF). Eur J Heart Fail 2023; 25:594-596. [PMID: 36924335 PMCID: PMC10905046 DOI: 10.1002/ejhf.2829] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Affiliation(s)
- Marat Fudim
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Kishan Parikh
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Arun Ganesh
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Jeroen Molinger
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Neil Ray
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Aubrie Coburn
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Brian J. Coyne
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Ashley G. Swavely
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Jennifer Andrews
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - James Matthew Gray
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Vishal N. Rao
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - G. Michael Felker
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Salvador Borges-Neto
- Department of Radiology and Division of Nuclear Cardiology, Duke University Medical Center, Durham, NC
| | - Adrian F. Hernandez
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Manesh R. Patel
- Department of Medicine and Division of Cardiology, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
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Govsyeyev N, Nehler M, Conte MS, Debus S, Chung J, Dorigo W, Gudz I, Krievins D, Mills J, Moll F, Norgren L, Piffaretti G, Powell R, Szalay D, Sillesen H, Wohlauer M, Szarek M, Bauersachs RM, Anand SS, Patel MR, Capell WH, Jaeger N, Hess CN, Muehlhofer E, Haskell LP, Berkowitz SD, Bonaca MP. Rivaroxaban in patients with symptomatic peripheral artery disease after lower extremity bypass surgery with venous and prosthetic conduits. J Vasc Surg 2023; 77:1107-1118.e2. [PMID: 36470531 DOI: 10.1016/j.jvs.2022.11.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with peripheral artery disease (PAD) requiring lower extremity revascularization (LER) have a high risk of adverse limb and cardiovascular events. The results from the VOYAGER PAD (efficacy and safety of rivaroxaban in reducing the risk of major thrombotic vascular events in subjects with symptomatic peripheral artery disease undergoing peripheral revascularization procedures of the lower extremities) trial have demonstrated that rivaroxaban significantly reduced this risk with an overall favorable net benefit for patients undergoing surgical revascularization. However, the efficacy and safety for those treated by surgical bypass, including stratification by bypass conduit (venous or prosthetic), has not yet been described. METHODS In the VOYAGER PAD trial, patients who had undergone surgical and endovascular infrainguinal LER to treat PAD were randomized to rivaroxaban 2.5 mg twice daily or placebo on top of background antiplatelet therapy (aspirin 100 mg to be used in all and clopidogrel in some at the treating physician's discretion) and followed up for a median of 28 months. The primary end point was a composite of acute limb ischemia, major amputation of vascular etiology, myocardial infarction, ischemic stroke, and cardiovascular death. The principal safety outcome was major bleeding using the TIMI (thrombolysis in myocardial infarction) scale. The index procedure details, including conduit type (venous vs prosthetic), were collected at baseline. RESULTS Among 6564 randomized patients, 2185 (33%) had undergone surgical LER. Of these 2185 patients, surgical bypass had been performed for 1448 (66%), using a prosthetic conduit for 773 patients (53%) and venous conduit for 646 patients (45%). Adjusting for the baseline differences and anatomic factors, the risk of unplanned limb revascularization in the placebo arm was 2.5-fold higher for those receiving a prosthetic conduit vs a venous conduit (adjusted hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.65-3.90; P < .001), and the risk of acute limb ischemia was three times greater (adjusted HR, 3.07; 95% CI, 1.84-5.11; P < .001). The use of rivaroxaban reduced the primary outcome for the patients treated with bypass surgery (HR, 0.78; 95% CI, 0.62-0.98), with consistent benefits for those receiving venous (HR, 0.66; 95% CI, 0.49-0.96) and prosthetic (HR, 0.87; 95% CI, 0.66-1.15) conduits (Pinteraction = .254). In the overall trial, major bleeding using the TIMI scale was increased with rivaroxaban. However, the numbers for those treated with bypass surgery were low (five with rivaroxaban vs nine with placebo; HR, 0.55; 95% CI, 0.18-1.65) and not powered to show statistical significance. CONCLUSIONS Surgical bypass with a prosthetic conduit was associated with significantly higher rates of major adverse limb events relative to venous conduits even after adjustment for patient and anatomic characteristics. Adding rivaroxaban 2.5 mg twice daily to aspirin or dual antiplatelet therapy significantly reduced this risk, with an increase in the bleeding risk, but had a favorable benefit risk for patients treated with bypass surgery, regardless of conduit type. Rivaroxaban should be considered after lower extremity bypass for symptomatic PAD to reduce ischemic complications of the heart, limb, and brain.
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Affiliation(s)
- Nicholas Govsyeyev
- CPC Clinical Research & Community Health, Aurora, CO; Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Mark Nehler
- CPC Clinical Research & Community Health, Aurora, CO; Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA
| | - Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery-Angiology-Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Jayer Chung
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX
| | - Walter Dorigo
- Department of Vascular Surgery, Careggi Polyclinic Hospital, University of Florence, Florence, Italy
| | - Ivan Gudz
- Department of Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Dainis Krievins
- Pauls Stradinš University Hospital, University of Latvia, Riga, Latvia
| | - Joseph Mills
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX
| | - Frans Moll
- Department of Vascular Surgery, University Medical Center, Utrecht, the Netherlands
| | - Lars Norgren
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Rick Powell
- Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH; Section of Vascular Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - David Szalay
- Division of Vascular Surgery, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Henrik Sillesen
- Division of Cardiology, Department of Vascular Surgery, Rigshospitalet, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Max Wohlauer
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Michael Szarek
- CPC Clinical Research & Community Health, Aurora, CO; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO; State University of New York, Downstate Health Sciences University, Brooklyn, NY
| | - Rupert M Bauersachs
- Cardioangiologic Center, Agaplesion Bethanien Hospital, Frankfurt am Main, Germany; Center for Thrombosis and Hemostasis, University of Mainz, Mainz, Germany
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Manesh R Patel
- Duke Clinical Research Institute, Division of Cardiology, Duke University, Durham, NC
| | - Warren H Capell
- CPC Clinical Research & Community Health, Aurora, CO; Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Nicole Jaeger
- CPC Clinical Research & Community Health, Aurora, CO
| | - Connie N Hess
- CPC Clinical Research & Community Health, Aurora, CO; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | | | - Scott D Berkowitz
- CPC Clinical Research & Community Health, Aurora, CO; Division of Hematology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Marc P Bonaca
- CPC Clinical Research & Community Health, Aurora, CO; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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Filbey L, Zhu JW, D'Angelo F, Thabane L, Khan MS, Lewis E, Patel MR, Powell-Wiley T, Miranda JJ, Zuhlke L, Butler J, Zannad F, Van Spall HGC. Improving representativeness in trials: a call to action from the Global Cardiovascular Clinical Trialists Forum. Eur Heart J 2023; 44:921-930. [PMID: 36702610 DOI: 10.1093/eurheartj/ehac810] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/24/2022] [Accepted: 12/20/2022] [Indexed: 01/28/2023] Open
Abstract
Participants enrolled in cardiovascular disease (CVD) randomized controlled trials are not often representative of the population living with the disease. Older adults, children, women, Black, Indigenous and People of Color, and people living in low- and middle-income countries are typically under-enrolled in trials relative to disease distribution. Treatment effect estimates of CVD therapies have been largely derived from trial evidence generated in White men without complex comorbidities, limiting the generalizability of evidence. This review highlights barriers and facilitators of trial enrollment, temporal trends, and the rationale for representativeness. It proposes strategies to increase representativeness in CVD trials, including trial designs that minimize the research burden on participants, inclusive recruitment practices and eligibility criteria, diversification of clinical trial leadership, and research capacity-building in under-represented regions. Implementation of such strategies could generate better and more generalizable evidence to reduce knowledge gaps and position the cardiovascular trial enterprise as a vehicle to counter existing healthcare inequalities.
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Affiliation(s)
- Lynaea Filbey
- Department of Medicine, McMaster University, 20 Copeland Avenue, David Braley Research Building, Suite C3-117, Hamilton, ON L8L 0A3, Canada
| | - Jie Wei Zhu
- Department of Medicine, McMaster University, 20 Copeland Avenue, David Braley Research Building, Suite C3-117, Hamilton, ON L8L 0A3, Canada
| | - Francesca D'Angelo
- Department of Medicine, McMaster University, 20 Copeland Avenue, David Braley Research Building, Suite C3-117, Hamilton, ON L8L 0A3, Canada
| | - Lehana Thabane
- Research Institute of St. Josephs, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON L8N 4A6, Canada.,Population Health Research Institute, 237 Barton St E, Hamilton ON L8L 2X2, Canada.,Faculty of Health Sciences, University of Johannesburg, 1 Bunting Road, FADA Building, Johannesburg, Gauteng 2092, South Africa.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, McMaster University Medical Centre, 2C Area, Hamilton, ON L8S 4K1, Canada
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Duke Clinical Research Institute, 300 W Morgan Street, Duke University School of Medicine, Durham, NC 27701, USA
| | - Eldrin Lewis
- Cardiovascular Division, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305-5101, USA
| | - Manesh R Patel
- Division of Cardiology, Duke Clinical Research Institute, 300 W Morgan Street, Duke University School of Medicine, Durham, NC 27701, USA
| | - Tiffany Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 31 Center Drive, Building 31, Bethesda, MD 20892, USA.,Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892-5465, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Av. Armendariz, 2nd floor, Miraflores 15074, Lima, Peru
| | - Liesl Zuhlke
- South African Medical Research Council and Division of Paediatric Cardiology, University of Cape Town and Red Cross Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, Western Cape 7700, South Africa
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.,Baylor Scott and White Research Insistute, 3434 Live Oak St, Suite 501, Dallas, TX 75204, USA
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, 4 rue du Morvan, ILM, ground floor, Vandoeuvre-des-Nancy, Meurthe-et-Moselle 54500, France.,Institut National de la Santé et de la Recherche Médicale 1116, Centre Hospitalier Régional, 18 av Mozart, Marseille, Bouches-du-Rhône 13276, France.,Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Universitaire de Nancy, French Clinical Research Infrastructure Network, 4 rue de Morvan, Vandoeuvre-des-Nancy, Meurthe-et-Moselle 54500, France
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, 20 Copeland Avenue, David Braley Research Building, Suite C3-117, Hamilton, ON L8L 0A3, Canada.,Research Institute of St. Josephs, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON L8N 4A6, Canada.,Population Health Research Institute, 237 Barton St E, Hamilton ON L8L 2X2, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, McMaster University Medical Centre, 2C Area, Hamilton, ON L8S 4K1, Canada
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Petek BJ, Moulson N, Klein CF, Drezner JA, Harmon KG, Kliethermes SA, Patel MR, Isselbacher EM, Baggish AL, Churchill TW. Echocardiographic Reporting of the Aorta in Young Competitive Athletes. J Am Soc Echocardiogr 2023; 36:335-337. [PMID: 36370965 PMCID: PMC10290883 DOI: 10.1016/j.echo.2022.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Nathaniel Moulson
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia
| | - Christian F Klein
- Department of Medicine, University of Washington, Seattle, Washington
| | - Jonathan A Drezner
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, Washington
| | - Kimberly G Harmon
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, Washington
| | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
| | - Manesh R Patel
- Division of Cardiology, Duke Heart Center, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Eric M Isselbacher
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts.
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43
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Khedagi A, Hoke C, Kelsey M, Coviello A, Jones WS, Jackson LR, Patel MR, McGarrah RW, Pagidipati NJ, Shah NP. Call to action: Understanding the differences in the use of SGLT-2 inhibitors and GLP-1 receptor agonists. Am J Prev Cardiol 2023; 13:100477. [PMID: 36915710 PMCID: PMC10006446 DOI: 10.1016/j.ajpc.2023.100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
Cardiovascular disease remains one of the most prominent global health problems and has been demonstrated to disproportionally affect certain communities. Despite an increasing collective effort to improve health inequalities, a multitude of disparities continue to affect cardiovascular outcomes. Among the most prominent disparities within cardiovascular disease prevention are with the use and distribution of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists. Several landmark trials have demonstrated the efficacy of these novel agents, not only in cardiovascular disease prevention among those with diabetes, but also in heart failure and chronic kidney disease. However, the use of these agents remains limited by disparities in certain racial/ethnic, sex, and socioeconomic groups. This review works to highlight and understand these differences on the use and prescribing patterns of pivotal agents in cardiovascular disease prevention, SGLT-2 inhibitors and GLP-1 agonists. Our aim is to enrich understanding and to inspire efforts to end disparities in cardiovascular morbidity and mortality due to race, sex and income inequality.
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Affiliation(s)
- Apurva Khedagi
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Cara Hoke
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Michelle Kelsey
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Andrea Coviello
- Division of Endocrinology, Metabolism, and Nutrition, Duke University School of Medicine
| | - W. Schuyler Jones
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Larry R. Jackson
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Manesh R Patel
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Rob W. McGarrah
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Neha J Pagidipati
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Nishant P. Shah
- Division of Cardiology, Duke University School of Medicine, Durham, NC
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44
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Rogers RK, Capell W, Colorado, Herold J, Nehler M, Govsyeyev N, Iezzi R, Morrison J, Bergmark B, Bricker R, Hogan SE, Cavender MA, Young MN, Malgor E, Anand S, Bauersachs R, Berkowitz SD, Debus ES, Haskell L, Muehlhofer E, Patel MR, Hess CN, Gubbi A, Auster S, Anderson V, Bonaca MP. DESIGN AND INITIAL RESULTS OF AN ANGIOGRAPHIC CORE LAB FROM THE VOYAGER PAD TRIAL. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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45
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Bonaca MP, Debus ES, Patel MR, Nehler M, Anand S, Hess CN, Hsia JA, Muehlhofer E, Haskell L, Berkowitz SD. CONSISTENT BENEFIT OF RIVAROXABAN EARLY AND LATE AFTER LOWER EXTREMITY REVASCULARIZATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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46
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Harrington J, Piccini JP, Alexander JH, Granger CB, Patel MR. Clinical Evaluation of Factor XIa Inhibitor Drugs: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:771-779. [PMID: 36813377 DOI: 10.1016/j.jacc.2022.11.057] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 02/22/2023]
Abstract
Factor XI/XIa (FXI/FXIa) represents a potential target for improved precision in anticoagulation because it is involved primarily in thrombus formation and plays a much smaller role in clotting and hemostasis. This suggests that the inhibition of FXI/XIa could prevent pathologic thrombi from forming, but largely preserve a patient's ability to clot in response to bleeding or trauma. This theory is supported by observational data showing that patients with congenital FXI deficiency have lower rates of embolic events without an increase in spontaneous bleeding. Small phase 2 trials of FXI/XIa inhibitors have offered encouraging data with regard to bleeding and safety and evidence of efficacy for the prevention of venous thromboembolism. However, larger clinical trials across multiple patient groups are needed for this emerging class of anticoagulants to understand their possible role in clinical use. Here we review the potential clinical indications for FXI/XIa inhibitors, data available to date, and consider future trials.
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Affiliation(s)
- Josephine Harrington
- Duke Clinical Research Institute, Durham, North Carolina, USA; Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. https://twitter.com/JLHarrington_MD
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Durham, North Carolina, USA; Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. https://twitter.com/JonPicciniSr
| | - John H Alexander
- Duke Clinical Research Institute, Durham, North Carolina, USA; Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher B Granger
- Duke Clinical Research Institute, Durham, North Carolina, USA; Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Manesh R Patel
- Duke Clinical Research Institute, Durham, North Carolina, USA; Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
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47
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Shah NP, Page C, Green CL, Gao M, Cavalier J, McGarrah RW, DeWald TA, Sangvai D, Patel MR, Pagidipati NJ. Bending the Cardiovascular Event Curve by Evaluating the Potential Impact of Achieving Low-Density Lipoprotein Cholesterol Goal Across a Large Health System Among Secondary Prevention Patients. Am J Cardiol 2023; 186:91-99. [PMID: 36371856 PMCID: PMC10725565 DOI: 10.1016/j.amjcard.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022]
Abstract
Guidelines recommend aggressive low-density lipoprotein cholesterol (LDL-C) lowering in patients with atherosclerotic cardiovascular disease (ASCVD). However, the recommended threshold of LDL-C ≤70 mg/dL is often not achieved. We used data from the Duke University Health System electronic health record to characterize patterns of lipid levels and lipid management in patients with ASCVD to estimate the number of clinical events that could be prevented by achieving LDL-C ≤70 mg/dL . A multivariable logistic regression model was developed to predict the 1-year composite of all-cause mortality, myocardial infarction, stroke, or coronary revascularization and was validated through bootstrapping. The number needed to treat to prevent an event was then determined. Among 56,230 patients with ASCVD, the median (quartile 1, quartile 3) age was 68.6 years (59.9, 76.2), 47% were women, and 27% were non-Hispanic Black. LDL-C was >70 mg/dL in 39,566 of patients (70%); these patients were more frequently female (51% vs 36%), non-Hispanic Black (28% vs 23%), and less frequently on statin therapy (67% vs 91%) than those with LDL-C ≤70 mg/dL . A predictive model with reasonable discrimination (c-index 0.77, 95% confidence interval 0.760 to 0.77) and calibration (slope 0.99) determined that if the overall population achieved an LDL-C ≤70 mg/dL, 734 clinical events (455 myocardial infarctions, 186 strokes, and 93 coronary revascularizations) could be prevented in a year. Achieving LDL-C ≤70 mg/dL in patients with ASCVD across a health system could prevent significant clinical events within a single year. In conclusion, this study quantifies the potential benefit of a system-wide effort to achieve guideline-based LDL-C goals.
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Affiliation(s)
- Nishant P Shah
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Courtney Page
- Duke Clinical Research Institute, Durham, North Carolina
| | - Cynthia L Green
- Duke Clinical Research Institute, Durham, North Carolina; Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Michael Gao
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina
| | - Joanna Cavalier
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina
| | - Robert W McGarrah
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina
| | - Tracy A DeWald
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina; Divisions of Clinical Pharmacology, Duke University Hospital, Durham, North Carolina
| | - Devdutta Sangvai
- Duke Population Health Management Office, Durham, North Carolina
| | - Manesh R Patel
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Neha J Pagidipati
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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48
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Weissler EH, Osazuwa-Peters OL, Greiner MA, Hardy NC, Kougias P, O’Brien SM, Mark DB, Jones WS, Secemsky EA, Vekstein AM, Shalhub S, Mussa FF, Patel MR, Vemulapalli S. Initial Thoracic Endovascular Aortic Repair vs Medical Therapy for Acute Uncomplicated Type B Aortic Dissection. JAMA Cardiol 2023; 8:44-53. [PMID: 36334259 PMCID: PMC9637274 DOI: 10.1001/jamacardio.2022.4187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
Importance Thoracic endovascular aortic repair (TEVAR) has increasingly been used for uncomplicated type B aortic dissection (uTBAD) despite limited supporting data. Objective To assess whether initial TEVAR following uTBAD is associated with reduced mortality or morbidity compared with medical therapy alone. Design, Setting, and Participants This cohort study included Centers for Medicare & Medicaid Services inpatient claims data for adults aged 65 years or older with index admissions for acute uTBAD from January 1, 2011, to December 31, 2018, with follow-up available through December 31, 2019. Exposures Initial TEVAR was defined as TEVAR within 30 days of admission for acute uTBAD. Main Outcomes and Measures Outcomes included all-cause mortality, cardiovascular hospitalizations, aorta-related and repeated aorta-related hospitalizations, and aortic interventions associated with initial TEVAR vs medical therapy. Propensity score inverse probability weighting was used. Results Of 7105 patients with eligible index admissions for acute uTBAD, 1140 (16.0%) underwent initial TEVAR (623 [54.6%] female; median age, 74 years [IQR, 68-80 years]) and 5965 (84.0%) did not undergo TEVAR (3344 [56.1%] female; median age, 76 years [IQR, 69-83 years]). Receipt of TEVAR was associated with region (vs South; Midwest: adjusted odds ratio [aOR], 0.66 [95% CI, 0.53-0.81]; P < .001; Northeast: aOR, 0.63 [95% CI, 0.50-0.79]; P < .001), Medicaid dual eligibility (aOR, 0.76; 95% CI, 0.63-0.91; P = .003), hypertension (aOR, 1.26; 95% CI, 1.03-1.54; P = .03), peripheral vascular disease (aOR, 1.24; 95% CI, 1.02-1.49; P = .03), and year of admission (2012, 2013, 2014, and 2015 were associated with greater odds of TEVAR compared with 2011). After inverse probability weighting, mortality was similar for the 2 strategies up to 5 years (hazard ratio [HR], 0.95; 95% CI, 0.85-1.06), as were aorta-related hospitalizations (HR, 1.12; 95% CI, 0.99-1.27), aortic interventions (HR, 1.01; 95% CI, 0.84-1.20), and cardiovascular hospitalizations (HR, 1.05; 95% CI, 0.93-1.20). In a sensitivity analysis that included deaths within the first 30 days, initial TEVAR was associated with lower mortality over a period of 1 year (adjusted HR [aHR], 0.86; 95% CI, 0.75-0.99; P = .03), 2 years (aHR, 0.85; 95% CI, 0.75-0.96; P = .008), and 5 years (aHR, 0.87; 95% CI, 0.80-0.96; P = .004). Conclusions and Relevance In this study, 16.0% of patients underwent initial TEVAR within 30 days of uTBAD, and receipt of initial TEVAR was associated with hypertension, peripheral vascular disease, region, Medicaid dual eligibility, and year of admission. Initial TEVAR was not associated with improved mortality or reduced hospitalizations or aortic interventions over a period of 5 years, but in a sensitivity analysis that included deaths within the first 30 days, initial TEVAR was associated with lower mortality. These findings, along with cost-effectiveness and quality of life, should be assessed in a prospective trial in the US population.
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Affiliation(s)
- E. Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Melissa A. Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - N. Chantelle Hardy
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Panagiotis Kougias
- Division of Vascular and Endovascular Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York
| | | | - Daniel B. Mark
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - W. Schuyler Jones
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Eric A. Secemsky
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrew M. Vekstein
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Sherene Shalhub
- Division of Vascular Surgery, University of Washington, Seattle
| | - Firas F. Mussa
- Section of Vascular Surgery, Imperial College London, London, England
| | - Manesh R. Patel
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- Duke University Medical Center, Durham, North Carolina
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49
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Bonaca MP, Szarek M, Debus ES, Nehler MR, Patel MR, Anand SS, Muehlhofer E, Berkowitz SD, Haskell LP, Bauersachs RM. Efficacy and safety of rivaroxaban versus placebo after lower extremity bypass surgery: A post hoc analysis of a "CASPAR like" outcome from VOYAGER PAD. Clin Cardiol 2022; 45:1143-1146. [PMID: 36251249 DOI: 10.1002/clc.23926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Clopidogrel and Acetylsalicylic Acid in Bypass Surgery for Peripheral Arterial Disease (CASPAR) trial is the only large, double-blind, placebo-controlled trial of dual antiplatelet therapy (DAPT) versus aspirin in patients with peripheral artery disease (PAD) after lower extremity revascularization (LER). The trial was neutral for index-graft occlusion/revascularization, amputation or death (hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.78-1.23, p = .87) with an excess of global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries moderate or severe bleeding (HR 2.84, 95% CI 1.32-6.08, p = .007). HYPOTHESIS AND METHODS VOYAGER-PAD demonstrated that rivaroxaban significantly reduces acute limb ischemia (ALI), major amputation, myocardial infarction (MI), stroke and CV death but increased bleeding. The relative efficacy and safety of rivaroxaban in a CASPAR like population and for similar outcomes is unknown. The current analysis is a post-hoc exploratory analysis of a "CASPAR like" composite of ALI, unplanned index limb revascularization (UILR), amputation or CV death in surgical patients. RESULTS In the 2185 who underwent surgical LER, rivaroxaban reduced the CASPAR endpoint at 1 (HR 0.76, 95% CI 0.62-0.95, p = .0133) and 3 years (HR 0.84, 95% CI 0.71-1.00, p = .0461, Figure). There were similar reductions in composites of ALI, amputation or CV death (HR 0.79, p = .0228) and ALI, UILR, amputation, MI, IS or CV death (HR 0.85, p = .0410). CONCLUSIONS The combination of rivaroxaban and aspirin significantly reduces ischemic outcomes in patients with PAD after LER. Although no formal head-to-head comparison exists, in a similar population and for similar outcomes, this regimen demonstrated benefit where trials of DAPT were neutral. These data suggest that factor Xa inhibition may provide specific benefits in this population and that DAPT should not be considered a proven substitution.
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Affiliation(s)
- Marc P Bonaca
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
| | - Michael Szarek
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
| | - E Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery - Angiology - Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Mark R Nehler
- CPC Clinical Research, Aurora, Colorado, USA.,Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Manesh R Patel
- Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Scott D Berkowitz
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
| | | | - Rupert M Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, and Center for Thrombosis and Hemostasis, University of Mainz, Mainz, Germany
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50
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Kester KM, Hatton J, Kelly J, Carroll M, Lindsay M, Jordan N, Fuchs MA, Patel MR, Engel J, Granger B. Moving nursing innovation to prime time through the use of creative partnerships. Nurs Outlook 2022; 70:820-826. [PMID: 36154773 DOI: 10.1016/j.outlook.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
Nurses are well-positioned to solve many problems in healthcare through engagement in innovation. Support from healthcare organizations to facilitate creative partnerships may accelerate nurses' ability to innovate and improve job satisfaction. The value of creative partnerships is rooted in the diversity of experiences and skillsets of each project team member. While nurses may be content experts and key stakeholders, they often lack experience with project management, information technology, product development, and other important skills. We describe the use of co-creation approaches in creative partnerships with diverse stakeholders to enhance the ability of nurse-led project teams to build valuable and sustainable products or services.
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Affiliation(s)
| | | | - Joe Kelly
- Duke University Hospital, Durham, NC
| | | | | | | | | | | | - Jill Engel
- Duke University Health System, Durham, NC
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