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Lee SE, Hong Y, Hong J, Jung J, Sung JM, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Chun EJ, Conte E, Gottlieb I, Hadamitzky M, Kim YJ, Lee BK, Leipsic JA, Maffei E, Marques H, Gonçalves PDA, Pontone G, Shin S, Stone PH, Samady H, Virmani R, Narula J, Shaw LJ, Bax JJ, Lin FY, Min JK, Chang HJ. Prediction of the development of new coronary atherosclerotic plaques with radiomics. J Cardiovasc Comput Tomogr 2024; 18:274-280. [PMID: 38378314 DOI: 10.1016/j.jcct.2024.02.003] [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: 11/20/2023] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Radiomics is expected to identify imaging features beyond the human eye. We investigated whether radiomics can identify coronary segments that will develop new atherosclerotic plaques on coronary computed tomography angiography (CCTA). METHODS From a prospective multinational registry of patients with serial CCTA studies at ≥ 2-year intervals, segments without identifiable coronary plaque at baseline were selected and radiomic features were extracted. Cox models using clinical risk factors (Model 1), radiomic features (Model 2) and both clinical risk factors and radiomic features (Model 3) were constructed to predict the development of a coronary plaque, defined as total PV ≥ 1 mm3, at follow-up CCTA in each segment. RESULTS In total, 9583 normal coronary segments were identified from 1162 patients (60.3 ± 9.2 years, 55.7% male) and divided 8:2 into training and test sets. At follow-up CCTA, 9.8% of the segments developed new coronary plaque. The predictive power of Models 1 and 2 was not different in both the training and test sets (C-index [95% confidence interval (CI)] of Model 1 vs. Model 2: 0.701 [0.690-0.712] vs. 0.699 [0.0.688-0.710] and 0.696 [0.671-0.725] vs. 0.0.691 [0.667-0.715], respectively, all p > 0.05). The addition of radiomic features to clinical risk factors improved the predictive power of the Cox model in both the training and test sets (C-index [95% CI] of Model 3: 0.772 [0.762-0.781] and 0.767 [0.751-0.787], respectively, all p < 00.0001 compared to Models 1 and 2). CONCLUSION Radiomic features can improve the identification of segments that would develop new coronary atherosclerotic plaque. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT0280341.
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Affiliation(s)
- Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea; CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Youngtaek Hong
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jongsoo Hong
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Juyeong Jung
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Min Sung
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Daniele Andreini
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA, USA
| | | | | | | | - Eun Ju Chun
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
| | | | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Dental and Surgical Sciences, University of Milan, Milan, Italy
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Peter H Stone
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Habib Samady
- Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Jagat Narula
- University of Texas Health Houston, Houston, TX, USA
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fay Y Lin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Hyuk-Jae Chang
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
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Elshawi R, Sakr S, Al-Mallah MH, Keteyian SJ, Brawner CA, Ehrman JK. FIT calculator: a multi-risk prediction framework for medical outcomes using cardiorespiratory fitness data. Sci Rep 2024; 14:8745. [PMID: 38627439 PMCID: PMC11021455 DOI: 10.1038/s41598-024-59401-z] [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: 08/25/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
Accurately predicting patients' risk for specific medical outcomes is paramount for effective healthcare management and personalized medicine. While a substantial body of literature addresses the prediction of diverse medical conditions, existing models predominantly focus on singular outcomes, limiting their scope to one disease at a time. However, clinical reality often entails patients concurrently facing multiple health risks across various medical domains. In response to this gap, our study proposes a novel multi-risk framework adept at simultaneous risk prediction for multiple clinical outcomes, including diabetes, mortality, and hypertension. Leveraging a concise set of features extracted from patients' cardiorespiratory fitness data, our framework minimizes computational complexity while maximizing predictive accuracy. Moreover, we integrate a state-of-the-art instance-based interpretability technique into our framework, providing users with comprehensive explanations for each prediction. These explanations afford medical practitioners invaluable insights into the primary health factors influencing individual predictions, fostering greater trust and utility in the underlying prediction models. Our approach thus stands to significantly enhance healthcare decision-making processes, facilitating more targeted interventions and improving patient outcomes in clinical practice. Our prediction framework utilizes an automated machine learning framework, Auto-Weka, to optimize machine learning models and hyper-parameter configurations for the simultaneous prediction of three medical outcomes: diabetes, mortality, and hypertension. Additionally, we employ a local interpretability technique to elucidate predictions generated by our framework. These explanations manifest visually, highlighting key attributes contributing to each instance's prediction for enhanced interpretability. Using automated machine learning techniques, the models simultaneously predict hypertension, mortality, and diabetes risks, utilizing only nine patient features. They achieved an average AUC of 0.90 ± 0.001 on the hypertension dataset, 0.90 ± 0.002 on the mortality dataset, and 0.89 ± 0.001 on the diabetes dataset through tenfold cross-validation. Additionally, the models demonstrated strong performance with an average AUC of 0.89 ± 0.001 on the hypertension dataset, 0.90 ± 0.001 on the mortality dataset, and 0.89 ± 0.001 on the diabetes dataset using bootstrap evaluation with 1000 resamples.
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Affiliation(s)
- Radwa Elshawi
- Institute of Computer Science, University of Tartu, Tartu, Estonia.
| | - Sherif Sakr
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | | | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, 6525 Second Ave., Detroit, MI, 48202, USA
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, 6525 Second Ave., Detroit, MI, 48202, USA
| | - Jonathan K Ehrman
- Division of Cardiovascular Medicine, Henry Ford Hospital, 6525 Second Ave., Detroit, MI, 48202, USA
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3
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Ahmed AI, Al Rifai M, Alahdab F, Alfawara MS, Han Y, Nayfeh M, Mahmarian JJ, Nabi F, Soliman A, Patel K, Zoghbi WA, Al-Mallah MH. Prognostic Interplay Between Exercise Capacity and PET-Derived Myocardial Flow Reserve: FIT-PET Study. JACC Cardiovasc Imaging 2024; 17:460-462. [PMID: 38099913 DOI: 10.1016/j.jcmg.2023.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 04/05/2024]
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Al Rifai M, Al-Mallah MH, Blaha MJ, Patel J, McEvoy JW, Nasir K, Shahid I, Patel KV, Sharma G, Marrugat J, Tizon-Marcos H, Erbel R, Stang A, Jöckel KH, Lehmann N, Schramm S, Schmidt B, Blumenthal RS, Virani SS, Nambi V, Cainzos-Achirica M. Epidemiology and Prognostic Implications of Coronary Artery Calcium in Asymptomatic Individuals With Prediabetes: A Multicohort Study. Diabetes Care 2024; 47:698-706. [PMID: 38329795 DOI: 10.2337/dc23-1864] [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: 10/04/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To describe the epidemiology and prognostic value of coronary artery calcium (CAC) in individuals with prediabetes. RESEARCH DESIGN AND METHODS We pooled participants free of clinical atherosclerotic cardiovascular disease (ASCVD) from four prospective cohorts: the Multi-Ethnic Study of Atherosclerosis, Heinz Nixdorf Recall Study, Framingham Heart Study, and Jackson Heart Study. Two definitions were used for prediabetes: inclusive (fasting plasma glucose [FPG] ≥100 to <126 mg/dL and hemoglobin A1c [HbA1c] ≥5.7% to <6.5%, if available, and no glucose-lowering medications) and restrictive (FPG ≥110 to <126 mg/dL and HbA1c ≥5.7% to <6.5%, if available, among participants not taking glucose-lowering medications). RESULTS The study included 13,376 participants (mean age 58 years; 54% women; 57% White; 27% Black). The proportions with CAC ≥100 were 17%, 22%, and 37% in those with euglycemia, prediabetes, and diabetes, respectively. Over a median (25th-75th percentile) follow-up time of 14.6 (interquartile range 7.8-16.4) years, individuals with prediabetes and CAC ≥100 had a higher unadjusted 10-year incidence of ASCVD (13.4%) than the overall group of those with diabetes (10.6%). In adjusted analyses, using the inclusive definition of prediabetes, compared with euglycemia, the hazard ratios (HRs) for ASCVD were 0.79 (95% CI 0.62, 1.01) for prediabetes and CAC 0, 0.70 (0.54, 0.89) for prediabetes and CAC 1-99, 1.54 (1.27, 1.88) for prediabetes and CAC ≥100, and 1.64 (1.39, 1.93) for diabetes. Using the restrictive definition, the HR for ASCVD was 1.63 (1.29, 2.06) for prediabetes and CAC ≥100. CONCLUSIONS CAC ≥100 is frequent among individuals with prediabetes and identifies a high ASCVD risk subgroup in which the adjusted ASCVD risk is similar to that in individuals with diabetes.
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Affiliation(s)
| | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- Johns Hopkins Heart Center, Greater Baltimore Medical Center, Baltimore, MD
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Houston Methodist Academic Institute, Houston, TX
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Izza Shahid
- Houston Methodist Academic Institute, Houston, TX
| | - Kershaw V Patel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Houston Methodist Academic Institute, Houston, TX
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- Inova Women's Cardiovascular Health, Fairfax, VA
| | - Jaume Marrugat
- Hospital del Mar, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Helena Tizon-Marcos
- Hospital del Mar, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Salim S Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Houston, TX
- Baylor College of Medicine, Houston, TX
| | - Vijay Nambi
- Section of Cardiology, Baylor College of Medicine, Houston, TX
- Center for Cardiometabolic Disease Prevention, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
- Hospital del Mar, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
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5
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Pontone G, Rossi A, Baggiano A, Andreini D, Conte E, Fusini L, Gebhard C, Rabbat MG, Guaricci A, Guglielmo M, Muscogiuri G, Mushtaq S, Al-Mallah MH, Berman DS, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Chun EJ, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Kim YJ, Lee BK, Lee SE, Maffei E, Marques H, Samady H, Shin S, Sung JM, van Rosendael A, Virmani R, Bax JJ, Leipsic JA, Lin FY, Min JK, Narula J, Shaw LJ, Chang HJ. Progression of non-obstructive coronary plaque: a practical CCTA-based risk score from the PARADIGM registry. Eur Radiol 2024; 34:2665-2676. [PMID: 37750979 DOI: 10.1007/s00330-023-09880-x] [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: 09/18/2022] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES No clear recommendations are endorsed by the different scientific societies on the clinical use of repeat coronary computed tomography angiography (CCTA) in patients with non-obstructive coronary artery disease (CAD). This study aimed to develop and validate a practical CCTA risk score to predict medium-term disease progression in patients at a low-to-intermediate probability of CAD. METHODS Patients were part of the Progression of AtheRosclerotic PlAque Determined by Computed Tomographic Angiography Imaging (PARADIGM) registry. Specifically, 370 (derivation cohort) and 219 (validation cohort) patients with two repeat, clinically indicated CCTA scans, non-obstructive CAD, and absence of high-risk plaque (≥ 2 high-risk features) at baseline CCTA were included. Disease progression was defined as the new occurrence of ≥ 50% stenosis and/or high-risk plaque at follow-up CCTA. RESULTS In the derivation cohort, 104 (28%) patients experienced disease progression. The median time interval between the two CCTAs was 3.3 years (2.7-4.8). Odds ratios for disease progression derived from multivariable logistic regression were as follows: 4.59 (95% confidence interval: 1.69-12.48) for the number of plaques with spotty calcification, 3.73 (1.46-9.52) for the number of plaques with low attenuation component, 2.71 (1.62-4.50) for 25-49% stenosis severity, 1.47 (1.17-1.84) for the number of bifurcation plaques, and 1.21 (1.02-1.42) for the time between the two CCTAs. The C-statistics of the model were 0.732 (0.676-0.788) and 0.668 (0.583-0.752) in the derivation and validation cohorts, respectively. CONCLUSIONS The new CCTA-based risk score is a simple and practical tool that can predict mid-term CAD progression in patients with known non-obstructive CAD. CLINICAL RELEVANCE STATEMENT The clinical implementation of this new CCTA-based risk score can help promote the management of patients with non-obstructive coronary disease in terms of timing of imaging follow-up and therapeutic strategies. KEY POINTS • No recommendations are available on the use of repeat CCTA in patients with non-obstructive CAD. • This new CCTA score predicts mid-term CAD progression in patients with non-obstructive stenosis at baseline. • This new CCTA score can help guide the clinical management of patients with non-obstructive CAD.
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Affiliation(s)
- Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Daniele Andreini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Edoardo Conte
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Chaterine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Edward Hines Jr. VA Hospital, Hines, Chicago, IL, USA
| | - Andrea Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico of Bari, Bari, Italy
| | - Marco Guglielmo
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giuseppe Muscogiuri
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | | | | | | | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Pedro de Araújo Gonçalves
- Unit of Cardiovascular Imaging, UNICA, Hospital da Luz, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Cardiovascular Center, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
- Yonsei‑Cedars‑Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR, Marche, Urbino, Italy
| | - Hugo Marques
- Unit of Cardiovascular Imaging, UNICA, Hospital da Luz, Lisbon, Portugal
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Ji Min Sung
- Yonsei‑Cedars‑Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Alexander van Rosendael
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Turku Heart Center, University of Turku, Turku University Hospital, Turku, Finland
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Hyuk-Jae Chang
- Yonsei‑Cedars‑Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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Khan SU, Al-Mallah MH. Air pollution and acute coronary syndrome: The air we breathe. Atherosclerosis 2024; 390:117453. [PMID: 38262845 DOI: 10.1016/j.atherosclerosis.2024.117453] [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] [Received: 12/14/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Safi U Khan
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Mouaz H Al-Mallah
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
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7
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Al-Mallah MH, Al Rifai M. Enhancing precision in test choice: Time for a personalized approach. J Nucl Cardiol 2024; 32:101792. [PMID: 38185407 DOI: 10.1016/j.nuclcard.2023.101792] [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] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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8
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Han Y, Ahmed AI, Saad JM, Alahdab F, Al Rifai MS, Murthy VL, Al-Mallah MH. Ejection fraction and ventricular volumes on rubidium positron emission tomography: Validation against cardiovascular magnetic resonance. J Nucl Cardiol 2024; 32:101810. [PMID: 38286326 DOI: 10.1016/j.nuclcard.2024.101810] [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] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/09/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) is the non-invasive gold standard for non-invasively determining left ventricular volumes (LVVs) and ejection fraction (EF). We aimed to assess the accuracy of LVV and left ventricular ejection fraction measured by positron emission tomography (PET) as compared to CMR. METHODS Patients who underwent both PET and CMR within 1 year were identified from prospective institutional registries. Analysis was performed to evaluate the agreement between the raw and body-surface-area-normalized left ventricular volume (LVV) and EF derived from PET vs. those derived from CMR. RESULTS The study population consisted of 669 patients (mean age 62 ± 13 years, 65% male). The median (interquartile range [IQR]) duration between CMR and PET imaging was 36 (7-118) days. The median (IQR) EF values were 52% (38-63%) on CMR and 53% (37-65%) on PET (mean difference: 0.53% ± 9.1, P = 0.129) with a strong correlation (Spearman rho = 0.84, P < 0.001; Intraclass Correlation Coefficient 0.84, 95% confidence interval [CI]: 0.82-0.86, P < 0.001; Lin's concordance correlation coefficient was 0.844, 95% CI: 0.822 to 0.865). Results were similar with LVV, normalized LVV/EF, and in subgroups of patients with reduced EF, coronary artery disease scar, and LV hypertrophy as well as in patients with defibrillators. However, PET tended to underestimate LVV compared to CMR. CONCLUSION Our analysis showed a strong correlation of EF and LVV by PET against a reference standard of CMR, whereas PET significantly underestimated LVV, but not EF, compared to CMR.
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Affiliation(s)
- Yushui Han
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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9
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Alqarni A, Aljizeeri A, Bakhsh AM, El-Zeftawy HAM, Farghaly HR, Alqadhi MAM, Algarni M, Asiri ZM, Osman A, Haddadin H, Alayary I, Al-Mallah MH. Best Practices in Nuclear Imaging for the Diagnosis of Transthyretin Amyloid Cardiomyopathy (ATTR-CM) in KSA: The Eagle Eyes of Local Experts. Diagnostics (Basel) 2024; 14:212. [PMID: 38248088 PMCID: PMC10814030 DOI: 10.3390/diagnostics14020212] [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: 11/01/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a complex and serious form of heart failure caused by the accumulation of transthyretin amyloid protein in the heart muscle. Variable symptoms of ATTR-CM can lead to a delayed diagnosis. Recognizing the diagnostic indicators is crucial to promptly detect this condition. A targeted literature review was conducted to examine the latest international consensus recommendations on a comprehensive diagnosis of ATTR-CM. Additionally, a panel consisting of nuclear medicine expert consultants (n = 10) and nuclear imaging technicians (n = 2) convened virtually from the Kingdom of Saudi Arabia (KSA) to formulate best practices for ATTR-CM diagnosis. The panel reached a consensus on a standard diagnostic pathway for ATTR-CM, which commences by evaluating the presence of clinical red flags and initiating a cardiac workup to assess the patient's echocardiogram. Cardiac magnetic resonance imaging may be needed, in uncertain cases. When there is a high suspicion of ATTR-CM, patients undergo nuclear scintigraphy and hematologic tests to rule out primary or light-chain amyloidosis. The expert panel emphasized that implementing best practices will support healthcare professionals in KSA to improve their ability to detect and diagnose ATTR-CM more accurately and promptly. Diagnosing ATTR-CM accurately and early can reduce morbidity and mortality rates through appropriate treatment.
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Affiliation(s)
- Abdullah Alqarni
- Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia; (A.A.); (H.R.F.)
| | - Ahmed Aljizeeri
- King Abdulaziz Cardiac Center, Ministry of the National Guard Health Affairs, Riyadh 14626, Saudi Arabia;
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 21423, Saudi Arabia
| | | | | | - Hussein R. Farghaly
- Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia; (A.A.); (H.R.F.)
| | | | - Mushref Algarni
- King Fahad Military Medical Complex, Dhahran 34313, Saudi Arabia;
| | | | - Ahmed Osman
- Pfizer Inc., Riyadh 13244, Saudi Arabia; (A.O.)
| | - Haya Haddadin
- Pfizer Gulf FZ LLC, Dubai 29553, United Arab Emirates;
| | | | - Mouaz H. Al-Mallah
- Houston Methodist, Weill Cornell Medical College, Houston, TX 77030, USA
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10
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Sanghani R, Al-Mallah MH, Thompson R. Challenges and strategies to enable access to cardiac positron emission tomography in different parts of the world: The North American perspective. J Nucl Cardiol 2024; 31:101790. [PMID: 38216083 DOI: 10.1016/j.nuclcard.2023.101790] [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] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Rupa Sanghani
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Randall Thompson
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
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11
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Al-Mallah MH. ASNC without borders: A global effort in nuclear cardiology. J Nucl Cardiol 2023; 30:2972-2975. [PMID: 37815667 DOI: 10.1007/s12350-023-03388-z] [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] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower, Suite 1801, Houston, TX, 77030, USA.
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12
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Moody JB, Poitrasson-Rivière A, Renaud JM, Hagio T, Al-Mallah MH, Weinberg RL, Ficaro EP, Murthy VL. Integrated myocardial flow reserve (iMFR) assessment: diffuse atherosclerosis and microvascular dysfunction are more strongly associated with mortality than focally impaired perfusion. Eur J Nucl Med Mol Imaging 2023; 51:123-135. [PMID: 37787848 DOI: 10.1007/s00259-023-06448-1] [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: 07/16/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND AND AIMS Although treatment of ischemia-causing epicardial stenoses may improve symptoms of ischemia, current evidence does not suggest that revascularization improves survival. Conventional myocardial ischemia imaging does not uniquely identify diffuse atherosclerosis, microvascular dysfunction, or nonobstructive epicardial stenoses. We sought to evaluate the prognostic value of integrated myocardial flow reserve (iMFR), a novel noninvasive approach to distinguish the perfusion impact of focal atherosclerosis from diffuse coronary disease. METHODS This study analyzed a large single-center registry of consecutive patients clinically referred for rest-stress myocardial perfusion positron emission tomography. Cox proportional hazards modeling was used to assess the association of two previously reported and two novel perfusion measures with mortality risk: global stress myocardial blood flow (MBF); global myocardial flow reserve (MFR); and two metrics derived from iMFR analysis: the extents of focal and diffusely impaired perfusion. RESULTS In total, 6867 patients were included with a median follow-up of 3.4 years [1st-3rd quartiles, 1.9-5.0] and 1444 deaths (21%). Although all evaluated perfusion measures were independently associated with death, diffusely impaired perfusion extent (hazard ratio 2.65, 95%C.I. [2.37-2.97]) and global MFR (HR 2.29, 95%C.I. [2.08-2.52]) were consistently stronger predictors than stress MBF (HR 1.62, 95%C.I. [1.46-1.79]). Focally impaired perfusion extent (HR 1.09, 95%C.I. [1.03-1.16]) was only moderately related to mortality. Diffusely impaired perfusion extent remained a significant independent predictor of death when combined with global MFR (p < 0.0001), providing improved risk stratification (overall net reclassification improvement 0.246, 95%C.I. [0.183-0.310]). CONCLUSIONS The extent of diffusely impaired perfusion is a strong independent and additive marker of mortality risk beyond traditional risk factors, standard perfusion imaging, and global MFR, while focally impaired perfusion is only moderately related to mortality.
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Affiliation(s)
| | | | | | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Richard L Weinberg
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Edward P Ficaro
- INVIA, LLC, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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13
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Poitrasson-Rivière A, Moody JB, Renaud JM, Hagio T, Arida-Moody L, Buckley CJ, Al-Mallah MH, Nallamothu BK, Weinberg RL, Ficaro EP, Murthy VL. Integrated myocardial flow reserve (iMFR) assessment: optimized PET blood flow quantification for diagnosis of coronary artery disease. Eur J Nucl Med Mol Imaging 2023; 51:136-146. [PMID: 37807004 DOI: 10.1007/s00259-023-06455-2] [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: 07/29/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Distinguishing obstructive epicardial coronary artery disease (CAD) from microvascular dysfunction and diffuse atherosclerosis would be of immense benefit clinically. However, quantitative measures of absolute myocardial blood flow (MBF) integrate the effects of focal epicardial stenosis, diffuse atherosclerosis, and microvascular dysfunction. In this study, MFR and relative perfusion quantification were combined to create integrated MFR (iMFR) which was evaluated using data from a large clinical registry and an international multi-center trial and validated against invasive coronary angiography (ICA). METHODS This study included 1,044 clinical patients referred for 82Rb rest/stress positron emission tomography myocardial perfusion imaging and ICA, along with 231 patients from the Flurpiridaz 301 trial (clinicaltrials.gov NCT01347710). MFR and relative perfusion quantification were combined to create an iMFR map. The incremental value of iMFR was evaluated for diagnosis of obstructive stenosis, adjusted for patient demographics and pre-test probability of CAD. Models for high-risk anatomy (left main or three-vessel disease) were also constructed. RESULTS iMFR parameters of focally impaired perfusion resulted in best fitting diagnostic models. Receiver-operating characteristic analysis showed a slight improvement compared to standard quantitative perfusion approaches (AUC 0.824 vs. 0.809). Focally impaired perfusion was also associated with high-risk CAD anatomy (OR 1.40 for extent, and OR 2.40 for decreasing mean MFR). Diffusely impaired perfusion was associated with lower likelihood of obstructive CAD, and, in the absence of transient ischemic dilation (TID), with lower likelihood of high-risk CAD anatomy. CONCLUSIONS Focally impaired perfusion extent derived from iMFR assessment is a powerful incremental predictor of obstructive CAD while diffusely impaired perfusion extent can help rule out obstructive and high-risk CAD in the absence of TID.
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Affiliation(s)
| | - Jonathan B Moody
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA
| | - Jennifer M Renaud
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA
| | - Tomoe Hagio
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA
| | - Liliana Arida-Moody
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Richard L Weinberg
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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14
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Chareonthaitawee P, Bateman TM, Beanlands RS, Berman DS, Calnon DA, Di Carli MF, Heller GV, Murthy VL, Patel KK, Schindler TH, Taqueti VR, Wiefels CC, Al-Mallah MH. Atlas for reporting PET myocardial perfusion imaging and myocardial blood flow in clinical practice: an information statement from the American Society of Nuclear Cardiology. J Nucl Cardiol 2023; 30:2850-2906. [PMID: 37889459 DOI: 10.1007/s12350-023-03378-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
| | - Timothy M Bateman
- Department of Cardiology, Saint-Luke's Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Rob S Beanlands
- Division of Cardiology, University of Ottawa, Ottawa, Canada
| | - Daniel S Berman
- Nuclear Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Gary V Heller
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Ann Arbor, MI, USA
| | | | - Thomas H Schindler
- Department of Cardiovascular Diseases, Washington University Physicians, St. Louis, MO, USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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15
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Alfawara MS, Al Rifai M, Nayfeh M, Chamsi-Pasha MAR, Al-Mallah MH. Unveiling the Hidden Patterns: Multimodality Cardiac Imaging in Takotsubo Cardiomyopathy Diagnosis. Methodist Debakey Cardiovasc J 2023; 19:73-76. [PMID: 38028970 PMCID: PMC10655750 DOI: 10.14797/mdcvj.1288] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is a reversible form of cardiomyopathy characterized by reduced ejection fraction with regional wall motion abnormalities, elevated cardiac enzyme levels, and signs of ischemia on electrocardiogram despite the absence of obstructive epicardial coronary artery disease. It is often preceded by intense emotional or physical illness stressors. This case describes a 65-year-old female patient who likely developed takotsubo cardiomyopathy precipitated by the stress of diverticulitis.
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Affiliation(s)
- Moath Said Alfawara
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Malek Nayfeh
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | | | - Mouaz H. Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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16
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Jonas R, Patel T, Crabtree TR, Jennings RS, Heo R, Park HB, Marques H, Chang HJ, Stuijfzand WJ, Rosendael ARV, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Shin SH, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Al-Mallah MH, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson RC, Jang JJ, Ridner M, Rowan C, Avelar E, Généreux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Bax JJ, Choi AD, Earls JP, Hoffmann U, Min JK, Villines TC. Corrigendum to 'Relation of Gender to Atherosclerotic Plaque Characteristics by Differing Angiographic Stenosis Severity' The American Journal of Cardiology, Volume 204, 1 October 2023, Pages 276-283. Am J Cardiol 2023; 207:523. [PMID: 37925201 DOI: 10.1016/j.amjcard.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Affiliation(s)
- Rebecca Jonas
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut.
| | - Toral Patel
- Department of Cardiology and Advanced Cardiac Imaging, Centra Heart and Vascular Institute, Lynchburg, Virginia
| | | | | | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea College of Medicine, Hanyang University, Seoul, Korea
| | - Hyung-Bok Park
- Division of Cardiology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Hugo Marques
- Faculdade de Medicina da Universidade Católica Portuguesa, Lisboa, Portugal
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Wijnand J Stuijfzand
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jung Hyun Choi
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University, College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chang-Wook Nam
- Department of Cardiology, Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Sang-Hoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Women's University Seoul Hospital, Seoul, South Korea
| | - Jason Cole
- Mobile Cardiology Associates, Mobile, Alabama
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Bin Lu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yang Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Faisal Nabi
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Ryo Nakazato
- Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan
| | - U Joseph Schoepf
- Department of Cardiology, Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Roel S Driessen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Michiel J Bom
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | | | - James J Jang
- Kaiser Permanente San Jose Medical Center, San Jose, California
| | | | - Chris Rowan
- Renown Heart and Vascular Institute, Reno, Nevada
| | - Erick Avelar
- Oconee Heart and Vascular Center at St Mary's Hospital, Athens, Georgia
| | - Philippe Généreux
- Gagnon Cardiovascular Institute at Morristown Medical Center, Morristown, New Jersey
| | - Paul Knaapen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Guus A de Waard
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Gianluca Pontone
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan Italy; Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Daniele Andreini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan Italy; Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew D Choi
- Department of Radiology, Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | | | | | | | - Todd C Villines
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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17
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Cardoso R, Choi AD, Shiyovich A, Besser SA, Min JK, Earls J, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Chun EJ, Conte E, Gottlieb I, Hadamitzky M, Kim YJ, Lee BK, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Lee SE, Sung JM, Virmani R, Samady H, Lin FY, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Chang HJ, Blankstein R. How early can atherosclerosis be detected by coronary CT angiography? Insights from quantitative CT analysis of serial scans in the PARADIGM trial. J Cardiovasc Comput Tomogr 2023; 17:407-412. [PMID: 37798157 DOI: 10.1016/j.jcct.2023.08.012] [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: 03/22/2023] [Revised: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Non-obstructing small coronary plaques may not be well recognized by expert readers during coronary computed tomography angiography (CCTA) evaluation. Recent developments in atherosclerosis imaging quantitative computed tomography (AI-QCT) enabled by machine learning allow for whole-heart coronary phenotyping of atherosclerosis, but its diagnostic role for detection of small plaques on CCTA is unknown. METHODS We performed AI-QCT in patients who underwent serial CCTA in the multinational PARADIGM study. AI-QCT results were verified by a level III experienced reader, who was blinded to baseline and follow-up status of CCTA. This retrospective analysis aimed to characterize small plaques on baseline CCTA and evaluate their serial changes on follow-up imaging. Small plaques were defined as a total plaque volume <50 mm3. RESULTS A total of 99 patients with 502 small plaques were included. The median total plaque volume was 6.8 mm3 (IQR 3.5-13.9 mm3), most of which was non-calcified (median 6.2 mm3; 2.9-12.3 mm3). The median age at the time of baseline CCTA was 61 years old and 63% were male. The mean interscan period was 3.8 ± 1.6 years. On follow-up CCTA, 437 (87%) plaques were present at the same location as small plaques on baseline CCTA; 72% were larger and 15% decreased in volume. The median total plaque volume and non-calcified plaque volume increased to 18.9 mm3 (IQR 8.3-45.2 mm3) and 13.8 mm3 (IQR 5.7-33.4 mm3), respectively, among plaques that persisted on follow-up CCTA. Small plaques no longer visualized on follow-up CCTA were significantly more likely to be of lower volume, shorter in length, non-calcified, and more distal in the coronary artery, as compared with plaques that persisted at follow-up. CONCLUSION In this retrospective analysis from the PARADIGM study, small plaques (<50 mm3) identified by AI-QCT persisted at the same location and were often larger on follow-up CCTA.
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Affiliation(s)
- Rhanderson Cardoso
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Andrew D Choi
- Department of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Arthur Shiyovich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephanie A Besser
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA, USA
| | | | | | | | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | | | - Ilan Gottlieb
- Department of Radiology, Casa de Saude Sao Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Younsei University College of Medicine, Seoul, South Korea
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | | | | | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University, Seoul, South Korea
| | - Ji Min Sung
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA, USA
| | - Fay Y Lin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter H Stone
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Jagat Narula
- University of Texas Health Houston, Houston, TX, USA
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Hyuk-Jae Chang
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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18
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Al Rifai M, Ahmed AI, Saad JM, Alahdab F, Nabi F, Al-Mallah MH. Prognostic value of global myocardial flow reserve in patients with history of coronary artery bypass grafting. Eur Heart J Cardiovasc Imaging 2023; 24:1470-1477. [PMID: 37485990 DOI: 10.1093/ehjci/jead120] [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: 03/09/2023] [Accepted: 05/14/2023] [Indexed: 07/25/2023] Open
Abstract
AIMS It is not well understood whether positron emission tomography (PET)-derived myocardial flow reserve (MFR) is prognostic among patients with prior coronary artery bypass grafting (CABG). METHODS AND RESULTS Consecutive patients with a clinical indication for PET were enrolled in the Houston Methodist DeBakey Heart and Vascular Center PET registry and followed prospectively for incident outcomes. The primary outcome was a composite of all-cause death, myocardial infarction (MI)/unplanned revascularization, and heart failure admissions. Cox proportional hazards models were used to study the association between MFR (<2 vs. ≥2) and incident events adjusting for clinical and myocardial perfusion imaging variables. The study population consisted of 836 patients with prior CABG; mean (SD) age 68 (10) years, 53% females, 79% Caucasian, 36% non-Hispanic, and 66% with MFR <2. Over a median (interquartile range [IQR]) follow-up time of 12 (4-24) months, there were 122 incident events (46 HF admissions, 28 all-cause deaths, 23 MI, 22 PCI/3 repeat CABG 90 days after imaging). In adjusted analyses, patients with impaired MFR had a higher risk of the primary outcome [hazard ratio (HR) 2.06; 95% CI 1.23-3.44]. Results were significant for admission for heart failure admissions (HR 2.92; 95% CI 1.11-7.67) but not for all-cause death (HR 2.01, 95% CI 0.85-4.79), or MI/UR (HR 1.93, 95% CI 0.92-4.05). CONCLUSION Among patients with a history of CABG, PET-derived global MFR <2 may identify those with a high risk of subsequent cardiovascular events, especially heart failure, independent of cardiovascular risk factors and perfusion data.
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Affiliation(s)
- Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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Ahmed AI, Al Rifai M, Alahdab F, Saad JM, Han Y, Alfawara MS, Nayfeh M, Malahfji M, Nabi F, Mahmarian JJ, Cooke JP, Zoghbi WA, Al-Mallah MH. Coronary microvascular health in symptomatic patients with prior COVID-19 infection: an updated analysis. Eur Heart J Cardiovasc Imaging 2023; 24:1544-1554. [PMID: 37254693 PMCID: PMC10610774 DOI: 10.1093/ehjci/jead118] [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: 03/10/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023] Open
Abstract
AIMS Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with endothelial dysfunction. We aimed to determine the effects of prior coronavirus disease 2019 (COVID-19) on the coronary microvasculature accounting for time from COVID-19, disease severity, SARS-CoV-2 variants, and in subgroups of patients with diabetes and those with no known coronary artery disease. METHODS AND RESULTS Cases consisted of patients with previous COVID-19 who had clinically indicated positron emission tomography (PET) imaging and were matched 1:3 on clinical and cardiovascular risk factors to controls having no prior infection. Myocardial flow reserve (MFR) was calculated as the ratio of stress to rest myocardial blood flow (MBF) in mL/min/g of the left ventricle. Comparisons between cases and controls were made for the odds and prevalence of impaired MFR (MFR < 2). We included 271 cases matched to 815 controls (mean ± SD age 65 ± 12 years, 52% men). The median (inter-quartile range) number of days between COVID-19 infection and PET imaging was 174 (58-338) days. Patients with prior COVID-19 had a statistically significant higher odds of MFR <2 (adjusted odds ratio 3.1, 95% confidence interval 2.8-4.25 P < 0.001). Results were similar in clinically meaningful subgroups. The proportion of cases with MFR <2 peaked 6-9 months from imaging with a statistically non-significant downtrend afterwards and was comparable across SARS-CoV-2 variants but increased with increasing severity of infection. CONCLUSION The prevalence of impaired MFR is similar by duration of time from infection up to 1 year and SARS-CoV-2 variants, but significantly differs by severity of infection.
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Affiliation(s)
- Ahmed Ibrahim Ahmed
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Yushui Han
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Moath Said Alfawara
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Malek Nayfeh
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Maan Malahfji
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - John J Mahmarian
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - John P Cooke
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - William A Zoghbi
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
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20
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Moody JB, Poitrasson-Rivière A, Renaud JM, Hagio T, Alahdab F, Al-Mallah MH, Vanderver MD, Ficaro EP, Murthy VL. Deep neural network for identification of impaired microvascular and vasomotor function from stress electrocardiography. medRxiv 2023:2023.10.25.23297552. [PMID: 37961713 PMCID: PMC10635192 DOI: 10.1101/2023.10.25.23297552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Impaired microvascular and vasomotor function is a common consequence of aging, diabetes, and other risk factors, and is associated with adverse cardiac outcomes. Such impairments are not readily identified by standard clinical methods of cardiovascular testing such as coronary angiography and noninvasive single photon emission tomography (SPECT) myocardial perfusion imaging (MPI). We hypothesized that signals embedded within stress electrocardiograms (ECGs) identify individuals with microvascular and vasomotor dysfunction. Methods We developed and validated a novel convolutional neural network (CNN) using stress and rest ECG data (ECG-Flow) to identify patients with impaired myocardial flow reserve (MFR) on quantitative positron emission tomography (PET) MPI (N=3887). Diagnostic accuracy was validated with an internal holdout set of patients undergoing stress PET MPI (N=963). The prognostic association of ECG-Flow with mortality was then evaluated in a separate cohort of patients undergoing SPECT MPI (N=5102). Results ECG-Flow achieved good diagnostic accuracy for impaired MFR in the holdout PET cohort (AUC, sensitivity, specificity: 0.737, 71.1%, 65.7%). Abnormal ECG-Flow was found to be significantly associated with mortality in both PET holdout and SPECT MPI cohorts (adjusted HR 2.12 [95 ρ CI 1.45, 2.10], ρ = 0.0001, and 2.07 [1.82, 2.36], ρ < 0.0001, respectively). Conclusion Signals predictive of microvascular and vasomotor dysfunction are embedded in stress ECG waveforms. These signals can be identified by deep learning methods and are related to prognosis in patients undergoing both stress PET and SPECT MPI.
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Williams C, Han D, Takagi H, Fordyce CB, Sellers S, Blanke P, Lin FY, Shaw LJ, Lee SE, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Bax JJ, Leipsic JA, Chang HJ. Effects of renin-angiotensin-aldosterone-system inhibitors on coronary atherosclerotic plaques: The PARADIGM registry. Atherosclerosis 2023; 383:117301. [PMID: 37769454 DOI: 10.1016/j.atherosclerosis.2023.117301] [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: 02/24/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND AND AIMS Inhibition of Renin-Angiotensin-Aldosterone-System (RAAS) has been hypothesized to improve endothelial function and reduce plaque inflammation, however, their impact on the progression of coronary atherosclerosis is unclear. We aim to study the effects of RAAS inhibitor on plaque progression and composition assessed by serial coronary CT angiography (CCTA). METHODS We performed a prospective, multinational study consisting of a registry of patients without history of CAD, who underwent serial CCTAs. Patients using RAAS inhibitors were propensity matched to RAAS inhibitor naïve patients based on clinical and CCTA characteristics at baseline. Atherosclerotic plaques in CCTAs were quantitatively analyzed for percent atheroma volume (PAV) according to plaque composition. Interactions between RAAS inhibitor use and baseline PAV on plaque progression were assessed in the unmatched cohort using a multivariate linear regression model. RESULTS Of 1248 patients from the registry, 299 RAAS inhibitor taking patients were matched to 299 RAAS inhibitor naïve patients. Over a mean interval of 3.9 years, there was no significant difference in annual progression of total PAV between RAAS inhibitor naïve vs taking patients (0.75 vs 0.79%/year, p = 0.66). With interaction testing in the unmatched cohort, however, RAAS inhibitor use was significantly associated with lower non-calcified plaque progression (Beta coefficient -0.100, adjusted p = 0.038) with higher levels of baseline PAV. CONCLUSIONS The use of RAAS inhibitors over a period of nearly 4 years did not significantly impact on total atherosclerotic plaque progression or various plaque components. However, interaction testing to assess the differential effect of RAAS inhibition based on baseline PAV suggested a significant decrease in progression of non-calcified plaque in patients with a higher burden of baseline atherosclerosis, which should be considered hypothesis generating.
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Affiliation(s)
- Curtis Williams
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donghee Han
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hidenobu Takagi
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Sellers
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Pedro de Araújo Gonçalves
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa, Italy
| | | | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eun Ju Chun
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Ji Min Sung
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea; Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Georgia Heart Institute, Gainesville, USA
| | - Peter H Stone
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Jonathon A Leipsic
- Department of Radiology and Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
| | - Hyuk-Jae Chang
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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22
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Malahfji M, Crudo V, Ahmed AI, Saeed M, Saad JM, Zoghbi WA, Al-Mallah MH. Coronary microvascular dysfunction and COVID-19: implications for long COVID patients. J Nucl Cardiol 2023; 30:2204-2206. [PMID: 35974260 PMCID: PMC9381148 DOI: 10.1007/s12350-022-03073-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/02/2022] [Indexed: 10/29/2022]
Affiliation(s)
- Maan Malahfji
- Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX 77030 USA
| | - Valentina Crudo
- Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX 77030 USA
| | - Ahmed Ibrahim Ahmed
- Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX 77030 USA
| | - Mujtaba Saeed
- Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX 77030 USA
| | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX 77030 USA
| | - William A. Zoghbi
- Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX 77030 USA
| | - Mouaz H. Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX 77030 USA
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23
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Nayfeh M, Ahmed AI, Al-Mallah MH. Unveiling the hidden link: deciphering the interplay between plaque characteristics and nuclear myocardial perfusion imaging. J Nucl Cardiol 2023; 30:1851-1855. [PMID: 37264216 DOI: 10.1007/s12350-023-03299-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Malek Nayfeh
- Beverly B. and Daniel C. Arnold Distinguished Chair, Houston Methodist Academic Institute, Weill Cornell Medicine, Cardiovascular PET, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Ahmed Ibrahim Ahmed
- Beverly B. and Daniel C. Arnold Distinguished Chair, Houston Methodist Academic Institute, Weill Cornell Medicine, Cardiovascular PET, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Mouaz H Al-Mallah
- Beverly B. and Daniel C. Arnold Distinguished Chair, Houston Methodist Academic Institute, Weill Cornell Medicine, Cardiovascular PET, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
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Al-Mallah MH. The heartbeat of tomorrow: welcoming the next generation of cardiologists. J Nucl Cardiol 2023; 30:2255-2257. [PMID: 37605059 DOI: 10.1007/s12350-023-03367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Mouaz H Al-Mallah
- Cardiovascular PET, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Academic Institute, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
- Weill Cornell Medicine, New York, NY, USA.
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25
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Cohen YA, Shetty M, Castillo M, Al-Mallah MH, Calnon DA, Einstein AJ. Thallium-201 Use in Medicare Patients From 2010-2021 and Implications of Potential Cessation of its Production. JACC Cardiovasc Imaging 2023; 16:1356-1358. [PMID: 37178078 DOI: 10.1016/j.jcmg.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/15/2023]
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Jonas R, Patel T, Crabtree TR, Jennings RS, Heo R, Park HB, Marques H, Chang HJ, Stuijfzand WJ, van Rosendael AR, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Shin SH, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Al-Mallah MH, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson RC, Jang JJ, Ridner M, Rowan C, Avelar E, Généreux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Bax JJ, Choi AD, Earls JP, Hoffmann U, Min JK, Villines TC. Relation of Gender to Atherosclerotic Plaque Characteristics by Differing Angiographic Stenosis Severity. Am J Cardiol 2023; 204:276-283. [PMID: 37562193 DOI: 10.1016/j.amjcard.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 06/07/2023] [Revised: 06/24/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023]
Abstract
It is unknown whether gender influences the atherosclerotic plaque characteristics (APCs) of lesions of varying angiographic stenosis severity. This study evaluated the imaging data of 303 symptomatic patients from the derivation arm of the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia) trial, all of whom underwent coronary computed tomographic angiography and clinically indicated nonemergent invasive coronary angiography upon study enrollment. Index tests were interpreted by 2 blinded core laboratories, one of which performed quantitative coronary computed tomographic angiography using an artificial intelligence application to characterize and quantify APCs, including percent atheroma volume (PAV), low-density noncalcified plaque (LD-NCP), noncalcified plaque (NCP), calcified plaque (CP), lesion length, positive arterial remodeling, and high-risk plaque (a combination of LD-NCP and positive remodeling ≥1.10); the other classified lesions as obstructive (≥50% diameter stenosis) or nonobstructive (<50% diameter stenosis) based on quantitative invasive coronary angiography. The relation between APCs and angiographic stenosis was further examined by gender. The mean age of the study cohort was 64.4 ± 10.2 years (29.0% female). In patients with obstructive disease, men had more LD-NCP PAV (0.5 ± 0.4 vs 0.3 ± 0.8, p = 0.03) and women had more CP PAV (11.7 ± 1.6 vs 8.0 ± 0.8, p = 0.04). Obstructive lesions had more NCP PAV compared with their nonobstructive lesions in both genders, however, obstructive lesions in women also demonstrated greater LD-NCP PAV (0.4 ± 0.5 vs 1.0 ± 1.8, p = 0.03), and CP PAV (17.4 ± 16.5 vs 25.9 ± 18.7, p = 0.03) than nonobstructive lesions. Comparing the composition of obstructive lesions by gender, women had more CP PAV (26.3 ± 3.4 vs 15.8 ± 1.5, p = 0.005) whereas men had more NCP PAV (33.0 ± 1.6 vs 26.7 ± 2.5, p = 0.04). Men had more LD-NCP PAV in nonobstructive lesions compared with women (1.2 ± 0.2 vs 0.6 ± 0.2, p = 0.02). In conclusion, there are gender-specific differences in plaque composition based on stenosis severity.
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Affiliation(s)
- Rebecca Jonas
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut.
| | - Toral Patel
- Department of Cardiology and Advanced Cardiac Imaging, Centra Heart and Vascular Institute, Lynchburg, Virginia
| | | | | | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea College of Medicine, Hanyang University, Seoul, Korea
| | - Hyung-Bok Park
- Division of Cardiology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Hugo Marques
- Faculdade de Medicina da Universidade Católica Portuguesa, Lisboa, Portugal
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Wijnand J Stuijfzand
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jung Hyun Choi
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University, College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chang-Wook Nam
- Department of Cardiology, Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Sang-Hoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Women's University Seoul Hospital, Seoul, South Korea
| | - Jason Cole
- Mobile Cardiology Associates, Mobile, Alabama
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Bin Lu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yang Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Faisal Nabi
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Ryo Nakazato
- Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan
| | - U Joseph Schoepf
- Department of Cardiology, Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Roel S Driessen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Michiel J Bom
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | | | - James J Jang
- Kaiser Permanente San Jose Medical Center, San Jose, California
| | | | - Chris Rowan
- Renown Heart and Vascular Institute, Reno, Nevada
| | - Erick Avelar
- Oconee Heart and Vascular Center at St Mary's Hospital, Athens, Georgia
| | - Philippe Généreux
- Gagnon Cardiovascular Institute at Morristown Medical Center, Morristown, New Jersey
| | - Paul Knaapen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Guus A de Waard
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Gianluca Pontone
- Department of University Cardiology and Cardiac Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Department of University Cardiology and Cardiac Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew D Choi
- Department of Radiology, Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | | | | | | | - Todd C Villines
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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El Bizri A, Al-Mallah MH. Planning interventions in chronic total occlusions: A comprehensive approach. Atherosclerosis 2023; 381:117212. [PMID: 37604739 DOI: 10.1016/j.atherosclerosis.2023.117212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023]
Affiliation(s)
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.
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Ehrman JK, Keteyian SJ, Johansen MC, Blaha MJ, Al-Mallah MH, Brawner CA. Improved cardiorespiratory fitness is associated with lower incident ischemic stroke risk: Henry Ford FIT project. J Stroke Cerebrovasc Dis 2023; 32:107240. [PMID: 37393688 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Change in cardiorespiratory fitness (CRF) modulates vascular disease risk; however, it's unclear if this adds further prognostic information, particularly for ischemic stroke. The objective of this analysis is to describe the association between the change in CRF over time and subsequent incident ischemic stroke. METHODS This is a retrospective, longitudinal, observational cohort study of 9,646 patients (age=55±11 years; 41% women; 25% black) who completed 2 clinically indicated exercise tests (> 12 months apart) and were free of any stroke at the time of test 2. CRF was expressed as metabolic-equivalents-of-task (METs). Incident ischemic stroke was identified using ICD codes. The adjusted hazard ratio (aHR) was determined for risk of ischemic stroke associated with change in CRF. RESULTS Mean time between tests was 3.7 years (IQR, 2.2, 6.0). During a median of 5.0 years (IQR, 2.7, 7.6 y) of follow-up, there were 873 (9.1%) ischemic stroke events. Each 1 MET increase between tests was associated with a 9% lower ischemic stroke risk (aHR 0.91 [0.88-0.94]; n = 9.646). There was an interaction effect by baseline CRF category, but not for sex or race. A sensitivity analysis which removed those who experienced an incident diagnosis known to be associated with an increased risk of ischemic vascular disease, validated our primary findings (aHR 0.91 [0.88, 0.95]; n= 6,943). CONCLUSIONS Improvement in CRF over time is independently and inversely associated with a lower risk of ischemic stroke. Encouragement of regular exercise focused on improving CRF may reduce ischemic stroke risk.
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Affiliation(s)
- Jonathan K Ehrman
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Michelle C Johansen
- Cerebrovascular Division, Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medicine, Lutherville, MD, USA
| | | | - Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
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Al-Mallah MH. The journey to exceptional imaging: Three steps we all must take. J Nucl Cardiol 2023; 30:1749-1750. [PMID: 37382874 DOI: 10.1007/s12350-023-03323-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Affiliation(s)
- Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
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Saad JM, Ahmed AI, Han Y, El Nihum LI, Alahdab F, Nabi F, Al-Mallah MH. Splenic switch-off in regadenoson 82Rb-PET myocardial perfusion imaging: assessment of clinical utility. J Nucl Cardiol 2023; 30:1484-1496. [PMID: 36607537 DOI: 10.1007/s12350-022-03158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/05/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Splenic switch-off (SSO) is a phenomenon describing a decrease in splenic radiotracer uptake after vasodilatory stress. We aimed to assess the diagnostic utility of regadenoson-induced SSO. METHODS We included consecutive patients who had clinically indicated Regadenoson Rb-82 PET-MPI for suspected CAD. This derivation cohort (no perfusion defects and myocardial flow reserves (MFR) ≥ 2) was used to calculate the splenic response ratio (SRR). The validation cohort was defined as patients who underwent both PET-MPI studies and invasive coronary angiography (ICA). RESULTS The derivation cohort (n = 100, 57.4 ± 11.6 years, 77% female) showed a decrease in splenic uptake from rest to stress (79.9 ± 16.8 kBq⋅mL vs 69.1 ± 16.2 kBq⋅mL, P < .001). From the validation cohort (n = 315, 66.3 ± 10.4 years, 67% male), 28% (via SRR = 0.88) and 15% (visually) were classified as splenic non-responders. MFR was lower in non-responders (SRR; 1.55 ± 0.65 vs 1.76 ± 0.78, P = .02 and visually; 1.18 ± 0.33 vs 1.79 ± 0.77, P < .001). Based on ICA, non-responders were more likely to note obstructive epicardial disease with normal PET scans especially in patients with MFR < 1.5 (SRR; 61% vs 34% P = .05 and visually; 68% vs 33%, P = .01). CONCLUSION Lack of splenic response based on visual or quantitative assessment of SSO may be used to identify an inadequate vasodilatory response.
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Affiliation(s)
- Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Yushui Han
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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31
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Nayfeh M, Ahmed AI, Al Rifai M, Alahdab F, Nagueh SF, Chamsi-Pasha MA, Mahmarian JJ, Chang SM, Zoghbi WA, Al-Mallah MH. Temporal trends in the use of cardiac computerized tomography angiography and transesophageal echocardiography for left atrial appendage thrombus detection. J Cardiovasc Comput Tomogr 2023; 17:289-290. [PMID: 37061438 DOI: 10.1016/j.jcct.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Malek Nayfeh
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | | | | | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | | | | | | | - Su Min Chang
- Houston Methodist DeBakey Heart & Vascular Center, USA
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Al-Mallah MH. Artificial intelligence in nuclear cardiology: your crucial role in transforming potential into reality. J Nucl Cardiol 2023; 30:1293-1296. [PMID: 37156962 DOI: 10.1007/s12350-023-03276-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
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Ahmed AI, Al-Mallah MH. Reply to SPECT and STE: Which one is better in incremental prognostic value over CCTA. Int J Cardiol 2023; 378:164-165. [PMID: 36863422 DOI: 10.1016/j.ijcard.2023.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
Affiliation(s)
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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Al Rifai M, Kanaya AM, Kandula NR, Patel J, Al-Mallah MH, Budoff M, Cainzos-Achirica M, Criqui MH, Virani SS. Association of Coronary Artery Calcium Density and Volume With Predicted Atherosclerotic Cardiovascular Disease Risk and Cardiometabolic Risk Factors in South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. Curr Probl Cardiol 2023; 48:101105. [PMID: 34999157 PMCID: PMC9259756 DOI: 10.1016/j.cpcardiol.2022.101105] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [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: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 02/07/2023]
Abstract
Individuals of South Asian (SA) ancestry are predisposed to a higher risk of atherosclerotic cardiovascular disease (ASCVD). Coronary artery calcium (CAC) volume and density can identify coronary plaque characteristics unique to SA that may provide important prognostic information to identify high risk individuals beyond traditional CAC scores. We used data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA). CAC density and volume were assessed according to established protocols. ASCVD risk was estimated using the pooled cohort equations (PCE). Multivariable-adjusted linear regression models were used to study the association between the PCE and advanced CAC measures, and between cardiovascular risk factors and CAC density and volume. Our analyses included 1,155 participants (mean age 57 (SD 9) years, 52% men) with information on advanced CAC measures. After multivariable-adjustment, the PCE was associated with both CAC density (β 0.24, 95% CI 0.12,0.35) and CAC volume (β 0.43, 95% CI 0.38,0.48). High-density lipoprotein cholesterol was directly associated with CAC density while waist circumference was inversely associated with it. Body mass index, hypertension status, statin use, diabetes, and HOMA-IR were all directly associated with CAC volume. Estimated ASCVD risk was associated with both CAC volume and density. Different cardiometabolic risk factors are associated with CAC density and volume. Future longitudinal studies are required to demonstrate the interrelationship of advanced CAC measures and cardiovascular risk factors with incident ASCVD outcomes.
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Affiliation(s)
- Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Alka M Kanaya
- Department of Medicine, University of California, San Francisco, CA
| | - Namratha R Kandula
- Feinberg School of Medicine, Division of General Internal Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Jaideep Patel
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, VA
| | - Mouaz H Al-Mallah
- Department of Cardiac Imaging, Houston Methodist Hospital, Houston, TX
| | - Matthew Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute, Torrance, CA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, DeBakey Heart & Vascular Center, Center for Outcomes Research, Houston Methodist, Houston TX
| | - Michael H Criqui
- Division of Preventive Medicine, Department of Family Medicine and Public Health, San Diego, CA; University of California, San Diego School of Medicine, CA
| | - Salim S Virani
- Division of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX.
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35
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Al-Mallah MH. 30 years of innovation: are you ready for a challenge? J Nucl Cardiol 2023; 30:908-910. [PMID: 36849634 DOI: 10.1007/s12350-023-03230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Mouaz H Al-Mallah
- Houston Methodist Academic Institute, Houston, TX, USA.
- Weill Cornell Medicine, New York, NY, USA.
- Cardiovascular PET, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
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36
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Nayfeh M, Ahmed AI, Alahdab F, Nabi F, Chang SM, Mahmarian JJ, Chamsi-Pasha MA, Malahfji M, Rifai MA, Al-Mallah MH. TEMPORAL TRENDS IN THE US OF CARDIAC CT FOR DIAGNOSIS OF LEFT ATRIAL APPENDAGE THROMBUS; THE IMPACT OF COVID-19 PANDEMIC. J Am Coll Cardiol 2023. [PMCID: PMC9982906 DOI: 10.1016/s0735-1097(23)01929-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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37
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Ahmed AI, Saad JM, Han Y, Alahdab F, Malahfji M, Nabi F, Mahmarian JJ, Cooke JP, Zoghbi WA, Al-Mallah MH. CORONARY MICROVASCULAR DYSFUNCTION AND PRIOR COVID-19 INFECTION: DO VARIANTS MATTER? J Am Coll Cardiol 2023. [PMCID: PMC9982885 DOI: 10.1016/s0735-1097(23)01914-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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38
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Ahmed AI, Saad JM, Han Y, Alahdab F, Malahfji M, Nabi F, Mahmarian JJ, Cooke JP, Zoghbi WA, Al-Mallah MH. CORONARY MICROVASCULAR DYSFUNCTION IN PATIENTS WITH PRIOR COVID-19 INFECTION AND PERSISTENT SYMPTOMS: IMPACT OF DURATION SINCE THE INFECTION. J Am Coll Cardiol 2023. [PMCID: PMC9982875 DOI: 10.1016/s0735-1097(23)01913-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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39
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Nayfeh M, Rifai MA, Alfawara MS, Alahdab F, Al-Mallah MH. CHALLENGES IN THE MANAGEMENT OF PATIENTS WITH ANOMALOUS ORIGIN OF THE LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY PRESENTING IN ADULTHOOD. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03279-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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40
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Alahdab F, Shawi RE, Ahmed AI, Al-Mallah MH. PATIENT-LEVEL EXPLAINABLE MACHINE LEARNING TO PREDICT MAJOR ADVERSE CARDIOVASCULAR EVENTS FROM SPECT MPI AND CCTA IMAGING. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01930-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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41
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Nayfeh M, Al Rifai M, Alahdab F, Alfawara MS, Ahmed AI, Saad JM, Han Y, Al-Mallah MH. PLAQUE BURDEN VERSUS STENOSIS AS PREDICTORS OF MAJOR ADVERSE CARDIAC EVENTS IN PATIENTS WITH CORONARY ATHEROSCLEROSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01601-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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42
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Saad JM, Ahmed AI, Alahdab F, Rifai MA, Han Y, Alfawara MS, Kassi M, Trachtenberg B, Al-Mallah MH. CARDIAC SCINTIGRAPHY ATRIAL UPTAKE AND HEART FAILURE ADMISSIONS IN ATTR-CARDIAC AMYLOIDOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01912-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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43
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Saad JM, Ahmed AI, Alahdab F, Rifai MA, Han Y, Alfawara MS, Kassi M, Trachtenberg B, Al-Mallah MH. PROGNOSTIC VALUE OF LOW QRS VOLTAGE IN PATIENTS WITH TRANSTHYRETIN CARDIAC AMYLOIDOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01176-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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Rifai MA, Ahmed AI, Alahdab F, Nabi F, Mahmarian JJ, Soliman A, Alfawara MS, Saad JM, Al-Mallah MH. PROGNOSTIC VALUE OF MYOCARDIAL FLOW RESERVE BY BODY MASS INDEX. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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Rifai MA, Ahmed AI, Saad JM, Alahdab F, Nabi F, Al-Mallah MH. PROGNOSTIC UTILITY OF MYOCARDIAL FLOW RESERVE IN PATIENTS WITH PRIOR CORONARY ARTERY BYPASS GRAFTS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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Ahmed AI, Saad JM, Alahdab F, Rifai MA, Han Y, Nayfeh M, Al-Mallah MH. PROGNOSTIC VALUE OF POSITRON EMISSION TOMOGRAPHY-DERIVED MYOCARDIAL FLOW RESERVE: SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01940-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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47
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Alfawara MS, Rifai MA, Ahmed AI, Saad JM, Han Y, Alahdab F, Nayfeh M, Al-Mallah MH. TRUST BUT VERIFY: IMPACT OF POSITRON EMISSION TOMOGRAPHY/CT MISREGISTRATION ON MYOCARDIAL BLOOD FLOW ASSESSMENT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03747-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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48
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Hussain A, Blaha MJ, Al-Mallah MH, Johansen M, Cainzos-Achirica M, Nambi V, Rotter J, Guo X, Rich S, Patel J, Mcevoy JW, Nasir K, Gottesman R, Blumenthal RS, Ballantyne CM, Virani SS, Rifai MA. DETERMINANTS OF INCIDENT STROKE AMONG THOSE WITH ABSENT CORONARY ARTERY CALCIFICATION: RESULTS FROM THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02290-8] [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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49
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Han Y, Ahmed AI, Alahdab F, Nayfeh M, Rifai MA, Alfawara MS, Saad JM, Al-Mallah MH. COMPARATIVE PROGNOSTIC ROLE OF CCTA DERIVED MEASURES OF ATHEROSCLEROTIC BURDEN. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01931-9] [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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50
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Aljizeeri A, Ahmed AI, Suliman I, Alfaris MA, Elneama A, Al-Mallah MH. Incremental prognostic value of positron emission tomography-derived myocardial flow reserve in patients with and without diabetes mellitus. Eur Heart J Cardiovasc Imaging 2023; 24:563-571. [PMID: 36814411 DOI: 10.1093/ehjci/jead023] [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: 12/16/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/24/2023] Open
Abstract
AIMS We aimed to assess the incremental prognostic value of positron emission tomography (PET)-derived myocardial flow reserve (MFR) among patients with diabetes and those without diabetes. METHODS AND RESULTS Consecutive patients with clinically indicated PET MPI for suspected or established coronary artery disease (CAD) were included. Myocardial blood flow (MBF) in mL/min/g was obtained from dynamic images at rest and stress, while MFR was calculated as the ratio of stress to rest MBF. Patients were followed from the date of PET imaging for the occurrence of the primary outcome (composite of all-cause death, myocardial infarction, and un-planned percutaneous coronary intervention/coronary artery bypass graft occurring more than 90 days after imaging). The final cohort consisted of 6019 patients (63% with diabetes) (mean age 61 ± 11 years, 45% female, 55% obese, 76% hypertensive, and 62% dyslipidaemia). Over half (53%) of the patients had an impaired MFR (<2). During a median follow-up of 22.6 (7.8-42.5) months, 619 patients (10%, 3.8 per 1000 person-years) experienced the primary outcome. Impaired MFR (MFR < 2) was significantly associated with the primary outcome in patients with and without diabetes (diabetes: HR 1.8, 95% CI 1.4-2.3, P < 0.001; no diabetes: 1.4, 95% CI 1.0-2.1, P = 0.046). There was no interaction between diabetes status and MFR (P = 0.234). Results were consistent across subgroups of patients with no CAD and normal perfusion study. CONCLUSION PET-derived MFR has a strong independent and incremental prognostic role in patients with diabetes and those without diabetes.
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Affiliation(s)
- Ahmed Aljizeeri
- King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Ibrahim Ahmed
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX 77030, USA
| | - Ihab Suliman
- King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mousa Alali Alfaris
- King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Awadelkarim Elneama
- King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX 77030, USA
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