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Barforoshi S, Shekar C, Yu Z, Liu E, Manubolu V, Budoff MJ, Roy SK. A Leaky False Pouch: Left Ventricle Pseudoaneurysm with Active Hemopericardium Detected on Cardiac Computed Tomography Angiography. Clin Med Insights Cardiol 2024; 18:11795468241249059. [PMID: 38686315 PMCID: PMC11057338 DOI: 10.1177/11795468241249059] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
Pseudoaneurysm is a rare but fatal complication of myocardial infarction (MI). With the advances in cardiovascular disease detection and treatments, fatal structural complications post-MI are now rare. When they occur, advanced diagnostic modalities can be used for early diagnosis, aiding surgical planning, and improving prognosis. In our case, post-MI left ventricle pseudoaneurysm complicated by hemopericardium was diagnosed using cardiac computed tomography angiography (CCTA). Use of attenuation measurement on CCTA helped diagnose active extravasation into the hemopericardium. This case highlights the high index of suspicion needed for rare but fatal complications post-MI and the utility of CCTA in their management.
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Affiliation(s)
- Shiva Barforoshi
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Chandana Shekar
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Zoe Yu
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Eugene Liu
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Venkat Manubolu
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Sion K Roy
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
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Naghavi M, Atlas K, Jaberzadeh A, Zhang C, Manubolu V, Li D, Budoff M. Validation of Opportunistic Artificial Intelligence-Based Bone Mineral Density Measurements in Coronary Artery Calcium Scans. J Am Coll Radiol 2024; 21:624-632. [PMID: 37336431 DOI: 10.1016/j.jacr.2023.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Previously we reported a manual method of measuring thoracic vertebral bone mineral density (BMD) using quantitative CT in noncontrast cardiac CT scans used for coronary artery calcium (CAC) scoring. In this report, we present validation studies of an artificial intelligence-based automated BMD measurement (AutoBMD) that recently received FDA approval as an opportunistic add-on to CAC scans. METHODS A deep learning model was trained to detect vertebral bodies. Subsequently, signal processing techniques were developed to detect intervertebral discs and the trabecular components of the vertebral body. The model was trained using 132 CAC scans comprising 7,649 slices. To validate AutoBMD, we used 5,785 cases of manual BMD measurements previously reported from CAC scans in the Multi-Ethnic Study of Atherosclerosis. RESULTS Mean ± SD for AutoBMD and manual BMD were 166.1 ± 47.9 mg/cc and 163.1 ± 46 mg/cc, respectively (P = .006). Multi-Ethnic Study of Atherosclerosis cases were 47.5% male and 52.5% female, with age 62.2 ± 10.3. A strong correlation was found between AutoBMD and manual measurements (R = 0.85, P < .0001). Accuracy, sensitivity, specificity, positive predictive value and negative predictive value for AutoBMD-based detection of osteoporosis were 99.6%, 96.7%, 97.7%, 99.7% and 99.8%, respectively. AutoBMD averaged 15 seconds per report versus 5.5 min for manual measurements (P < .0001). CONCLUSIONS AutoBMD is an FDA-approved, artificial intelligence-enabled opportunistic tool that reports BMD with Z-scores and T-scores and accurately detects osteoporosis and osteopenia in CAC scans, demonstrating results comparable to manual measurements. No extra cost of scanning and no extra radiation to patients, plus the high prevalence of asymptomatic osteoporosis, make AutoBMD a promising candidate to enhance patient care.
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Affiliation(s)
| | - Kyle Atlas
- American Heart Technologies, Torrance, California
| | | | - Chenyu Zhang
- American Heart Technologies, Torrance, California
| | | | - Dong Li
- The Lundquist Institute, Torrance, California
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Ansari S, Pourafkari L, Kinninger A, Manubolu V, Budoff MJ. Risk stratifying individuals with zero, minimal, and mild coronary artery calcium for cardiovascular disease by determining coronary plaque burden. J Cardiovasc Comput Tomogr 2024; 18:137-141. [PMID: 38097409 DOI: 10.1016/j.jcct.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND AIMS Use of coronary artery calcium (CAC) continues to expand, and several different categories of risk have been developed. Some categorize CAC as <10, 11-100 and > 100, while others use CAC = 0,1-10, 11-100 and > 100 as categories. We sought to evaluate the plaque burden in patients with CAC 0, 1-10 and 11-100 to evaluate the best use of CAC scoring for risk assessment. METHODS Patients were recruited from existing prospective CCTA trials with CAC scores ≤100 and quantitative coronary plaque analysis (QAngio, Medis). CAC was categorized into three groups: zero (CAC = 0), minimal (CAC 1-10), and mild (CAC 11-100). Plaque levels (low attenuated, fibrous, fibro-fatty, dense calcified, total non-calcified) were assessed using multivariable linear regression adjusted for cardiovascular risk factors (age, ethnicity, BMI, gender, hypertension, dyslipidemia, diabetes mellitus, past smoking). RESULTS 378 subjects were included, with an average age of 53.9 ± 10.7 years and 53 % female. Among them, 51 % had 0 CAC, 16 % had minimal CAC (scores 1-10), and 33 % had mild CAC (scores 11-100). The minimal and mild CAC groups were significantly older, with higher rates of diabetes, hypertension, and hyperlipidemia. Multivariable analysis found no significant difference in low attenuated, fibro-fatty, and dense calcified plaque levels between the minimal and zero CAC groups. However, minimal CAC subjects had significantly higher fibrous, total non-calcified, and total plaque volumes than zero CAC. All plaque types were significantly higher in the mild group when comparing mild CAC to minimal CAC. CONCLUSION Individuals with minimal calcium scores (1-10) had greater noncalcified coronary plaque (NCAP) and total plaque volume than individuals with a calcium score of zero. The increased presence of NCAP and total plaque volume in the minimal CAC (1-10) is clinically significant and place those patients at higher coronary vascular disease (CVD) risk than individuals with absent CAC (CAC = zero). Therefore, the use of CAC = 0, 1-10 and 11-100 is prudent to better categorize CVD risk.
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Affiliation(s)
- Salman Ansari
- California University of Science and Medicine - School of Medicine, Colton, CA, USA.
| | - Leili Pourafkari
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - April Kinninger
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Venkat Manubolu
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
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Wu S, Rhee JW, Iukuridze A, Bosworth A, Chen S, Atencio L, Manubolu V, Bhandari R, Jamal F, Mei M, Herrera A, Rodriguez F, Forman S, Nakamura R, Wong FL, Budoff M, Armenian SH. Coronary artery calcium and cardiovascular outcomes in patients with lymphoma undergoing autologous hematopoietic cell transplantation. Cancer 2024. [PMID: 38358333 DOI: 10.1002/cncr.35252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/17/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Patients undergoing autologous hematopoietic cell transplantation (HCT) have a >2-fold risk of developing cardiovascular disease (CVD; heart failure, myocardial infarction, and stroke), compared to the general population. Coronary artery calcium (CAC) is predictive of CVD in nononcology patients but is not as well studied in patients who underwent HCT and survivors of HCT.The objective of this study was to examine the association between CAC and CVD risk and outcomes after HCT in patients with lymphoma. METHODS This was a retrospective cohort study of 243 consecutive patients who underwent a first autologous HCT for lymphoma between 2009 and 2014. CAC (Agatston score) was determined from chest computed tomography obtained <60 days from HCT. Multivariable Cox regression analysis was used to calculate hazard ratio (HR) estimates and 95% confidence intervals (CIs), adjusted for covariates (age, conventional risk factors [e.g., hypertension and dyslipidemia], and cancer treatment). RESULTS The median age at HCT was 55.7 years (range, 18.5-75.1 years), 59% were male, and 60% were non-Hispanic White. The prevalence of CAC was 37%. The 5-year CVD incidence for the cohort was 12%, and there was an incremental increase in the incidence according to CAC score: 0 (6%), 1-100 (20%), and >100 (32%) (p = .001). CAC was significantly associated with CVD risk (HR, 3.0; 95% CI, 1.2-7.5) and worse 5-year survival (77% vs. 50%; p < .001; HR, 2.0; 95% CI, 1.1-3.4), compared to those without CAC. CONCLUSIONS CAC is independently associated with CVD and survival after HCT. This highlights the importance of integrating readily available imaging information in risk stratification and decision-making in patients undergoing HCT, which sets the stage for strategies to optimize outcomes after HCT.
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Affiliation(s)
- Stephanie Wu
- Department of Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - June-Wha Rhee
- Department of Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Aleksi Iukuridze
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Alysia Bosworth
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Sitong Chen
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Liezl Atencio
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Venkat Manubolu
- Department of Cardiology, Lundquist Institute, Torrance, California, USA
| | - Rusha Bhandari
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
- Department of Pediatrics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Faizi Jamal
- Department of Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Matthew Mei
- Department of Hematology & Hematopoietic Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Alex Herrera
- Department of Hematology & Hematopoietic Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Fatima Rodriguez
- Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Stephen Forman
- Department of Hematology & Hematopoietic Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Matthew Budoff
- Department of Cardiology, Lundquist Institute, Torrance, California, USA
| | - Saro H Armenian
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
- Department of Pediatrics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
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Naghavi M, De Oliveira I, Mao SS, Jaberzadeh A, Montoya J, Zhang C, Atlas K, Manubolu V, Montes M, Li D, Atlas T, Reeves A, Henschke C, Yankelevitz D, Budoff M. Opportunistic AI-enabled automated bone mineral density measurements in lung cancer screening and coronary calcium scoring CT scans are equivalent. Eur J Radiol Open 2023; 10:100492. [PMID: 37214544 PMCID: PMC10196960 DOI: 10.1016/j.ejro.2023.100492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Rationale and objectives We previously reported a novel manual method for measuring bone mineral density (BMD) in coronary artery calcium (CAC) scans and validated our method against Dual X-Ray Absorptiometry (DEXA). Furthermore, we have developed and validated an artificial intelligence (AI) based automated BMD (AutoBMD) measurement as an opportunistic add-on to CAC scans that recently received FDA approval. In this report, we present evidence of equivalency between AutoBMD measurements in cardiac vs lung CT scans. Materials and methods AI models were trained using 132 cases with 7649 (3 mm) slices for CAC, and 37 cases with 21918 (0.5 mm) slices for lung scans. To validate AutoBMD against manual measurements, we used 6776 cases of BMD measured manually on CAC scans in the Multi-Ethnic Study of Atherosclerosis (MESA). We then used 165 additional cases from Harbor UCLA Lundquist Institute to compare AutoBMD in patients who underwent both cardiac and lung scans on the same day. Results Mean±SD for age was 69 ± 9.4 years with 52.4% male. AutoBMD in lung and cardiac scans, and manual BMD in cardiac scans were 153.7 ± 43.9, 155.1 ± 44.4, and 163.6 ± 45.3 g/cm3, respectively (p = 0.09). Bland-Altman agreement analysis between AutoBMD lung and cardiac scans resulted in 1.37 g/cm3 mean differences. Pearson correlation coefficient between lung and cardiac AutoBMD was R2 = 0.95 (p < 0.0001). Conclusion Opportunistic BMD measurement using AutoBMD in CAC and lung cancer screening scans is promising and yields similar results. No extra radiation plus the high prevalence of asymptomatic osteoporosis makes AutoBMD an ideal screening tool for osteopenia and osteoporosis in CT scans done for other reasons.
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Affiliation(s)
- Morteza Naghavi
- HeartLung AI Technologies, TMC Innovation, 2450 Holcomb Blvd, Houston, TX 77021
| | - Isabel De Oliveira
- HeartLung AI Technologies, TMC Innovation, 2450 Holcomb Blvd, Houston, TX 77021
| | - Song Shou Mao
- Lundquist Institute, Harbor UCLA Medical Center, 1124 W Carson St, Torrance, CA 90502, USA
| | | | - Juan Montoya
- HeartLung AI Technologies, TMC Innovation, 2450 Holcomb Blvd, Houston, TX 77021
| | - Chenyu Zhang
- HeartLung AI Technologies, TMC Innovation, 2450 Holcomb Blvd, Houston, TX 77021
| | - Kyle Atlas
- HeartLung AI Technologies, TMC Innovation, 2450 Holcomb Blvd, Houston, TX 77021
| | - Venkat Manubolu
- Lundquist Institute, Harbor UCLA Medical Center, 1124 W Carson St, Torrance, CA 90502, USA
| | - Marlon Montes
- HeartLung AI Technologies, TMC Innovation, 2450 Holcomb Blvd, Houston, TX 77021
| | - Dong Li
- Emory University, 201 Dowman Dr, Atlanta, GA 30322, USA
| | - Thomas Atlas
- HeartLung AI Technologies, TMC Innovation, 2450 Holcomb Blvd, Houston, TX 77021
| | | | | | | | - Matthew Budoff
- Lundquist Institute, Harbor UCLA Medical Center, 1124 W Carson St, Torrance, CA 90502, USA
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Barforoshi S, Sheker C, Ullal AV, Manubolu V, Budoff MJ, Roy SK. Ruptured Sinus of Valsalva Aneurysm Diagnosed on Coronary Computed Tomography Angiography in a Patient With Trisomy 13 Syndrome. Tex Heart Inst J 2023; 50:493191. [PMID: 37231901 DOI: 10.14503/thij-22-8022] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Trisomy 13 is a rare chromosomal disorder in which all or a percentage (mosaicism) of cells contain an extra 13th chromosome. Sinus of Valsalva aneurysms are rare, with an incidence of 0.1% to 3.5% of all congenital heart defects. This article reports the case of a patient with trisomy 13 with a new systolic murmur found to have a ruptured sinus of Valsalva aneurysm diagnosed on coronary computed tomography angiography. This is the first case to report sinus of Valsalva aneurysm rupture secondary to Streptococcus viridans endocarditis in a patient with trisomy 13 syndrome and highlights the importance of coronary computed tomography angiography in noninvasive imaging and surgical planning.
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Affiliation(s)
- Shiva Barforoshi
- Harbor-UCLA Medical Center, Department of Internal Medicine, Torrance, California
| | - Chandana Sheker
- The Lundquist Institute, Cardiac CT, Division of Cardiology, Torrance, California
| | - Ajayram V Ullal
- The Lundquist Institute, Cardiac CT, Division of Cardiology, Torrance, California
| | - Venkat Manubolu
- The Lundquist Institute, Cardiac CT, Division of Cardiology, Torrance, California
| | - Matthew J Budoff
- The Lundquist Institute, Cardiac CT, Division of Cardiology, Torrance, California
| | - Sion K Roy
- The Lundquist Institute, Cardiac CT, Division of Cardiology, Torrance, California
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Alalawi L, Kinninger A, Manubolu V, Verghese D, Aldana J, Ahmad K, Ghanem A, Al-Chokhachi Z, Golub I, Shafter A, Roy S, Earls J, Budoff M. 409 Prevalence Of Atherosclerosis And Plaque Types Among Firefighters Assessed By CCTA-based Quantitative Coronary Plaque Analysis. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.014] [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: 10/17/2022]
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Mao S, Manubolu V, Li D, Flores F, Gao Y. 504 Precise Quantification Of Hepatic Steatosis On Chest CT: A Novel Method. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.115] [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: 11/16/2022]
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Bhatia S, Manubolu V, Rudenko I, Lakshmanan S, Budoff M. 515 Lower Extremity Atherosclerotic Plaque Burden And Composition Can Be Assessed Via CT Angiography With High Inter-reader Reproducibility. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.126] [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: 11/28/2022]
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Aldana-Bitar J, Cho G, Anderson L, Manubolu V, Verghese D, Hussein L, Quesada C, Budoff M, Karlsberg R. 492 CAC Score Correlation Between Artificial Intelligence Augmented Cardiac CT And Expert Human Readers: Early Clinical Experience. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.103] [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: 10/17/2022]
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Jaalouk E, Barforoshi S, Schwarzman L, Manubolu V, Kinninger A, Roy S, Budoff M. 521 Evaluating The Relationship Between Diastolic Function And Total Plaque Burden As Determined By Cardiac Ct. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.132] [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: 11/25/2022]
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Aldana Bitar J, Lakshmanan S, Manubolu V, Dahal S, Shafter A, Havistin R, Ahmad K, Crabtree T, Earls J, Jonas R, Choi A, Jennings R, Min J, Budoff M. Differential Effects Of Apixaban Versus Rivaroxaban On Atherosclerosis Plaque Progression In Patients With Atrial Fibrillation. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.266] [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: 11/15/2022]
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Ahmad K, Lakshmanan S, Nimmagadda M, Verghese D, Cherukuri L, Kinninger A, Ghanem AK, Rezvanizadeh V, Dahal S, Manubolu V, Havistin R, Joshi T, Hadeed SJ, Hamal S, Flores F, Budoff MJ. CAN SIGNAL-PROCESSED ELECTROCARDIOGRAM (SPECG) DIAGNOSE SUBCLINICAL ATHEROSCLEROSIS? J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02673-5] [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: 11/30/2022]
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