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Cao T, Hu Z, Mao X, Chen Z, Kwan AC, Xie Y, Berman DS, Li D, Christodoulou AG. Alternating low-rank tensor reconstruction for improved multiparametric mapping with cardiovascular MR Multitasking. Magn Reson Med 2024. [PMID: 38726884 DOI: 10.1002/mrm.30131] [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: 09/14/2023] [Revised: 03/20/2024] [Accepted: 04/08/2024] [Indexed: 05/15/2024]
Abstract
PURPOSE To develop a novel low-rank tensor reconstruction approach leveraging the complete acquired data set to improve precision and repeatability of multiparametric mapping within the cardiovascular MR Multitasking framework. METHODS A novel approach that alternated between estimation of temporal components and spatial components using the entire data set acquired (i.e., including navigator data and imaging data) was developed to improve reconstruction. The precision and repeatability of the proposed approach were evaluated on numerical simulations, 10 healthy subjects, and 10 cardiomyopathy patients at multiple scan times for 2D myocardial T1/T2 mapping with MR Multitasking and were compared with those of the previous navigator-derived fixed-basis approach. RESULTS In numerical simulations, the proposed approach outperformed the previous fixed-basis approach with lower T1 and T2 error against the ground truth at all scan times studied and showed better motion fidelity. In human subjects, the proposed approach showed no significantly different sharpness or T1/T2 measurement and significantly improved T1 precision by 20%-25%, T2 precision by 10%-15%, T1 repeatability by about 30%, and T2 repeatability by 25%-35% at 90-s and 50-s scan times The proposed approach at the 50-s scan time also showed comparable results with that of the previous fixed-basis approach at the 90-s scan time. CONCLUSION The proposed approach improved precision and repeatability for quantitative imaging with MR Multitasking while maintaining comparable motion fidelity, T1/T2 measurement, and septum sharpness and had the potential for further reducing scan time from 90 s to 50 s.
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Affiliation(s)
- Tianle Cao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
| | - Zheyuan Hu
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
| | - Xianglun Mao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zihao Chen
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
| | - Alan C Kwan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Departments of Imaging and Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel S Berman
- Departments of Imaging and Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
| | - Anthony G Christodoulou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
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Miller RJH, Shanbhag A, Michalowska AM, Kavanagh P, Liang JX, Builoff V, Fine NM, Dey D, Berman DS, Slomka PJ. Deep Learning-Enabled Quantification of 99mTc-Pyrophosphate SPECT/CT for Cardiac Amyloidosis. J Nucl Med 2024:jnumed.124.267542. [PMID: 38724278 DOI: 10.2967/jnumed.124.267542] [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: 01/29/2024] [Revised: 04/03/2024] [Indexed: 05/16/2024] Open
Abstract
Transthyretin cardiac amyloidosis (ATTR CA) is increasingly recognized as a cause of heart failure in older patients, with 99mTc-pyrophosphate imaging frequently used to establish the diagnosis. Visual interpretation of SPECT images is the gold standard for interpretation but is inherently subjective. Manual quantitation of SPECT myocardial 99mTc-pyrophosphate activity is time-consuming and not performed clinically. We evaluated a deep learning approach for fully automated volumetric quantitation of 99mTc-pyrophosphate using segmentation of coregistered anatomic structures from CT attenuation maps. Methods: Patients who underwent SPECT/CT 99mTc-pyrophosphate imaging for suspected ATTR CA were included. Diagnosis of ATTR CA was determined using standard criteria. Cardiac chambers and myocardium were segmented from CT attenuation maps using a foundational deep learning model and then applied to attenuation-corrected SPECT images to quantify radiotracer activity. We evaluated the diagnostic accuracy of target-to-background ratio (TBR), cardiac pyrophosphate activity (CPA), and volume of involvement (VOI) using the area under the receiver operating characteristic curve (AUC). We then evaluated associations with the composite outcome of cardiovascular death or heart failure hospitalization. Results: In total, 299 patients were included (median age, 76 y), with ATTR CA diagnosed in 83 (27.8%) patients. CPA (AUC, 0.989; 95% CI, 0.974-1.00) and VOI (AUC, 0.988; 95% CI, 0.973-1.00) had the highest prediction performance for ATTR CA. The next highest AUC was for TBR (AUC, 0.979; 95% CI, 0.964-0.995). The AUC for CPA was significantly higher than that for heart-to-contralateral ratio (AUC, 0.975; 95% CI, 0.952-0.998; P = 0.046). Twenty-three patients with ATTR CA experienced cardiovascular death or heart failure hospitalization. All methods for establishing TBR, CPA, and VOI were associated with an increased risk of events after adjustment for age, with hazard ratios ranging from 1.41 to 1.84 per SD increase. Conclusion: Deep learning segmentation of coregistered CT attenuation maps is not affected by the pattern of radiotracer uptake and allows for fully automatic quantification of hot-spot SPECT imaging such as 99mTc-pyrophosphate. This approach can be used to accurately identify patients with ATTR CA and may play a role in risk prediction.
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Affiliation(s)
- Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; and
- Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California
| | - Anna M Michalowska
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Paul Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Valerie Builoff
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Nowell M Fine
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; and
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Kuronuma K, Miller RJH, Wei CC, Singh A, Lemley MH, Van Kriekinge SD, Kavanagh PB, Gransar H, Han D, Hayes SW, Thomson L, Dey D, Friedman JD, Berman DS, Slomka PJ. Downward myocardial creep during stress PET imaging is inversely associated with mortality. Eur J Nucl Med Mol Imaging 2024; 51:1622-1631. [PMID: 38253908 PMCID: PMC11042981 DOI: 10.1007/s00259-024-06611-2] [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: 10/17/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE The myocardial creep is a phenomenon in which the heart moves from its original position during stress-dynamic PET myocardial perfusion imaging (MPI) that can confound myocardial blood flow measurements. Therefore, myocardial motion correction is important to obtain reliable myocardial flow quantification. However, the clinical importance of the magnitude of myocardial creep has not been explored. We aimed to explore the prognostic value of myocardial creep quantified by an automated motion correction algorithm beyond traditional PET-MPI imaging variables. METHODS Consecutive patients undergoing regadenoson rest-stress [82Rb]Cl PET-MPI were included. A newly developed 3D motion correction algorithm quantified myocardial creep, the maximum motion at stress during the first pass (60 s), in each direction. All-cause mortality (ACM) served as the primary endpoint. RESULTS A total of 4,276 patients (median age 71 years; 60% male) were analyzed, and 1,007 ACM events were documented during a 5-year median follow-up. Processing time for automatic motion correction was < 12 s per patient. Myocardial creep in the superior to inferior (downward) direction was greater than the other directions (median, 4.2 mm vs. 1.3-1.7 mm). Annual mortality rates adjusted for age and sex were reduced with a larger downward creep, with a 4.2-fold ratio between the first (0 mm motion) and 10th decile (11 mm motion) (mortality, 7.9% vs. 1.9%/year). Downward creep was associated with lower ACM after full adjustment for clinical and imaging parameters (adjusted hazard ratio, 0.93; 95%CI, 0.91-0.95; p < 0.001). Adding downward creep to the standard PET-MPI imaging model significantly improved ACM prediction (area under the receiver operating characteristics curve, 0.790 vs. 0.775; p < 0.001), but other directions did not (p > 0.5). CONCLUSIONS Downward myocardial creep during regadenoson stress carries additional information for the prediction of ACM beyond conventional flow and perfusion PET-MPI. This novel imaging biomarker is quantified automatically and rapidly from stress dynamic PET-MPI.
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Affiliation(s)
- Keiichiro Kuronuma
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- Department of Cardiology, Nihon University, Tokyo, Japan
| | - Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Chih-Chun Wei
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Ananya Singh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Mark H Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Paul B Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Sean W Hayes
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Louise Thomson
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - John D Friedman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
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Huo L, Montano E, Tumurkhuu G, Bose M, Berman DS, Wallace D, Wei J, Ishimori M, Merz CNB, Jefferies C. Alterations in genes associated with cytosolic RNA sensing in whole blood are associated with coronary microvascular disease in SLE. Res Sq 2024:rs.3.rs-4171759. [PMID: 38746373 PMCID: PMC11092805 DOI: 10.21203/rs.3.rs-4171759/v1] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Systemic lupus erythematosus (SLE) patients are 90% women and over three times more likely to die of cardiovascular disease than women in the general population. Chest pain with no obstructive cardiac disease is associated with coronary microvascular disease (CMD), where narrowing of the small blood vessels can lead to ischemia, and frequently reported by SLE patients. Using whole blood RNA samples, we asked whether gene signatures discriminate SLE patients with coronary microvascular dysfunction (CMD) on cardiac MRI (n=4) from those without (n=7) and whether any signaling pathway is linked to the underlying pathobiology of SLE CMD. RNA-seq analysis revealed 143 differentially expressed (DE) genes between the SLE and healthy control (HC) groups, with virus defense and interferon (IFN) signaling being the key pathways identified as enriched in SLE as expected. We next conducted a comparative analysis of genes differentially expressed in SLE-CMD and SLE-non-CMD relative to HC samples. Our analysis highlighted differences in IFN signaling, RNA sensing and ADP-ribosylation pathways between SLE-CMD and SLE-non-CMD. This is the first study to investigate possible gene signatures associating with CMD in SLE, and our data strongly suggests that distinct molecular mechanisms underly vascular changes in CMD and non-CMD involvement in SLE.
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Michalowska AM, Zhang W, Shanbhag A, Miller RJ, Lemley M, Ramirez G, Buchwald M, Killekar A, Kavanagh PB, Feher A, Miller EJ, Einstein AJ, Ruddy TD, Liang JX, Builoff V, Ouyang D, Berman DS, Dey D, Slomka PJ. Holistic AI analysis of hybrid cardiac perfusion images for mortality prediction. medRxiv 2024:2024.04.23.24305735. [PMID: 38712025 PMCID: PMC11071553 DOI: 10.1101/2024.04.23.24305735] [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] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background While low-dose computed tomography scans are traditionally used for attenuation correction in hybrid myocardial perfusion imaging (MPI), they also contain additional anatomic and pathologic information not utilized in clinical assessment. We seek to uncover the full potential of these scans utilizing a holistic artificial intelligence (AI)-driven image framework for image assessment. Methods Patients with SPECT/CT MPI from 4 REFINE SPECT registry sites were studied. A multi-structure model segmented 33 structures and quantified 15 radiomics features for each on CT attenuation correction (CTAC) scans. Coronary artery calcium and epicardial adipose tissue scores were obtained from separate deep-learning models. Normal standard quantitative MPI features were derived by clinical software. Extreme Gradient Boosting derived all-cause mortality risk scores from SPECT, CT, stress test, and clinical features utilizing a 10-fold cross-validation regimen to separate training from testing data. The performance of the models for the prediction of all-cause mortality was evaluated using area under the receiver-operating characteristic curves (AUCs). Results Of 10,480 patients, 5,745 (54.8%) were male, and median age was 65 (interquartile range [IQR] 57-73) years. During the median follow-up of 2.9 years (1.6-4.0), 651 (6.2%) patients died. The AUC for mortality prediction of the model (combining CTAC, MPI, and clinical data) was 0.80 (95% confidence interval [0.74-0.87]), which was higher than that of an AI CTAC model (0.78 [0.71-0.85]), and AI hybrid model (0.79 [0.72-0.86]) incorporating CTAC and MPI data (p<0.001 for all). Conclusion In patients with normal perfusion, the comprehensive model (0.76 [0.65-0.86]) had significantly better performance than the AI CTAC (0.72 [0.61-0.83]) and AI hybrid (0.73 [0.62-0.84]) models (p<0.001, for all).CTAC significantly enhances AI risk stratification with MPI SPECT/CT beyond its primary role - attenuation correction. A comprehensive multimodality approach can significantly improve mortality prediction compared to MPI information alone in patients undergoing cardiac SPECT/CT.
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Affiliation(s)
- Anna M Michalowska
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Wenhao Zhang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Robert Jh Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Giselle Ramirez
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mikolaj Buchwald
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aditya Killekar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul B Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, United States
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Valerie Builoff
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Ouyang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Sahashi Y, Vukadinovic M, Duffy G, Li D, Cheng S, Berman DS, Ouyang D, Kwan AC. Using Deep learning to Predict Cardiovascular Magnetic Resonance Findings from Echocardiography Videos. medRxiv 2024:2024.04.16.24305936. [PMID: 38699330 PMCID: PMC11065018 DOI: 10.1101/2024.04.16.24305936] [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: 05/05/2024]
Abstract
Background Echocardiography is the most common modality for assessing cardiac structure and function. While cardiac magnetic resonance (CMR) imaging is less accessible, CMR can provide unique tissue characterization including late gadolinium enhancement (LGE), T1 and T2 mapping, and extracellular volume (ECV) which are associated with tissue fibrosis, infiltration, and inflammation. While deep learning has been shown to uncover findings not recognized by clinicians, it is unknown whether CMR-based tissue characteristics can be derived from echocardiography videos using deep learning. We hypothesized that deep learning applied to echocardiography could predict CMR-based measurements. Methods In a retrospective single-center study, adult patients with CMRs and echocardiography studies within 30 days were included. A video-based convolutional neural network was trained on echocardiography videos to predict CMR-derived labels including wall motion abnormality (WMA) presence, LGE presence, and abnormal T1, T2 or ECV across echocardiography views. The model performance was evaluated in a held-out test dataset not used for training. Results The study population included 1,453 adult patients (mean age 56±18 years, 42% female) with 2,556 paired echocardiography studies occurring on average 2 days after CMR (interquartile range 2 days prior to 6 days after). The model had high predictive capability for presence of WMA (AUC 0.873 [95%CI 0.816-0.922]), however, the model was unable to reliably detect the presence of LGE (AUC 0.699 [0.613-0.780]), native T1 (AUC 0.614 [0.500-0.715]), T2 0.553 [0.420-0.692], or ECV 0.564 [0.455-0.691]). Conclusions Deep learning applied to echocardiography accurately identified CMR-based WMA, but was unable to predict tissue characteristics, suggesting that signal for these tissue characteristics may not be present within ultrasound videos, and that the use of CMR for tissue characterization remains essential within cardiology. Clinical Perspective Tissue characterization of the heart muscle is useful for clinical diagnosis and prognosis by identifying myocardial fibrosis, inflammation, and infiltration, and can be measured using cardiac MRI. While echocardiography is highly accessible and provides excellent functional information, its ability to provide tissue characterization information is limited at this time. Our study using a deep learning approach to predict cardiac MRI-based tissue characteristics from echocardiography showed limited ability to do so, suggesting that alternative approaches, including non-deep learning methods should be considered in future research.
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Han D, Hyun MC, Miller RJH, Gransar H, Slomka PJ, Dey D, Hayes SW, Friedman JD, Thomson LEJ, Berman DS, Rozanski A. 10-year experience of utilizing a stress-first SPECT myocardial perfusion imaging. Int J Cardiol 2024; 401:131863. [PMID: 38365012 DOI: 10.1016/j.ijcard.2024.131863] [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: 08/09/2023] [Revised: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Despite its potential benefits, the utilization of stress-only protocol in clinical practice has been limited. We report utilizing stress-first single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). METHODS We assessed 12,472 patients who were referred for SPECT-MPI between 2013 and 2020. The temporal changes in frequency of stress-only imaging were assessed according to risk factors, mode of stress, prior coronary artery disease (CAD) history, left ventricular function, and symptom status. The clinical endpoint was all-cause mortality. RESULTS In our lab, stress/rest SPECT-MPI in place of rest/stress SPECT-MPI was first introduced in November 2011 and was performed more commonly than rest/stress imaging after 2013. Stress-only SPECT-MPI scanning has been performed in 30-34% of our SPECT-MPI studies since 2013 (i.e.. 31.7% in 2013 and 33.6% in 2020). During the study period, we routinely used two-position imaging (additional prone or upright imaging) to reduce attenuation and motion artifact and introduced SPECT/CT scanner in 2018. The rate of stress-only study remained consistent before and after implementing the SPECT/CT scanner. The frequency of stress-only imaging was 43% among patients without a history of prior CAD and 19% among those with a prior CAD history. Among patients undergoing treadmill exercise, the frequency of stress-only imaging was 48%, while 32% among patients undergoing pharmacologic stress test. In multivariate Cox analysis, there was no significant difference in mortality risk between stress-only and stress/rest protocols in patients with normal SPECT-MPI results (p = 0.271). CONCLUSION Implementation of a stress-first imaging protocol has consistently resulted in safe cancellation of 30% of rest SPECT-MPI studies.
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Affiliation(s)
- Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Mark C Hyun
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Piotr J Slomka
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Damini Dey
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Sean W Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - John D Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Louise E J Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Alan Rozanski
- The Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Natanzon SS, Han D, Kuronuma K, Gransar H, Miller RJH, Slomka PJ, Dey D, Hayes SW, Friedman JD, Thomson LEJ, Berman DS, Rozanski A. Self-reported exercise activity influences the relationship between coronary computed tomography angiographic finding and mortality. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00070-4. [PMID: 38589269 DOI: 10.1016/j.jcct.2024.03.011] [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: 12/14/2023] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
AIM Recent studies suggest that the application of exercise activity questionnaires, including the use of a single-item exercise question, can be additive to the prognostic efficacy of imaging findings. This study aims to evaluate the prognostic efficacy of exercise activity in patients undergoing coronary computed tomography angiography (CCTA). METHODS AND RESULTS We assessed 9772 patients who underwent CCTA at a single center between 2007 and 2020. Patients were divided into 4 groups of physical activity as no exercise (n = 1643, 17%), mild exercise (n = 3156, 32%), moderate exercise (n = 3542, 36%), and high exercise (n = 1431,15%), based on a single-item self-reported questionnaire. Coronary stenosis was categorized as no (0%), non-obstructive (1-49%), borderline (50-69%), and obstructive (≥70%). During a median follow-up of 4.64 (IQR 1.53-7.89) years, 490 (7.6%) died. There was a stepwise inverse relationship between exercise activity and mortality (p < 0.001). Compared with the high activity group, the no activity group had a 3-fold higher mortality risk (HR: 3.3, 95%CI (1.94-5.63), p < 0.001) after adjustment for age, clinical risk factors, symptoms, and statin use. For any level of CCTA stenosis, mortality rates were inversely associated with the degree of patients' exercise activity. The risk of all-cause mortality was similar among the patients with obstructive stenosis with high exercise versus those with no coronary stenosis but no exercise activity (p = 0.912). CONCLUSION Physical activity as assessed by a single-item self-reported questionnaire is a strong stepwise inverse predictor of mortality risk among patients undergoing CCTA.
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Affiliation(s)
- Sharon Shalom Natanzon
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keiichiro Kuronuma
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J H Miller
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean W Hayes
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise E J Thomson
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Rozanski
- Division of Cardiac Sciences, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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9
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Lorenzatti D, Piña P, Huang D, Apple SJ, Fernandez-Hazim C, Ippolito P, Abdullah A, Rodriguez-Guerra M, Skendelas JP, Scotti A, Kuno T, Latib A, Schenone AL, Nasir K, Blankstein R, Blaha MJ, Berman DS, Dey D, Virani SS, Garcia MJ, Slipczuk L. Interaction Between Risk Factors, Coronary Calcium, and CCTA Plaque Characteristics in Patients Age 18-45. Eur Heart J Cardiovasc Imaging 2024:jeae094. [PMID: 38578944 DOI: 10.1093/ehjci/jeae094] [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: 10/09/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
AIMS The atherosclerotic profile and advanced plaque subtype burden in symptomatic patients ≤45 years old have not been established. This study aimed to assess the prevalence and predictors of coronary artery calcium (CAC), plaque subtypes, and plaque burden by coronary computed tomography angiography (CCTA) in symptomatic young patients. METHODS AND RESULTS We included 907 symptomatic young patients (18-45 years) from Montefiore undergoing CCTA for chest pain evaluation. Prevalence and predictors of CAC, plaque subtypes, and burden were evaluated using semi-automated software. In the overall population (55% female and 44% Hispanic), 89% had CAC = 0. The likelihood of CAC or any plaque by CCTA increased with >3 risk factors (RF, OR 7.13 [2.14-23.7] and OR 10.26 [3.36-31.2], respectively). Any plaque by CCTA was present in 137 (15%); the strongest independent predictors were age ≥35 years (OR 3.62 [2.05-6.41]) and family history of premature CAD (FHx) (OR 2.76 [1.67-4.58]). Stenosis ≥50% was rare (1.8%), with 31% of those having CAC = 0. Significant non-calcified (NCP, 37.2%) and low-attenuation (LAP, 4.24%) plaque burdens were seen, even in those with non-obstructive stenosis. Among patients with CAC = 0, 5% had plaque, and the only predictor of exclusively non-calcified plaque was FHx (OR 2.29 [1.08-4.86]). CONCLUSIONS In symptomatic young patients undergoing CCTA, the prevalence of CAC or any coronary atherosclerosis was not negligible, and the likelihood increased with RF burden. The presence of coronary stenosis ≥50% was rare and most often accompanied by CAC > 0 but there was a significant burden of NCP and LAP even within the non-obstructive group.
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Affiliation(s)
- Daniel Lorenzatti
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Pamela Piña
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
- Department of Cardiology, CEDIMAT. Santo Domingo, Dominican Republic
| | - Dou Huang
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Samuel J Apple
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Carol Fernandez-Hazim
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Paul Ippolito
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Aftab Abdullah
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Miguel Rodriguez-Guerra
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - John P Skendelas
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Andrea Scotti
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Toshiki Kuno
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Azeem Latib
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Aldo L Schenone
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness. Houston Methodist DeBakey Heart & Vascular Center. Houston Methodist. Houston, TX, USA
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital. Boston, MA, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine. Baltimore, MD, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center. Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center. Los Angeles, CA, USA
| | - Salim S Virani
- Office of the Vice Provost (Research), The Aga Khan University. Karachi, Pakistan. Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine. Houston, TX, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
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10
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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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11
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Erhabor J, Boakye E, Dardari Z, Dzaye O, Soroosh G, Berman DS, Budoff MJ, Miedema MD, Nasir K, Rumberger JA, Shaw LJ, Johansen MC, Blaha MJ. Coronary artery calcium for stroke mortality prediction. Vasc Med 2024; 29:213-214. [PMID: 38334053 DOI: 10.1177/1358863x231226217] [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] [Indexed: 02/10/2024]
Affiliation(s)
- John Erhabor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Garshasb Soroosh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Med Center, Los Angeles, CA, USA
- Department of Cardiology, Cedars-Sinai Med Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center and Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
| | - Michael D Miedema
- Nolan Family Center for Cardiovascular Health, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - John A Rumberger
- Department of Cardiac Imaging, Princeton Longevity Center, Princeton, NJ, USA
| | - Leslee J Shaw
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Michelle C Johansen
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
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12
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Miller RJH, Killekar A, Shanbhag A, Bednarski B, Michalowska AM, Ruddy TD, Einstein AJ, Newby DE, Lemley M, Pieszko K, Van Kriekinge SD, Kavanagh PB, Liang JX, Huang C, Dey D, Berman DS, Slomka PJ. Predicting mortality from AI cardiac volumes mass and coronary calcium on chest computed tomography. Nat Commun 2024; 15:2747. [PMID: 38553462 PMCID: PMC10980695 DOI: 10.1038/s41467-024-46977-3] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
Chest computed tomography is one of the most common diagnostic tests, with 15 million scans performed annually in the United States. Coronary calcium can be visualized on these scans, but other measures of cardiac risk such as atrial and ventricular volumes have classically required administration of contrast. Here we show that a fully automated pipeline, incorporating two artificial intelligence models, automatically quantifies coronary calcium, left atrial volume, left ventricular mass, and other cardiac chamber volumes in 29,687 patients from three cohorts. The model processes chamber volumes and coronary artery calcium with an end-to-end time of ~18 s, while failing to segment only 0.1% of cases. Coronary calcium, left atrial volume, and left ventricular mass index are independently associated with all-cause and cardiovascular mortality and significantly improve risk classification compared to identification of abnormalities by a radiologist. This automated approach can be integrated into clinical workflows to improve identification of abnormalities and risk stratification, allowing physicians to improve clinical decision-making.
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Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Aditya Killekar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bryan Bednarski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anna M Michalowska
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, NY, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Interventional Cardiology and Cardiac Surgery, University of Zielona Gora, Gora, Poland
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul B Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cathleen Huang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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13
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Flores Tomasino G, Han D, Pimentel R, Paz W, Liang J, Cheng VY, Slomka P, Berman DS, Dey D. Reproducibility of artificial intelligence-enabled plaque measurements between systolic and diastolic phases from coronary computed tomography angiography. Eur Radiol 2024:10.1007/s00330-024-10688-6. [PMID: 38466392 DOI: 10.1007/s00330-024-10688-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES Current coronary CT angiography (CTA) guidelines suggest both end-systolic and mid-diastolic phases of the cardiac cycle can be used for CTA image acquisition. However, whether differences in the phase of the cardiac cycle influence coronary plaque measurements is not known. We aim to explore the potential impact of cardiac phases on quantitative plaque assessment. METHODS We enrolled 39 consecutive patients (23 male, age 66.2 ± 11.5 years) who underwent CTA with dual-source CT with visually evident coronary atherosclerosis and with good image quality. End-systolic and mid- to late-diastolic phase images were reconstructed from the same CTA scan. Quantitative plaque and stenosis were analyzed in both systolic and diastolic images using artificial intelligence (AI)-enabled plaque analysis software (Autoplaque). RESULTS Overall, 186 lesions from 39 patients were analyzed. There were excellent agreement and correlation between systolic and diastolic images for all plaque volume measurements (Lin's concordance coefficient ranging from 0.97 to 0.99; R ranging from 0.96 to 0.98). There were no substantial intrascan differences per patient between systolic and diastolic phases (p > 0.05 for all) for total (1017.1 ± 712.9 mm3 vs. 1014.7 ± 696.2 mm3), non-calcified (861.5 ± 553.7 mm3 vs. 856.5 ± 528.7 mm3), calcified (155.7 ± 229.3 mm3 vs. 158.2 ± 232.4 mm3), and low-density non-calcified plaque volume (151.4 ± 106.1 mm3 vs. 151.5 ± 101.5 mm3) and diameter stenosis (42.5 ± 18.4% vs 41.3 ± 15.1%). CONCLUSION Excellent agreement and no substantial differences were observed in AI-enabled quantitative plaque measurements on CTA in systolic and diastolic images. Following further validation, standardized plaque measurements can be performed from CTA in systolic or diastolic cardiac phase. CLINICAL RELEVANCE STATEMENT Quantitative plaque assessment using artificial intelligence-enabled plaque analysis software can provide standardized plaque quantification, regardless of cardiac phase. KEY POINTS • The impact of different cardiac phases on coronary plaque measurements is unknown. • Plaque analysis using artificial intelligence-enabled software on systolic and diastolic CT angiography images shows excellent agreement. • Quantitative coronary artery plaque assessment can be performed regardless of cardiac phase.
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Affiliation(s)
- Guadalupe Flores Tomasino
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | - Donghee Han
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | - Raymond Pimentel
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | - William Paz
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | - Juni Liang
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | | | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA
| | - Damini Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, 116 N Robertson Blvd, Los Angeles, CA, 90048, USA.
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Miller RJH, Shanbhag A, Killekar A, Lemley M, Bednarski B, Kavanagh PB, Feher A, Miller EJ, Bateman T, Builoff V, Liang JX, Newby DE, Dey D, Berman DS, Slomka PJ. AI-Defined Cardiac Anatomy Improves Risk Stratification of Hybrid Perfusion Imaging. JACC Cardiovasc Imaging 2024:S1936-878X(24)00038-X. [PMID: 38456877 DOI: 10.1016/j.jcmg.2024.01.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Computed tomography attenuation correction (CTAC) improves perfusion quantification of hybrid myocardial perfusion imaging by correcting for attenuation artifacts. Artificial intelligence (AI) can automatically measure coronary artery calcium (CAC) from CTAC to improve risk prediction but could potentially derive additional anatomic features. OBJECTIVES The authors evaluated AI-based derivation of cardiac anatomy from CTAC and assessed its added prognostic utility. METHODS The authors considered consecutive patients without known coronary artery disease who underwent single-photon emission computed tomography/computed tomography (CT) myocardial perfusion imaging at 3 separate centers. Previously validated AI models were used to segment CAC and cardiac structures (left atrium, left ventricle, right atrium, right ventricular volume, and left ventricular [LV] mass) from CTAC. They evaluated associations with major adverse cardiovascular events (MACEs), which included death, myocardial infarction, unstable angina, or revascularization. RESULTS In total, 7,613 patients were included with a median age of 64 years. During a median follow-up of 2.4 years (IQR: 1.3-3.4 years), MACEs occurred in 1,045 (13.7%) patients. Fully automated AI processing took an average of 6.2 ± 0.2 seconds for CAC and 15.8 ± 3.2 seconds for cardiac volumes and LV mass. Patients in the highest quartile of LV mass and left atrium, LV, right atrium, and right ventricular volume were at significantly increased risk of MACEs compared to patients in the lowest quartile, with HR ranging from 1.46 to 3.31. The addition of all CT-based volumes and CT-based LV mass improved the continuous net reclassification index by 23.1%. CONCLUSIONS AI can automatically derive LV mass and cardiac chamber volumes from CT attenuation imaging, significantly improving cardiovascular risk assessment for hybrid perfusion imaging.
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Affiliation(s)
- Robert J H Miller
- Department of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiac Sciences, University of Calgary, Calgary Alberta, Canada
| | - Aakash Shanbhag
- Department of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Aditya Killekar
- Department of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mark Lemley
- Department of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Bryan Bednarski
- Department of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Paul B Kavanagh
- Department of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Timothy Bateman
- Cardiovascular Imaging Technologies LLC, Kansas City, Missouri, USA
| | - Valerie Builoff
- Department of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joanna X Liang
- Department of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Department of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel S Berman
- Department of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Piotr J Slomka
- Department of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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15
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Randazzo MJ, Elias P, Poterucha TJ, Sharir T, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman T, Dorbala S, Di Carli M, Castillo M, Liang JX, Miller RJH, Dey D, Berman DS, Slomka PJ, Einstein AJ. Impact of cardiac size on SPECT myocardial perfusion imaging performance: Insights from the REFINE-SPECT registry. Eur Heart J Cardiovasc Imaging 2024:jeae055. [PMID: 38445511 DOI: 10.1093/ehjci/jeae055] [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: 08/29/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 03/07/2024] Open
Abstract
AIMS Variation in diagnostic performance of SPECT myocardial perfusion imaging (MPI) has been observed, yet the impact of cardiac size has not been well characterized. We assessed whether low left ventricular volume influences SPECT MPI's ability to detect obstructive coronary artery disease (CAD), and its interaction with age and sex. METHODS AND RESULTS A total of 2,066 patients without known CAD (67% male, 64.7 ± 11.2 years) across 9 institutions underwent SPECT MPI with solid-state scanners followed by coronary angiography as part of the REgistry of Fast Myocardial Perfusion Imaging with NExt Generation SPECT. Area under receiver-operating characteristic curve (AUC) analyses evaluated performance of quantitative and visual assessments according to cardiac size (end- diastolic volume [EDV]; < 20th vs. ≥ 20th population or sex-specific percentiles), age (<75 vs. ≥ 75 years), and sex. Significantly decreased performance was observed in patients with low EDV compared to those without (AUC: population 0.72 vs. 0.78, p = 0.03; sex-specific 0.72 vs. 0.79, p = 0.01) and elderly patients compared to younger patients (AUC 0.72 vs. 0.78, p = 0.03), whereas males and females demonstrated similar AUC (0.77 vs. 0.76, p = 0.67). The reduction in accuracy attributed to lower volumes was primarily observed in males (sex-specific threshold: EDV 0.69 vs. 0.79, p = 0.01). Accordingly, a significant decrease in AUC, sensitivity, specificity, and negative predictive value for quantitative and visual assessments was noted in patients with at least two characteristics of low EDV, elderly age, or male sex. CONCLUSIONS Detection of CAD with SPECT MPI is negatively impacted by small cardiac size, most notably in elderly and male patients.
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Affiliation(s)
- Michael J Randazzo
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Pierre Elias
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Timothy J Poterucha
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel
| | - Matthews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Timothy Bateman
- Cardiovascular Imaging Technologies LLC, Kansas City, MO, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle Castillo
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Joanna X Liang
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J H Miller
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
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16
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Reynolds HR, Cyr DD, Merz CNB, Shaw LJ, Chaitman BR, Boden WE, Alexander KP, Rosenberg YD, Bangalore S, Stone GW, Held C, Spertus J, Goetschalckx K, Bockeria O, Newman JD, Berger JS, Elghamaz A, Lopes RD, Min JK, Berman DS, Picard MH, Kwong RY, Harrington RA, Thomas B, O'Brien SM, Maron DJ, Hochman JS. Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial. J Am Heart Assoc 2024; 13:e029850. [PMID: 38410945 PMCID: PMC10944079 DOI: 10.1161/jaha.122.029850] [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: 02/22/2023] [Accepted: 11/09/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Women with chronic coronary disease are generally older than men and have more comorbidities but less atherosclerosis. We explored sex differences in revascularization, guideline-directed medical therapy, and outcomes among patients with chronic coronary disease with ischemia on stress testing, with and without invasive management. METHODS AND RESULTS The ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial randomized patients with moderate or severe ischemia to invasive management with angiography, revascularization, and guideline-directed medical therapy, or initial conservative management with guideline-directed medical therapy alone. We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. Invasive group catheterization rates were similar, with less revascularization among women (73.4% of invasive-assigned women revascularized versus 81.2% of invasive-assigned men; P<0.001). Women had less coronary artery disease: multivessel in 60.0% of invasive-assigned women and 74.8% of invasive-assigned men, and no ≥50% stenosis in 12.3% versus 4.5% (P<0.001). In the conservative group, 4-year catheterization rates were 26.3% of women versus 25.6% of men (P=0.72). Guideline-directed medical therapy use was lower among women with fewer risk factor goals attained. There were no sex differences in the primary outcome (adjusted hazard ratio [HR] for women versus men, 0.93 [95% CI, 0.77-1.13]; P=0.47) or the major secondary outcome of cardiovascular death/myocardial infarction (adjusted HR, 0.93 [95% CI, 0.76-1.14]; P=0.49), with no significant sex-by-treatment-group interactions. CONCLUSIONS Women had less extensive coronary artery disease and, therefore, lower revascularization rates in the invasive group. Despite lower risk factor goal attainment, women with chronic coronary disease experienced similar risk-adjusted outcomes to men in the ISCHEMIA trial. REGISTRATION URL: http://wwwclinicaltrials.gov. Unique identifier: NCT01471522.
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Affiliation(s)
| | | | | | - Leslee J. Shaw
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research FoundationNew YorkNYUSA
| | | | | | | | | | | | - Gregg W. Stone
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research FoundationNew YorkNYUSA
| | - Claes Held
- Dept of Medical Sciences, CardiologyUppsala University and Uppsala Clinical Research CenterUppsalaSweden
| | - John Spertus
- Saint Luke’s Mid America Heart Institute/University of Missouri ‐ Kansas City (UMKC)Kansas CityMOUSA
| | | | - Olga Bockeria
- National Research Center for Cardiovascular SurgeryMoscowRussia
| | | | | | - Ahmed Elghamaz
- Northwick Park Hospital‐Royal Brompton HospitalLondonUnited Kingdom
| | | | | | | | - Michael H. Picard
- Massachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | | | | | | | | | - David J. Maron
- Department of MedicineStanford University School of MedicineStanfordCAUSA
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17
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Torosyan N, Schwartz B, Chen B, Ebinger JE, Gransar H, Park R, Rozanski A, Bairey Merz CN, Berman DS. Changes in Preventive Therapies Following Coronary Computed Tomography Angiography vs Invasive Angiography in Nonobstructive CAD. JACC Cardiovasc Imaging 2024; 17:339-341. [PMID: 37921720 DOI: 10.1016/j.jcmg.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/28/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023]
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18
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Razavi AC, Shaw LJ, Berman DS, Budoff MJ, Wong ND, Vaccarino V, van Assen M, De Cecco CN, Quyyumi AA, Mehta A, Muntner P, Miedema MD, Rozanski A, Rumberger JA, Nasir K, Blumenthal RS, Sperling LS, Mortensen MB, Whelton SP, Blaha MJ, Dzaye O. Left Main Coronary Artery Calcium and Diabetes Confer Very-High-Risk Equivalence in Coronary Artery Calcium >1,000. JACC Cardiovasc Imaging 2024:S1936-878X(24)00026-3. [PMID: 38385932 DOI: 10.1016/j.jcmg.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Although a coronary artery calcium (CAC) of ≥1,000 is a subclinical atherosclerosis threshold to consider combination lipid-lowering therapy, differentiating very high from high atherosclerotic cardiovascular disease (ASCVD) risk in this patient population is not well-defined. OBJECTIVES Among persons with a CAC of ≥1,000, the authors sought to identify risk factors equating with very high-risk ASCVD mortality rates. METHODS The authors studied 2,246 asymptomatic patients with a CAC of ≥1,000 from the CAC Consortium without a prior ASCVD event. Cox proportional hazards regression modelling was performed for ASCVD mortality during a median follow-up of 11.3 years. Crude ASCVD mortality rates were compared with those reported for secondary prevention trial patients classified as very high risk, defined by ≥2 major ASCVD events or 1 major event and ≥2 high-risk conditions (1.4 per 100 person-years). RESULTS The mean age was 66.6 years, 14% were female, and 10% were non-White. The median CAC score was 1,592 and 6% had severe left main (LM) CAC (vessel-specific CAC ≥300). Diabetes (HR: 2.04 [95% CI: 1.47-2.83]) and severe LM CAC (HR: 2.32 [95% CI: 1.51-3.55]) were associated with ASCVD mortality. The ASCVD mortality per 100 person-years for all patients was 0.8 (95% CI: 0.7-0.9), although higher rates were observed for diabetes (1.4 [95% CI: 0.8-1.9]), severe LM CAC (1.3 [95% CI: 0.6-2.0]), and both diabetes and severe LM CAC (7.1 [95% CI: 3.4-10.8]). CONCLUSIONS Among asymptomatic patients with a CAC of ≥1,000 without a prior index event, diabetes, and severe LM CAC define very high risk ASCVD, identifying individuals who may benefit from more intensive prevention therapies across several domains, including low-density lipoprotein-cholesterol lowering.
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Affiliation(s)
- Alexander C Razavi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA; Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, New York, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA
| | - Viola Vaccarino
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marly van Assen
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carlo N De Cecco
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anurag Mehta
- VCU Health Pauley Heart Center and Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael D Miedema
- Nolan Family Center for Cardiovascular Health, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai, St Luke's Hospital, New York, New York, USA
| | | | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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19
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Piña P, Lorenzatti D, Castagna F, Miles J, Kuno T, Scotti A, Arce J, Feinberg A, Huang D, Gilman J, Leiderman E, Daich J, Ippolito P, Gongora CA, Schenone AL, Zhang L, Rodriguez CJ, Blaha MJ, Dey D, Berman DS, Virani SS, Levsky JM, Garcia MJ, Slipczuk L. Association of cardiometabolic and vascular atherosclerosis phenotypes on non-contrast chest CT with incident heart failure in patients with severe hypercholesterolemia. J Clin Lipidol 2024:S1933-2874(24)00020-5. [PMID: 38368138 DOI: 10.1016/j.jacl.2024.02.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/16/2023] [Accepted: 02/01/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Coronary artery calcium (CAC), thoracic aorta calcification (TAC), non-alcoholic fatty liver disease (NAFLD), and epicardial adipose tissue (EAT) are associated with atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). OBJECTIVES We aimed to determine whether these cardiometabolic and atherosclerotic risk factors identified by non-contrast chest computed tomography (CT) are associated with HF hospitalizations in patients with LDL-C≥ 190 mg/dL. METHODS We conducted a retrospective cohort analysis of patients with LDL-C ≥190 mg/dL, aged ≥40 years without established ASCVD or HF, who had a non-contrast chest CT within 3 years of LDL-C measurement. Ordinal CAC, ordinal TAC, EAT, and NAFLD were measured. Kaplan-Meier curves and multivariable Cox regression models were built to ascertain the association with HF hospitalization. RESULTS We included 762 patients with median age 60 (53-68) years, 68% (n=520) female, and median LDL-C level of 203 (194-216) mg/dL. Patients were followed for 4.7 (IQR 2.75-6.16) years, and 107 (14%) had a HF hospitalization. Overall, 355 (47%) patients had CAC=0, 210 (28%) had TAC=0, 116 (15%) had NAFLD, and median EAT was 79 mL (49-114). Moderate-Severe CAC (log-rank p<0.001) and TAC (log-rank p=0.006) groups were associated with increased HF hospitalizations. This association persisted when considering myocardial infarction (MI) as a competing risk. NAFLD and EAT volume were not associated with HF. CONCLUSIONS In patients without established ASCVD and LDL-C≥190 mg/dL, CAC was independently associated with increased HF hospitalizations while TAC, NAFLD and EAT were not.
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Affiliation(s)
- Pamela Piña
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk); Division of Cardiology, CEDIMAT, Santo Domingo, Dominican Republic (Dr Piña)
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Francesco Castagna
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Jeremy Miles
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Javier Arce
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Ari Feinberg
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Dou Huang
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Jake Gilman
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Ephraim Leiderman
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Jonathan Daich
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Paul Ippolito
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Carlos A Gongora
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Aldo L Schenone
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Lili Zhang
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Carlos J Rodriguez
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Michael J Blaha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA (Dr Blaha)
| | - Damini Dey
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA (Drs Dey and Berman)
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA (Drs Dey and Berman)
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan. Section of Cardiology, Texas Heart Institute & Baylor College of Medicine, Houston, TX, USA (Dr Virani)
| | - Jeffrey M Levsky
- Division of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA (Dr Levsky)
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk).
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20
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Miller RJH, Shanbhag A, Killekar A, Lemley M, Bednarski B, Van Kriekinge SD, Kavanagh PB, Feher A, Miller EJ, Einstein AJ, Ruddy TD, Liang JX, Builoff V, Berman DS, Dey D, Slomka PJ. AI-derived epicardial fat measurements improve cardiovascular risk prediction from myocardial perfusion imaging. NPJ Digit Med 2024; 7:24. [PMID: 38310123 PMCID: PMC10838293 DOI: 10.1038/s41746-024-01020-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024] Open
Abstract
Epicardial adipose tissue (EAT) volume and attenuation are associated with cardiovascular risk, but manual annotation is time-consuming. We evaluated whether automated deep learning-based EAT measurements from ungated computed tomography (CT) are associated with death or myocardial infarction (MI). We included 8781 patients from 4 sites without known coronary artery disease who underwent hybrid myocardial perfusion imaging. Of those, 500 patients from one site were used for model training and validation, with the remaining patients held out for testing (n = 3511 internal testing, n = 4770 external testing). We modified an existing deep learning model to first identify the cardiac silhouette, then automatically segment EAT based on attenuation thresholds. Deep learning EAT measurements were obtained in <2 s compared to 15 min for expert annotations. There was excellent agreement between EAT attenuation (Spearman correlation 0.90 internal, 0.82 external) and volume (Spearman correlation 0.90 internal, 0.91 external) by deep learning and expert segmentation in all 3 sites (Spearman correlation 0.90-0.98). During median follow-up of 2.7 years (IQR 1.6-4.9), 565 patients experienced death or MI. Elevated EAT volume and attenuation were independently associated with an increased risk of death or MI after adjustment for relevant confounders. Deep learning can automatically measure EAT volume and attenuation from low-dose, ungated CT with excellent correlation with expert annotations, but in a fraction of the time. EAT measurements offer additional prognostic insights within the context of hybrid perfusion imaging.
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Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Aditya Killekar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bryan Bednarski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul B Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Valerie Builoff
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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21
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Rozanski A, Miller RJH, Han D, Gransar H, Hayes SW, Friedman JD, Thomson LEJ, Berman DS. Comparative predictors of mortality among patients referred for stress single-photon emission computed tomography versus positron emission tomography myocardial perfusion imaging. J Nucl Cardiol 2024; 32:101811. [PMID: 38244976 DOI: 10.1016/j.nuclcard.2024.101811] [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] [Indexed: 01/22/2024]
Abstract
BACKGROUND There is currently little information regarding the usage and comparative predictors of mortality among patients referred for single-photon emission computed tomography (SPECT) versus positron emission tomography (PET) myocardial perfusion imaging (MPI) within multimodality imaging laboratories. METHODS We compared the clinical characteristics and mortality outcomes among 15,718 patients referred for SPECT-MPI and 6202 patients referred for PET-MPI between 2008 and 2017. RESULTS Approximately two-thirds of MPI studies were performed using SPECT-MPI. The PET-MPI group was substantially older and included more patients with known coronary artery disease (CAD), hypertension, diabetes, and myocardial ischemia. The annualized mortality rate was also higher in the PET-MPI group, and this difference persisted after propensity matching 3615 SPECT-MPI and 3615 PET-MPI patients to have similar clinical profiles. Among the SPECT-MPI patients, the most potent predictor of mortality was exercise ability and performance, including consideration of patients' mode of stress testing and exercise duration. Among the PET-MPI patients, myocardial flow reserve (MFR) was the most potent predictor of mortality. CONCLUSIONS In our real-world setting, PET-MPI was more commonly employed among older patients with more cardiac risk factors than SPECT-MPI patients. The most potent predictors of mortality in our SPECT and PET-MPI groups were variables exclusive to each test: exercise ability/capacity for SPECT-MPI patients and MFR for PET-MPI patients.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Robert J H Miller
- Division of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Canada
| | - Donghee Han
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean W Hayes
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise E J Thomson
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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22
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Han D, Shanbhag A, Miller RJH, Kwok N, Waechter P, Builoff V, Newby DE, Dey D, Berman DS, Slomka P. Artificial intelligence-based automated left ventricular mass quantification from non-contrast cardiac CT scans: correlation with contrast CT and cardiac MRI. medRxiv 2024:2024.01.12.24301169. [PMID: 38260634 PMCID: PMC10802664 DOI: 10.1101/2024.01.12.24301169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Non-contrast CT scans are not used for evaluating left ventricle myocardial mass (LV mass), which is typically evaluated with contrast CT or cardiovascular magnetic resonance imaging (MRI). We assessed the feasibility of LV mass estimation from standard, ECG-gated, non-contrast CT using an artificial intelligence (AI) approach and compare it with coronary CT angiography (CTA) and cardiac MRI. Methods We enrolled consecutive patients who underwent coronary CTA, which included non-contrast CT calcium scanning and contrast CTA, and cardiac MRI. The median interval between coronary CTA and MRI was 22 days (IQR: 3-76). We utilized an nn-Unet AI model that automatically segmented non-contrast CT structures. AI measurement of LV mass was compared to contrast CTA and MRI. Results A total of 316 patients (Age: 57.1±16.7, 56% male) were included. The AI segmentation took on average 22 seconds per case. An excellent correlation was observed between AI and contrast CTA LV mass measures (r=0.84, p<0.001), with no significant differences (136.5±55.3 vs. 139.6±56.9 g, p=0.133). Bland-Altman analysis showed minimal bias of 2.9. When compared to MRI, measured LV mass was higher with AI (136.5±55.3 vs. 127.1±53.1 g, p<0.001). There was an excellent correlation between AI and MRI (r=0.85, p<0.001), with a small bias (-9.4). There were no statistical differences between the correlations of LV mass between contrast CTA and MRI, or AI and MRI. Conclusions The AI-based automated estimation of LV mass from non-contrast CT demonstrated excellent correlations and minimal biases when compared to contrast CTA and MRI.
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Affiliation(s)
- Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Robert JH Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Nicholas Kwok
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Parker Waechter
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Valerie Builoff
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
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23
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Kuronuma K, Wei CC, Singh A, Lemley M, Hayes SW, Otaki Y, Hyun MC, Van Kriekinge SD, Kavanagh P, Huang C, Han D, Dey D, Berman DS, Slomka PJ. Automated Motion Correction for Myocardial Blood Flow Measurements and Diagnostic Performance of 82Rb PET Myocardial Perfusion Imaging. J Nucl Med 2024; 65:139-146. [PMID: 38050106 PMCID: PMC10755521 DOI: 10.2967/jnumed.123.266208] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/17/2023] [Indexed: 12/06/2023] Open
Abstract
Motion correction (MC) affects myocardial blood flow (MBF) measurements in 82Rb PET myocardial perfusion imaging (MPI); however, frame-by-frame manual MC of dynamic frames is time-consuming. This study aims to develop an automated MC algorithm for time-activity curves used in compartmental modeling and compare the predictive value of MBF with and without automated MC for significant coronary artery disease (CAD). Methods: In total, 565 patients who underwent PET-MPI were considered. Patients without angiographic findings were split into training (n = 112) and validation (n = 112) groups. The automated MC algorithm used simplex iterative optimization of a count-based cost function and was developed using the training group. MBF measurements with automated MC were compared with those with manual MC in the validation group. In a separate cohort, 341 patients who underwent PET-MPI and invasive coronary angiography were enrolled in the angiographic group. The predictive performance in patients with significant CAD (≥70% stenosis) was compared between MBF measurements with and without automated MC. Results: In the validation group (n = 112), MBF measurements with automated and manual MC showed strong correlations (r = 0.98 for stress MBF and r = 0.99 for rest MBF). The automatic MC took less time than the manual MC (<12 s vs. 10 min per case). In the angiographic group (n = 341), MBF measurements with automated MC decreased significantly compared with those without (stress MBF, 2.16 vs. 2.26 mL/g/min; rest MBF, 1.12 vs. 1.14 mL/g/min; MFR, 2.02 vs. 2.10; all P < 0.05). The area under the curve (AUC) for the detection of significant CAD by stress MBF with automated MC was higher than that without (AUC, 95% CI, 0.76 [0.71-0.80] vs. 0.73 [0.68-0.78]; P < 0.05). The addition of stress MBF with automated MC to the model with ischemic total perfusion deficit showed higher diagnostic performance for detection of significant CAD (AUC, 95% CI, 0.82 [0.77-0.86] vs. 0.78 [0.74-0.83]; P = 0.022), but the addition of stress MBF without MC to the model with ischemic total perfusion deficit did not reach significance (AUC, 95% CI, 0.81 [0.76-0.85] vs. 0.78 [0.74-0.83]; P = 0.067). Conclusion: Automated MC on 82Rb PET-MPI can be performed rapidly with excellent agreement with experienced operators. Stress MBF with automated MC showed significantly higher diagnostic performance than without MC.
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Affiliation(s)
- Keiichiro Kuronuma
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
- Department of Cardiology, Nihon University, Tokyo, Japan
| | - Chih-Chun Wei
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Ananya Singh
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Mark Lemley
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Sean W Hayes
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Yuka Otaki
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Mark C Hyun
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Serge D Van Kriekinge
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Paul Kavanagh
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Cathleen Huang
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Donghee Han
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Damini Dey
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Daniel S Berman
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; and
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24
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Rozanski A, Han D, Miller RJH, Gransar H, Hayes SW, Friedman JD, Thomson L, Berman DS. Is typical angina still prognostically important? The influence of "treatment bias" upon prognostic assessments. J Nucl Cardiol 2024; 31:101778. [PMID: 38237364 DOI: 10.1016/j.nuclcard.2023.101778] [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] [Indexed: 02/13/2024]
Abstract
BACKGROUND Since typical angina has become less frequent, it is unclear if this symptom still has prognostic significance. METHODS We evaluated 38,383 patients undergoing stress/rest SPECT myocardial perfusion imaging followed for a median of 10.9 years. After dividing patients by clinical symptoms, we evaluated the magnitude of myocardial ischemia and subsequent mortality among medically treated versus revascularized subgroups following testing. RESULTS Patients with typical angina had more frequent and greater ischemia than other symptom groups, but not higher mortality. Among typical angina patients, those who underwent early revascularization had substantially greater ischemia than the medically treated subgroup, including a far higher proportion with severe ischemia (44.9% vs 4.3%, P < 0.001) and transient ischemic dilation of the LV (31.3% vs 4.7%, P < 0.001). Nevertheless, the revascularized typical angina subgroup had a lower adjusted mortality risk than the medically treated subgroup (HR = 0.72, 95% CI: 0.57-0.92, P = 0.009) CONCLUSIONS: Typical angina is associated with substantially more ischemia than other clinical symptoms. However, the high referral of patients with typical angina patients with ischemia to early revascularization resulted in this group having a lower rather than higher mortality risk versus other symptom groups. These findings illustrate the need to account for "treatment bias" among prognostic studies.
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Affiliation(s)
- Alan Rozanski
- Department of Cardiology, Mount Sinai Morningside Hospital and Mount Sinai Heart, New York, NY, USA.
| | - Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, CA, USA
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Sean W Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - John D Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Louise Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
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25
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Malhotra P, Han D, Chen B, Siegel R, Friedman J, Dey D, Makkar R, Berman DS, Tamarappoo B. Predictive Value of CTA-Derived Extracellular Volume for Pacemaker Implantation Post-TAVR in Low-Flow Low-Gradient Aortic Stenosis. JACC Cardiovasc Imaging 2024:S1936-878X(23)00537-5. [PMID: 38180414 DOI: 10.1016/j.jcmg.2023.11.012] [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: 10/16/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
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26
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Miller RJH, Bednarski BP, Pieszko K, Kwiecinski J, Williams MC, Shanbhag A, Liang JX, Huang C, Sharir T, Hauser MT, Dorbala S, Di Carli MF, Fish MB, Ruddy TD, Bateman TM, Einstein AJ, Kaufmann PA, Miller EJ, Sinusas AJ, Acampa W, Han D, Dey D, Berman DS, Slomka PJ. Clinical phenotypes among patients with normal cardiac perfusion using unsupervised learning: a retrospective observational study. EBioMedicine 2024; 99:104930. [PMID: 38168587 PMCID: PMC10794922 DOI: 10.1016/j.ebiom.2023.104930] [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: 08/31/2023] [Revised: 11/24/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) is one of the most common cardiac scans and is used for diagnosis of coronary artery disease and assessment of cardiovascular risk. However, the large majority of MPI patients have normal results. We evaluated whether unsupervised machine learning could identify unique phenotypes among patients with normal scans and whether those phenotypes were associated with risk of death or myocardial infarction. METHODS Patients from a large international multicenter MPI registry (10 sites) with normal perfusion by expert visual interpretation were included in this cohort analysis. The training population included 9849 patients, and external testing population 12,528 patients. Unsupervised cluster analysis was performed, with separate training and external testing cohorts, to identify clusters, with four distinct phenotypes. We evaluated the clinical and imaging features of clusters and their associations with death or myocardial infarction. FINDINGS Patients in Clusters 1 and 2 almost exclusively underwent exercise stress, while patients in Clusters 3 and 4 mostly required pharmacologic stress. In external testing, the risk for Cluster 4 patients (20.2% of population, unadjusted hazard ratio [HR] 6.17, 95% confidence interval [CI] 4.64-8.20) was higher than the risk associated with pharmacologic stress (HR 3.03, 95% CI 2.53-3.63), or previous myocardial infarction (HR 1.82, 95% CI 1.40-2.36). INTERPRETATION Unsupervised learning identified four distinct phenotypes of patients with normal perfusion scans, with a significant proportion of patients at very high risk of myocardial infarction or death. Our results suggest a potential role for patient phenotyping to improve risk stratification of patients with normal imaging results. FUNDING This work was supported by the National Heart, Lung, and Blood Institute at the National Institutes of Health [R35HL161195 to PS]. The REFINE SPECT database was supported by the National Heart, Lung, and Blood Institute at the National Institutes of Health [R01HL089765 to PS]. MCW was supported by the British Heart Foundation [FS/ICRF/20/26002].
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Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Bryan P Bednarski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jacek Kwiecinski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Michelle C Williams
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cathleen Huang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel; Israel and Ben Gurion University of the Negev, Beer Sheba, Israel
| | - M Timothy Hauser
- Department of Nuclear Cardiology, Oklahoma Heart Hospital, Oklahoma City, OK, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo F Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | - Andrew J Einstein
- Division of Cardiology, Department of Medicine and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Hagiwara AM, Montano E, Tumurkhuu G, Bose M, Bernardo M, Berman DS, Wiens GC, Nelson MD, Wallace DJ, Wei J, Ishimori M, Bairey Merz CN, Jefferies C. Reduced Left Ventricular Function on Cardiac MRI in SLE Patients Correlates with Measures of SLE Disease Activity and Inflammation. J Radiol Clin Imaging 2023; 6:197-207. [PMID: 38505536 PMCID: PMC10949413 DOI: 10.26502/jrci.2809088] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Background Women with SLE have an elevated risk of CVD morbidity and mortality and frequently report chest pain in the absence of obstructive CAD. Echocardiographic studies often demonstrate reduced LV function, correlating with higher disease activity. We used cardiac MRI (cMRI) to investigate the relationship between SLE, related inflammatory biomarkers and cardiac function in female SLE patients. Methods Women with SLE reporting chest pain with no obstructive CAD (n=13) and reference controls (n=22) were evaluated using stress-rest cMRI to measure LV structure, function, tissue characteristics, and myocardial perfusion reserve index (MPRI). Coronary microvascular dysfunction (CMD) was defined as MPRI <1.84. Serum samples were analyzed for inflammatory markers. Relationships between clinical and cMRI values of SLE subjects were assessed, and groups were compared. Results 40% of SLE subjects had MPRI < 1.84 on cMRI. Compared to controls, SLE subjects had higher LV volumes and mass and lower LV systolic function. SLICC DI was related to worse cardiac function and higher T1. CRP was related to higher cardiac output and a trend to better systolic function, while ESR and fasting insulin were related to lower LV mass. Lower fasting insulin levels correlated with increased ECV. Conclusions Among our female SLE cohort, 40% had CMD, and SLICC DI correlated with worse cardiac function and diffuse fibrosis. Higher inflammatory markers and low insulin levels may associate with LV dysfunction. Our findings underline the potential of non-invasive cMRI as a tool for monitoring cardiovascular function in SLE patients.
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Affiliation(s)
- Audrey M Hagiwara
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Erica Montano
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Gantseg Tumurkhuu
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Moumita Bose
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
- Kao Autoimmunity Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marianne Bernardo
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel S Berman
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center
- Department of Cardiology, Cedars-Sinai Medical Center
| | - Galen Cook Wiens
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
| | - Michael D Nelson
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
- Applied Physiology and Advanced Imaging Laboratory, University of Texas at Arlington, Texas, USA
| | - Daniel J Wallace
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
- David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA
| | - Janet Wei
- Department of Cardiology, Cedars-Sinai Medical Center
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
| | - Mariko Ishimori
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
- David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA
| | - C Noel Bairey Merz
- Department of Cardiology, Cedars-Sinai Medical Center
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
| | - Caroline Jefferies
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
- Kao Autoimmunity Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Miller RJH, Gransar H, Rozanski A, Dey D, Al‐Mallah M, Chow BJW, Kaufmann PA, Cademartiri F, Maffei E, Han D, Slomka PJ, Berman DS. Simplified Approach to Predicting Obstructive Coronary Disease With Integration of Coronary Calcium: Development and External Validation. J Am Heart Assoc 2023; 12:e031601. [PMID: 38108259 PMCID: PMC10863788 DOI: 10.1161/jaha.123.031601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The Diamond-Forrester model was used extensively to predict obstructive coronary artery disease (CAD) but overestimates probability in current populations. Coronary artery calcium (CAC) is a useful marker of CAD, which is not routinely integrated with other features. We derived simple likelihood tables, integrating CAC with age, sex, and cardiac chest pain to predict obstructive CAD. METHODS AND RESULTS The training population included patients from 3 multinational sites (n=2055), with 2 sites for external testing (n=3321). We determined associations between age, sex, cardiac chest pain, and CAC with the presence of obstructive CAD, defined as any stenosis ≥50% on coronary computed tomography angiography. Prediction performance was assessed using area under the receiver-operating characteristic curves (AUCs) and compared with the CAD Consortium models with and without CAC, which require detailed calculations, and the updated Diamond-Forrester model. In external testing, the proposed likelihood tables had higher AUC (0.875 [95% CI, 0.862-0.889]) than the CAD Consortium clinical+CAC score (AUC, 0.868 [95% CI, 0.855-0.881]; P=0.030) and the updated Diamond-Forrester model (AUC, 0.679 [95% CI, 0.658-0.699]; P<0.001). The calibration for the likelihood tables was better than the CAD Consortium model (Brier score, 0.116 versus 0.121; P=0.005). CONCLUSIONS We have developed and externally validated simple likelihood tables to integrate CAC with age, sex, and cardiac chest pain, demonstrating improved prediction performance compared with other risk models. Our tool affords physicians with the opportunity to rapidly and easily integrate a small number of important features to estimate a patient's likelihood of obstructive CAD as an aid to clinical management.
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Affiliation(s)
- Robert J. H. Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryAlbertaCanada
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Alan Rozanski
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
- Division of Cardiology and Department of MedicineMount Sinai Morningside HospitalMount Sinai Heart and the Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Mouaz Al‐Mallah
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | - Benjamin J. W. Chow
- Departments of Medicine (Cardiology and Nuclear Medicine) and RadiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Philipp A. Kaufmann
- Department of Nuclear MedicineUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | | | - Erica Maffei
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) SYNLAB SDNNaplesItaly
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Piotr J. Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Daniel S. Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
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Razavi AC, Kim C, van Assen M, De Cecco CN, Berman DS, Budoff MJ, Quyyumi AA, Vaccarino V, Miedema MD, Nasir K, Rozanski A, Fernandez C, Rumberger JA, Shaw LJ, Mortensen MB, Wong ND, Blumenthal RS, Sperling LS, Whelton SP, Blaha MJ, Dzaye O. Thoracic Aortic Calcium Density and Area in Long-Term Atherosclerotic Cardiovascular Disease Risk Among Men Versus Women. Circ Cardiovasc Imaging 2023; 16:e015690. [PMID: 38054290 PMCID: PMC10841590 DOI: 10.1161/circimaging.123.015690] [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: 05/17/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The development of thoracic aortic calcium (TAC) temporally precedes coronary artery calcium more often in women versus men. Whether TAC density and area confer sex-specific differences in atherosclerotic cardiovascular disease (ASCVD) risk is unknown. METHODS We studied 5317 primary prevention patients who underwent coronary artery calcium scoring on noncontrast cardiac gated computed tomography with TAC >0. The Agatston TAC score (Agatston units), density (Hounsfield units), and area (mm2) were compared between men and women. Cox proportional hazards regression calculated adjusted hazard ratios for TAC density-area groups with ASCVD mortality, adjusting for traditional risk factors, coronary artery calcium, and TAC. Multinomial logistic regression calculated adjusted odds ratios for the association between traditional risk factors and TAC density-area groups. RESULTS The mean age was 60.7 years, 38% were women, and 163 ASCVD deaths occurred over a median of 11.7-year follow-up. Women had higher median TAC scores (97 versus 84 Agatston units; P=0.004), density (223 versus 210 Hounsfield units; P<0.001), and area (37 versus 32 mm2; P=0.006) compared with men. There was a stepwise higher incidence of ASCVD deaths across increasing TAC density-area groups in men though women with low TAC density relative to TAC area (3.6 per 1000 person-years) had survival probability commensurate with the high-density-high-area group (4.8 per 1000 person-years). Compared with low TAC density-area, low TAC density/high TAC area conferred a 3.75-fold higher risk of ASCVD mortality in women (adjusted hazard ratio, 3.75 [95% CI, 1.13-12.44]) but not in men (adjusted hazard ratio, 1.16 [95% CI, 0.48-2.84]). Risk factors most strongly associated with low TAC density/high TAC area differed in women (diabetes: adjusted odds ratio, 2.61 [95% CI, 1.34-5.07]) versus men (hypertension: adjusted odds ratio, 1.45 [95% CI, 1.11-1.90]). CONCLUSIONS TAC density-area phenotypes do not consistently associate with ASCVD mortality though low TAC density relative to area may be a marker of increased ASCVD risk in women.
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Affiliation(s)
- Alexander C. Razavi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, United States
| | - Cherry Kim
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, United States
- Department of Radiology, Korea University College of Medicine, Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, South Korea
| | - Marly van Assen
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, United States
| | - Carlo N. De Cecco
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniel S. Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Matthew J. Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Arshed A. Quyyumi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Viola Vaccarino
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael D. Miedema
- Minneapolis Heart Institute and Foundation, Minneapolis, MN, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai, St Luke’s Hospital, New York, NY, United States
| | - Camilo Fernandez
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | | | - Leslee J. Shaw
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | | | - Nathan D. Wong
- Heart Disease Prevention Program, University of California Irvine, Irvine, CA, United States
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Laurence S. Sperling
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Seamus P. Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Rozanski A, Gransar H, Sakul S, Miller RJH, Han D, Hayes SW, Friedman JD, Thomson LEJ, Berman DS. Increasing frequency of dyspnea among patients referred for cardiac stress testing. J Nucl Cardiol 2023; 30:2303-2313. [PMID: 37861920 DOI: 10.1007/s12350-023-03375-4] [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: 06/13/2023] [Accepted: 08/09/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To assess the frequency, change in prevalence, and prognostic significance of dyspnea among contemporary patients referred for cardiac stress testing. PATIENTS AND METHODS We evaluated the prevalence of dyspnea and its relationship to all-cause mortality among 33,564 patients undergoing stress/rest SPECT-MPI between January 1, 2002 and December 31, 2017. Dyspnea was assessed as a single-item question. Patients were divided into three temporal groups. RESULTS The overall prevalence of dyspnea in our cohort was 30.2%. However, there was a stepwise increase in the temporal prevalence of dyspnea, which was present in 25.6% of patients studied between 2002 and 2006, 30.5% of patients studied between 2007 and 2011, and 38.7% of patients studied between 2012 and 2017. There was a temporal increase in the prevalence of dyspnea in each age, symptom, and risk factor subgroup. The adjusted hazard ratio for mortality was higher among patients with dyspnea vs those without dyspnea both among all patients, and within each chest pain subgroup. CONCLUSIONS Dyspnea has become increasingly prevalent among patients referred for cardiac stress testing and is now present among nearly two-fifths of contemporary cohorts referred for stress-rest SPECT-MPI. Prospective study is needed to standardize the assessment of dyspnea and evaluate the reasons for its increasing prevalence.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sakul Sakul
- Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean W Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise E J Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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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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Arai AE, Schulz-Menger J, Shah DJ, Han Y, Bandettini WP, Abraham A, Woodard PK, Selvanayagam JB, Hamilton-Craig C, Tan RS, Carr J, Teo L, Kramer CM, Wintersperger BJ, Harisinghani MG, Flamm SD, Friedrich MG, Klem I, Raman SV, Haverstock D, Liu Z, Brueggenwerth G, Santiuste M, Berman DS, Pennell DJ. Stress Perfusion Cardiac Magnetic Resonance vs SPECT Imaging for Detection of Coronary Artery Disease. J Am Coll Cardiol 2023; 82:1828-1838. [PMID: 37914512 DOI: 10.1016/j.jacc.2023.08.046] [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: 07/17/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND GadaCAD2 was 1 of 2 international, multicenter, prospective, Phase 3 clinical trials that led to U.S. Food and Drug Administration approval of gadobutrol to assess myocardial perfusion and late gadolinium enhancement (LGE) in adults with known or suspected coronary artery disease (CAD). OBJECTIVES A prespecified secondary objective was to determine if stress perfusion cardiovascular magnetic resonance (CMR) was noninferior to single-photon emission computed tomography (SPECT) for detecting significant CAD and for excluding significant CAD. METHODS Participants with known or suspected CAD underwent a research rest and stress perfusion CMR that was compared with a gated SPECT performed using standard clinical protocols. For CMR, adenosine or regadenoson served as vasodilators. The total dose of gadobutrol was 0.1 mmol/kg body weight. The standard of reference was a 70% stenosis defined by quantitative coronary angiography (QCA). A negative coronary computed tomography angiography could exclude CAD. Analysis was per patient. CMR, SPECT, and QCA were evaluated by independent central core lab readers blinded to clinical information. RESULTS Participants were predominantly male (61.4% male; mean age 58.9 ± 10.2 years) and were recruited from the United States (75.0%), Australia (14.7%), Singapore (5.7%), and Canada (4.6%). The prevalence of significant CAD was 24.5% (n = 72 of 294). Stress perfusion CMR was statistically superior to gated SPECT for specificity (P = 0.002), area under the receiver operating characteristic curve (P < 0.001), accuracy (P = 0.003), positive predictive value (P < 0.001), and negative predictive value (P = 0.041). The sensitivity of CMR for a 70% QCA stenosis was noninferior and nonsuperior to gated SPECT. CONCLUSIONS Vasodilator stress perfusion CMR, as performed with gadobutrol 0.1 mmol/kg body weight, had superior diagnostic accuracy for diagnosis and exclusion of significant CAD vs gated SPECT.
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Affiliation(s)
| | - Jeanette Schulz-Menger
- Helios Klinikum Berlin Buch Klinik für Kardiologie und Nephrologie Abteilung Kardio-MRT, Berlin, Germany
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Yuchi Han
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Arun Abraham
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Pamela K Woodard
- Washington University School of Medicine, St Louis, Missouri, USA
| | | | | | - Ru-San Tan
- National Heart Centre Singapore, Singapore
| | - James Carr
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynette Teo
- National University Hospital, Singapore, Singapore
| | | | - Bernd J Wintersperger
- University of Toronto, Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | | | - Igor Klem
- Duke University, Durham, North Carolina, USA
| | - Subha V Raman
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Zheyu Liu
- Bayer Pharmaceuticals LLC, Whippany, New Jersey, USA
| | | | | | | | - Dudley J Pennell
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Piña P, Fernandez C, Lorenzatti D, Castagna F, Miles J, Kuno T, Scotti A, Arce J, Gongora CA, Schenone AL, Budoff MJ, Nasir K, Blankstein R, Blaha MJ, Dey D, Berman DS, Levsky JM, Virani SS, Garcia MJ, Slipczuk L. Subclinical atherosclerosis on chest computed tomography and mortality in young patients with severe hypercholesterolemia. Prog Cardiovasc Dis 2023; 81:105-108. [PMID: 37926153 DOI: 10.1016/j.pcad.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Pamela Piña
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Division of Cardiology, CEDIMAT, Santo Domingo, Dominican Republic
| | - Carol Fernandez
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Francesco Castagna
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeremy Miles
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Javier Arce
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carlos A Gongora
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aldo L Schenone
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, TX, USA
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael J Blaha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Damini Dey
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey M Levsky
- Division of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan. Section of Cardiology, Texas Heart Institute & Baylor College of Medicine, Houston, TX, USA
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
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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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Rozanski A, Han D, Miller RJH, Gransar H, Slomka P, Hayes SW, Friedman JD, Thomson LEJ, Berman DS. Comparison of coronary artery calcium scores among patients referred for cardiac imaging tests. Prog Cardiovasc Dis 2023; 81:24-32. [PMID: 37858662 DOI: 10.1016/j.pcad.2023.10.005] [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: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND While coronary artery calcium (CAC) can now be evaluated by multiple imaging modalities, there is presently scant study regarding how CAC scores may vary among populations of varying clinical risk. METHODS We evaluated the distribution of CAC scores among three patient groups: 18,941 referred for CAC scanning, 5101 referred for diagnostic coronary CT angiography (CCTA), and 3307 referred for diagnostic positron emission tomography (PET) myocardial perfusion imaging (MPI). We assessed the relationship between CAC score and myocardial ischemia, obstructive coronary artery disease (CAD), and all-cause mortality across imaging modalities. RESULTS Within each age group, the frequency of CAC abnormalities were relatively similar across testing modalities, despite an annualized mortality rate which varied from 0.5%/year among CAC patients to 3.8%/year among PET-MPI patients (p < 0.001). Among CCTA and PET-MPI patients, a zero CAC score was common, occurring in ~70% of patients <50 years, ~40% of patients 50-59 years, and ~ 25% of patients 60-69 years. Among CCTA patients, zero CAC was associated with a normal coronary angiogram with high frequency, ranging from 92.2% among patients <50 years to 87.9% among patients ≥70 years. Among PET-MPI patients, zero CAC was associated with a very low frequency of inducible ischemia across all age groups, ranging from 1.5% among patients <50 years to 0.9% among patients ≥70 years. CONCLUSIONS In our study, relatively similar CAC scores were noted among patients varying markedly in mortality risk. Clinically, zero CAC scores predicted both a low likelihood of obstructive CAD and inducible myocardial ischemia in all age groups and were observed with high frequency across diagnostic testing modalities.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Robert J H Miller
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Piotr Slomka
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Sean W Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - John D Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Louise E J Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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Park HB, Arsanjani R, Sung JM, Heo R, Lee BK, Lin FY, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, Gonçalves PDA, Leipsic JA, Lee SE, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK, Chang HJ. Impact of statins based on high-risk plaque features on coronary plaque progression in mild stenosis lesions: results from the PARADIGM study. Eur Heart J Cardiovasc Imaging 2023; 24:1536-1543. [PMID: 37232393 DOI: 10.1093/ehjci/jead110] [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: 01/31/2023] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
AIMS To investigate the impact of statins on plaque progression according to high-risk coronary atherosclerotic plaque (HRP) features and to identify predictive factors for rapid plaque progression in mild coronary artery disease (CAD) using serial coronary computed tomography angiography (CCTA). METHODS AND RESULTS We analyzed mild stenosis (25-49%) CAD, totaling 1432 lesions from 613 patients (mean age, 62.2 years, 63.9% male) and who underwent serial CCTA at a ≥2 year inter-scan interval using the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (NCT02803411) registry. The median inter-scan period was 3.5 ± 1.4 years; plaques were quantitatively assessed for annualized percent atheroma volume (PAV) and compositional plaque volume changes according to HRP features, and the rapid plaque progression was defined by the ≥90th percentile annual PAV. In mild stenotic lesions with ≥2 HRPs, statin therapy showed a 37% reduction in annual PAV (0.97 ± 2.02 vs. 1.55 ± 2.22, P = 0.038) with decreased necrotic core volume and increased dense calcium volume compared to non-statin recipient mild lesions. The key factors for rapid plaque progression were ≥2 HRPs [hazard ratio (HR), 1.89; 95% confidence interval (CI), 1.02-3.49; P = 0.042], current smoking (HR, 1.69; 95% CI 1.09-2.57; P = 0.017), and diabetes (HR, 1.55; 95% CI, 1.07-2.22; P = 0.020). CONCLUSION In mild CAD, statin treatment reduced plaque progression, particularly in lesions with a higher number of HRP features, which was also a strong predictor of rapid plaque progression. Therefore, aggressive statin therapy might be needed even in mild CAD with higher HRPs. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02803411.
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Affiliation(s)
- Hyung-Bok Park
- Department of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Ji Min Sung
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Ran Heo
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Byoung Kwon Lee
- Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | | | | | | | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, South Korea
| | | | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa, Italy
| | - Hugo Marques
- Unit of Cardiovascular Imaging, Hospital da Luz, Catolica Medical School, Lisbon, Portugal
| | - Pedro de Araújo Gonçalves
- Unit of Cardiovascular Imaging, Hospital da Luz, Catolica Medical School, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Sang-Eun Lee
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Sanghoon Shin
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Jung Hyun Choi
- Department of Cardiology, Pusan University Hospital, Busan, South Korea
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Habib Samady
- Department of Cardiology, Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA 30501, USA
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI 48073, USA
| | - Peter H Stone
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, 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 10029, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Hyuk-Jae Chang
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
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Maddahi J, Agostini D, Bateman TM, Bax JJ, Beanlands RSB, Berman DS, Dorbala S, Garcia EV, Feldman J, Heller GV, Knuuti JM, Martinez-Clark P, Pelletier-Galarneau M, Shepple B, Tamaki N, Tranquart F, Udelson JE. Flurpiridaz F-18 PET Myocardial Perfusion Imaging in Patients With Suspected Coronary Artery Disease. J Am Coll Cardiol 2023; 82:1598-1610. [PMID: 37821170 DOI: 10.1016/j.jacc.2023.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Flurpiridaz F-18 (flurpiridaz) is a novel positron emission tomography (PET) myocardial perfusion imaging tracer. OBJECTIVES The purpose of this study was to further assess the diagnostic efficacy and safety of flurpiridaz for the detection and evaluation of coronary artery disease (CAD) defined as ≥50% stenosis by quantitative invasive coronary angiography (ICA). METHODS In this second phase 3 prospective multicenter clinical study, 730 patients with suspected CAD from 48 clinical sites in the United States, Canada, and Europe were enrolled. Patients underwent 1-day rest/stress flurpiridaz PET and 1- or 2-day rest-stress Tc-99m-labeled single photon emission computed tomography (SPECT) before ICA. PET and SPECT images were read by 3 experts blinded to clinical and ICA data. RESULTS A total of 578 patients (age 63.7 ± 9.5 years) were evaluable; 32.5% were women, 52.3% had body mass index ≥30 kg/m2, and 33.6% had diabetes. Flurpiridaz PET met the efficacy endpoints of the study; its sensitivity and specificity were significantly higher than the prespecified threshold value by 2 of the 3 readers. The sensitivity of flurpiridaz PET was higher than SPECT (80.3% vs 68.7%; P = 0.0003) and its specificity was noninferior to SPECT (63.8% vs 61.7%; P = 0.0004). PET area under the receiver-operating characteristic curves were higher than SPECT in the overall population (0.80 vs 0.68; P < 0.001), women, and obese patients (P < 0.001 for both). Flurpiridaz PET was superior to SPECT (P < 0.001) for perfusion defect size/severity evaluation, image quality, diagnostic certainty, and radiation exposure. Flurpiridaz PET was safe and well tolerated. CONCLUSIONS This second flurpiridaz PET myocardial perfusion imaging trial shows that flurpiridaz has utility as a new tracer for CAD detection, specifically in women and obese patients. (An International Study to Evaluate Diagnostic Efficacy of Flurpiridaz [18F] Injection PET MPI in the Detection of Coronary Artery Disease [CAD]; NCT03354273).
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Affiliation(s)
- Jamshid Maddahi
- Department of Molecular and Medical Pharmacology (Nuclear Medicine), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA; Department of Medicine (Cardiology), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA.
| | | | | | | | - Rob S B Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | | | | | - Gary V Heller
- Morristown Medical Center, Morristown, New Jersey, USA
| | | | | | | | - Benjamin Shepple
- University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Nagara Tamaki
- Kyoto Prefectural University of Medicine, Kyoto, Japan
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Berman DS. Making fair comparisons: The potency and necessity of combining myocardial perfusion imaging and CAC scanning. J Nucl Cardiol 2023; 30:1751-1755. [PMID: 37624563 DOI: 10.1007/s12350-023-03362-9] [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: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, USA.
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Hirschfeld CB, Dorbala S, Shaw LJ, Villines TC, Choi AD, Better N, Cerci RJ, Karthikeyan G, Vitola JV, Williams MC, Al-Mallah M, Berman DS, Bernheim A, Biederman RW, Bravo PE, Budoff MJ, Bullock-Palmer RP, Chen MY, DiLorenzo MP, Doukky R, Ferencik M, Geske JB, Hage FG, Hendel RC, Koweek L, Murthy VL, Narula J, Rodriguez Lozano PF, Shah NR, Shah A, Soman P, Thompson RC, Wolinsky D, Cohen YA, Malkovskiy E, Randazzo MJ, Lopez-Mattei J, Parwani P, Shetty M, Pascual TNB, Pynda Y, Dondi M, Paez D, Einstein AJ. Cardiovascular Testing in the United States during the COVID-19 Pandemic: Volume Recovery and Worldwide Comparison. Radiol Cardiothorac Imaging 2023; 5:e220288. [PMID: 37908554 PMCID: PMC10613928 DOI: 10.1148/ryct.220288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/27/2023] [Accepted: 08/08/2023] [Indexed: 11/02/2023]
Abstract
Purpose To characterize the recovery of diagnostic cardiovascular procedure volumes in U.S. and non-U.S. facilities in the year following the initial COVID-19 outbreak. Materials and Methods The International Atomic Energy Agency (IAEA) coordinated a worldwide study called the IAEA Noninvasive Cardiology Protocols Study of COVID-19 2 (INCAPS COVID 2), collecting data from 669 facilities in 107 countries, including 93 facilities in 34 U.S. states, to determine the impact of the pandemic on diagnostic cardiovascular procedure volumes. Participants reported volumes for each diagnostic imaging modality used at their facility for March 2019 (baseline), April 2020, and April 2021. This secondary analysis of INCAPS COVID 2 evaluated differences in changes in procedure volume between U.S. and non-U.S. facilities and among U.S. regions. Factors associated with return to prepandemic volumes in the United States were also analyzed in a multivariable regression analysis. Results Reduction in procedure volumes in April 2020 compared with baseline was similar for U.S. and non-U.S. facilities (-66% vs -71%, P = .27). U.S. facilities reported greater return to baseline in April 2021 than did all non-U.S. facilities (4% vs -6%, P = .008), but there was no evidence of a difference when comparing U.S. facilities with non-U.S. high-income country (NUHIC) facilities (4% vs 0%, P = .18). U.S. regional differences in return to baseline were observed between the Midwest (11%), Northeast (9%), South (1%), and West (-7%, P = .03), but no studied factors were significant predictors of 2021 change from prepandemic baseline. Conclusion The reductions in cardiac testing during the early pandemic have recovered within a year to prepandemic baselines in the United States and NUHICs, while procedure volumes remain depressed in lower-income countries.Keywords: SPECT, Cardiac, Epidemiology, Angiography, CT Angiography, CT, Echocardiography, SPECT/CT, MR Imaging, Radionuclide Studies, COVID-19, Cardiovascular Imaging, Diagnostic Cardiovascular Procedure, Cardiovascular Disease, Cardiac Testing Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Cole B. Hirschfeld
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Sharmila Dorbala
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Leslee J. Shaw
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Todd C. Villines
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Andrew D. Choi
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Nathan Better
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Rodrigo J. Cerci
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Ganesan Karthikeyan
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - João V. Vitola
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Michelle C. Williams
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Mouaz Al-Mallah
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Daniel S. Berman
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Adam Bernheim
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Robert W. Biederman
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Paco E. Bravo
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Matthew J. Budoff
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Renee P. Bullock-Palmer
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Marcus Y. Chen
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Michael P. DiLorenzo
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Rami Doukky
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Maros Ferencik
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Jeffrey B. Geske
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Fadi G. Hage
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Robert C. Hendel
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Lynne Koweek
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Venkatesh L. Murthy
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Jagat Narula
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Patricia F. Rodriguez Lozano
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Nishant R. Shah
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Amee Shah
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Prem Soman
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Randall C. Thompson
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - David Wolinsky
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Yosef A. Cohen
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Eli Malkovskiy
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Michael J. Randazzo
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Juan Lopez-Mattei
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Purvi Parwani
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Mrinali Shetty
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Thomas N. B. Pascual
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Yaroslav Pynda
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Maurizio Dondi
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Diana Paez
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
| | - Andrew J. Einstein
- From the Division of Cardiology, Weill Cornell Medicine and
NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine
and Radiology, Brigham and Women’s Hospital, Boston, Mass (S.D.);
Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical
Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department
of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George
Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini
Health, Royal Melbourne Hospital and University of Melbourne, Melbourne,
Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C.,
J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New
Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and
Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and
Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.);
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School
of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre
for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital,
Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.);
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
(R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons and
NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
(M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.);
Knight Cardiovascular Institute, Oregon Health & Science University,
Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham
Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of
Cardiology, Deming Department of Medicine, Tulane University School of Medicine,
New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.);
Division of Cardiovascular Medicine, Department of Internal Medicine, University
of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai
Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department
of Medicine, Cardiovascular Division, University of Virginia Health System,
Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine,
Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of
Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St
Luke’s Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland
Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology,
Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of
Cardiology, Columbia University Irving Medical Center and New York-Presbyterian
Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.);
Department of Medicine, Columbia University Irving Medical Center and New
York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart &
Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma
Linda University Health, Loma Linda, Calif (P.P.); University of Chicago
(NorthShore), NorthShore University Health System, Evanston, Ill (M.S.);
Department of Science and Technology, Philippine Nuclear Research Institute,
Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna,
Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University
Irving Medical Center and New York-Presbyterian Hospital, New York, NY
(A.J.E.)
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40
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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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41
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Gulsin GS, Tzimas G, Holmes KR, Takagi H, Sellers SL, Blanke P, Koweek LMH, Nørgaard BL, Jensen J, Rabbat MG, Pontone G, Fairbairn TA, Chinnaiyan KM, Douglas PS, Huey W, Matsuo H, Sand NPR, Nieman K, Bax JJ, Amano T, Kawasaki T, Akasaka T, Rogers C, Berman DS, Patel MR, De Bruyne B, Mullen S, Leipsic JA. Impact of Coronary CT Angiography-derived Fractional Flow Reserve on Downstream Management and Clinical Outcomes in Individuals with and without Diabetes. Radiol Cardiothorac Imaging 2023; 5:e220276. [PMID: 37908552 PMCID: PMC10613926 DOI: 10.1148/ryct.220276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 06/21/2023] [Accepted: 09/01/2023] [Indexed: 11/02/2023]
Abstract
Purpose To compare the clinical use of coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) in individuals with and without diabetes mellitus (DM). Materials and Methods This secondary analysis included participants (enrolled July 2015 to October 2017) from the prospective, multicenter, international The Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care (ADVANCE) registry (ClinicalTrials.gov identifier, NCT02499679) who were evaluated for suspected coronary artery disease (CAD), with one or more coronary stenosis ≥30% on CCTA images, using CT-FFR. CCTA and CT-FFR findings, treatment strategies at 90 days, and clinical outcomes at 1-year follow-up were compared in participants with and without DM. Results The study included 4290 participants (mean age, 66 years ± 10 [SD]; 66% male participants; 22% participants with DM). Participants with DM had more obstructive CAD (one or more coronary stenosis ≥50%; 78.8% vs 70.6%, P < .001), multivessel CAD (three-vessel obstructive CAD; 18.9% vs 11.2%, P < .001), and proportionally more vessels with CT-FFR ≤ 0.8 (74.3% vs 64.6%, P < .001). Treatment reclassification by CT-FFR occurred in two-thirds of participants which was consistent regardless of the presence of DM. There was a similar graded increase in coronary revascularization with declining CT-FFR in both groups. At 1 year, presence of DM was associated with higher rates of major adverse cardiovascular events (hazard ratio, 2.2; 95% CI: 1.2, 4.1; P = .01). However, no between group differences were observed when stratified by stenosis severity (<50% or ≥50%) or CT-FFR positivity. Conclusion Both anatomic CCTA findings and CT-FFR demonstrated a more complex pattern of CAD in participants with versus without DM. Rates of treatment reclassification were similar regardless of the presence of DM, and DM was not an adverse prognostic indicator when adjusted for diameter stenosis and CT-FFR.Clinical trial registration no. NCT 02499679Keywords: Fractional Flow Reserve, CT Angiography, Diabetes Mellitus, Coronary Artery Disease Supplemental material is available for this article. See also the commentary by Ghoshhajra in this issue.© RSNA, 2023.
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Affiliation(s)
- Gaurav S. Gulsin
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Georgios Tzimas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Kenneth-Royce Holmes
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Hidenobu Takagi
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Stephanie L. Sellers
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Philipp Blanke
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Lynne M. H. Koweek
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Bjarne L. Nørgaard
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jesper Jensen
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Mark G. Rabbat
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Gianluca Pontone
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Timothy A. Fairbairn
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Kavitha M. Chinnaiyan
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Pamela S. Douglas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Whitney Huey
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Hitoshi Matsuo
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Niels P. R. Sand
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Koen Nieman
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jeroen J. Bax
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Tetsuya Amano
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Tomohiro Kawasaki
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Takashi Akasaka
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Campbell Rogers
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Daniel S. Berman
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Manesh R. Patel
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Bernard De Bruyne
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Sarah Mullen
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jonathon A. Leipsic
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| |
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Kuronuma K, Miller RJH, Van Kriekinge SD, Han D, Singh A, Gransar H, Dey D, Berman DS, Slomka PJ. Incremental prognostic value of stress phase entropy over standard PET myocardial perfusion imaging variables. Eur J Nucl Med Mol Imaging 2023; 50:3619-3629. [PMID: 37428217 PMCID: PMC10547643 DOI: 10.1007/s00259-023-06323-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: 05/10/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Phase analysis can assess left ventricular dyssynchrony. The independent prognostic value of phase variables over positron emission tomography myocardial perfusion imaging (PET-MPI) variables including myocardial flow reserve (MFR) has not been studied. The aim of this study was to explore the prognostic value of phase variables for predicting mortality over standard PET-MPI variables. METHODS Consecutive patients who underwent pharmacological stress-rest 82Rb PET study were enrolled. All PET-MPI variables including phase variables (phase entropy, phase bandwidth, and phase standard deviation) were automatically obtained by QPET software (Cedars-Sinai, Los Angeles, CA). Cox proportional hazard analyses were used to assess associations with all-cause mortality (ACM). RESULTS In a total of 3963 patients (median age 71 years; 57% male), 923 patients (23%) died during a median follow-up of 5 years. Annualized mortality rates increased with stress phase entropy, with a 4.6-fold difference between the lowest and highest decile groups of entropy (2.6 vs. 12.0%/year). Abnormal stress phase entropy (optimal cutoff value, 43.8%) stratified ACM risk in patients with normal and impaired MFR (both p < 0.001). Among three phase variables, only stress phase entropy was significantly associated with ACM after the adjustment of standard clinical and PET-MPI variables including MFR and stress-rest change of phase variables, whether modeled as binary variables (adjusted hazard ratio, 1.44 for abnormal entropy [> 43.8%]; 95%CI, 1.18-1.75; p < 0.001) or continuous variables (adjusted hazard ratio, 1.05 per 5% increase; 95%CI, 1.01-1.10; p = 0.030). The addition of stress phase entropy to the standard PET-MPI variables significantly improved the discriminatory power for ACM prediction (p < 0.001), but the other phase variables did not (p > 0.1). CONCLUSION Stress phase entropy is independently and incrementally associated with ACM beyond standard PET-MPI variables including MFR. Phase entropy can be obtained automatically and included in clinical reporting of PET-MPI studies to improve patient risk prediction.
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Affiliation(s)
- Keiichiro Kuronuma
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
- Department of Cardiology, Nihon University, Tokyo, Japan
| | - Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Ananya Singh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA.
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Han D, Lin A, Kuronuma K, Gransar H, Dey D, Friedman JD, Berman DS, Tamarappoo BK. Cardiac Computed Tomography for Quantification of Myocardial Extracellular Volume Fraction: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023; 16:1306-1317. [PMID: 37269267 DOI: 10.1016/j.jcmg.2023.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/10/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Extracellular volume (ECV) is a quantitative measure of extracellular compartment expansion, and an increase in ECV is a marker of myocardial fibrosis. Although cardiac magnetic resonance (CMR) is considered the standard imaging tool for ECV quantification, cardiac computed tomography (CT) has also been used for ECV assessment. OBJECTIVES The aim of this meta-analysis was to evaluate the correlation and agreement in the quantification of myocardial ECV by CT and CMR. METHODS PubMed and Web of Science were searched for relevant publications reporting on the use of CT for ECV quantification compared with CMR as the reference standard. The authors employed a meta-analysis using the restricted maximum-likelihood estimator with a random-effects method to estimate summary correlation and mean difference. A subgroup analysis was performed to compare the correlation and mean differences between single-energy CT (SECT) and dual-energy CT (DECT) techniques for the ECV quantification. RESULTS Of 435 papers, 13 studies comprising 383 patients were identified. The mean age range was 57.3 to 82 years, and 65% of patients were male. Overall, there was an excellent correlation between CT-derived ECV and CMR-derived ECV (mean: 0.90 [95% CI: 0.86-0.95]). The pooled mean difference between CT and CMR was 0.96% (95% CI: 0.14%-1.78%). Seven studies reported correlation values using SECT, and 4 studies reported those using DECT. The pooled correlation from studies utilizing DECT for ECV quantification was significantly higher compared with those with SECT (mean: 0.94 [95% CI: 0.91-0.98] vs 0.87 [95% CI: 0.80-0.94], respectively; P = 0.01). There was no significant difference in pooled mean differences between SECT vs DECT (P = 0.85). CONCLUSIONS CT-derived ECV showed an excellent correlation and mean difference of <1% with CMR-derived ECV. However, the overall quality of the included studies was low, and larger, prospective studies are needed to examine the accuracy and diagnostic and prognostic utility of CT-derived ECV.
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Affiliation(s)
- Donghee Han
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Keiichiro Kuronuma
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Heidi Gransar
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John D Friedman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| | - Balaji K Tamarappoo
- Cardiovascular Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Stone GW, Ali ZA, O'Brien SM, Rhodes G, Genereux P, Bangalore S, Mavromatis K, Horst J, Dressler O, Poh KK, Nath RK, Moorthy N, Witkowski A, Dwivedi SK, Bockeria O, Chen J, Smanio PEP, Picard MH, Chaitman BR, Berman DS, Shaw LJ, Boden WE, White HD, Fremes SE, Rosenberg Y, Reynolds HR, Spertus JA, Hochman JS, Maron DJ. Impact of Complete Revascularization in the ISCHEMIA Trial. J Am Coll Cardiol 2023; 82:1175-1188. [PMID: 37462593 PMCID: PMC10529674 DOI: 10.1016/j.jacc.2023.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 02/24/2023] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Anatomic complete revascularization (ACR) and functional complete revascularization (FCR) have been associated with reduced death and myocardial infarction (MI) in some prior studies. The impact of complete revascularization (CR) in patients undergoing an invasive (INV) compared with a conservative (CON) management strategy has not been reported. OBJECTIVES Among patients with chronic coronary disease without prior coronary artery bypass grafting randomized to INV vs CON management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, we examined the following: 1) the outcomes of ACR and FCR compared with incomplete revascularization; and 2) the potential impact of achieving CR in all INV patients compared with CON management. METHODS ACR and FCR in the INV group were assessed at an independent core laboratory. Multivariable-adjusted outcomes of CR were examined in INV patients. Inverse probability weighted modeling was then performed to estimate the treatment effect had CR been achieved in all INV patients compared with CON management. RESULTS ACR and FCR were achieved in 43.4% and 58.4% of 1,824 INV patients. ACR was associated with reduced 4-year rates of cardiovascular death or MI compared with incomplete revascularization. By inverse probability weighted modeling, ACR in all 2,296 INV patients compared with 2,498 CON patients was associated with a lower 4-year rate of cardiovascular death or MI (difference -3.5; 95% CI: -7.2% to 0.0%). In comparison, the event rate difference of cardiovascular death or MI for INV minus CON in the overall ISCHEMIA trial was -2.4%. Results were similar but less pronounced with FCR. CONCLUSIONS The outcomes of an INV strategy may be improved if CR (especially ACR) is achieved. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
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Affiliation(s)
- Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Ziad A Ali
- St Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Sean M O'Brien
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Grace Rhodes
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Philippe Genereux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | | | | | - Jennifer Horst
- Cardiovascular Research Foundation, New York, New York, USA
| | | | - Kian Keong Poh
- National University Heart Center Singapore and the Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Nagaraja Moorthy
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore-Karnataka, Karnataka, India
| | | | | | - Olga Bockeria
- National Research Center for Cardiovascular Surgery, Moscow, Russia
| | - Jiyan Chen
- Guangdong Provincial People's Hospital, Guangdong, China
| | - Paola E P Smanio
- Instituto Dante Pazzanese de Cardiologia e Fleury Medicina e Saúde, São Paulo, Brazil
| | - Michael H Picard
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard R Chaitman
- St Louis University School of Medicine Center for Comprehensive Cardiovascular Care, St Louis, Missouri, USA
| | | | - Leslee J Shaw
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William E Boden
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Harvey D White
- Auckland City Hospital Green Lane Cardiovascular Services and University of Auckland, Auckland, New Zealand
| | - Stephen E Fremes
- University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yves Rosenberg
- National Heart, Lung, and Blood Institute, Washington, DC, USA
| | | | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, Kansas City, Missouri, USA
| | | | - David J Maron
- Department of Medicine, Stanford School of Medicine, Stanford, California, USA
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Kuno T, Arce J, Fattouh M, Sarkar S, Skendelas JP, Daich J, Schenone AL, Zhang L, Rodriguez CJ, Virani SS, Slomka PJ, Shaw LJ, Williamson EE, Berman DS, Garcia MJ, Dey D, Slipczuk L. Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population. Am J Prev Cardiol 2023; 15:100578. [PMID: 37675408 PMCID: PMC10477443 DOI: 10.1016/j.ajpc.2023.100578] [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: 06/04/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Low-attenuation non-calcified plaque (LAP) burden and vascular inflammation by pericoronary adipose tissue (PCAT) measured from coronary CT angiography (CCTA) have shown to be predictors of cardiovascular outcomes. We aimed to investigate the relationships of cardiometabolic risk factors including lipoprotein(a) and epicardial adipose tissue (EAT) with CCTA high-risk imaging biomarkers, LAP and vascular inflammation. Methods The patient population consisted of consecutive patients who underwent CCTA for stable chest pain and had a complete cardiometabolic panel including lipoprotein(a). Plaque, PCAT and EAT were measured from CT using semiautomated software. Elevated LAP burden and PCAT attenuation were defined as ≥4% and ≥70.5 HU, respectively. The primary clinical end-point was a composite of myocardial infarction, revascularization or cardiovascular death. Results A total of 364 consecutive patients were included (median age 56 years, 64% female); the majority of patients were of Hispanic (60%), and the rest were of non-Hispanic Black (21%), non-Hispanic White (6%) and non-Hispanic Asian (4%) race/ethnicity. The prevalence of elevated LAP burden and PCAT attenuation was 31 and 18%, respectively, while only 8% had obstructive stenosis. There were significant differences in plaque characteristics among different racial/ethnic groups (p<0.001). Lipoprotein(a) correlated with LAP burden in Hispanic patients. Patients with elevated LAP were older, more likely to be have diabetes, hypertension, hyperlipidemia and smoke with higher CAC and EAT volume (all P<0.05). Patients with elevated LAP were more likely to develop the primary clinical outcome (p<0.001) but those with elevated PCAT were not (p=0.797). Conclusion The prevalence of LAP and PCAT attenuation were 31 and 18%, respectively. Lipoprotein(a) levels correlated with LAP burden in Hispanic patients. Age, male sex, hypertension and hyperlipidemia increased the odds of elevated LAP, which showed prognostic significance.
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Affiliation(s)
- Toshiki Kuno
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Javier Arce
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Michael Fattouh
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Sharmila Sarkar
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - John P Skendelas
- Cardiothoracic and Vascular Surgery Department, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jonathan Daich
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Aldo L Schenone
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Lili Zhang
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Carlos J Rodriguez
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Salim S Virani
- Office of the Vice Provost (Research), The Aga Khan University, Karachi, Pakistan
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, United States
| | - Piotr J Slomka
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, United States
| | - Leslee J Shaw
- Departments of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Daniel S Berman
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, United States
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Damini Dey
- Department of Imaging, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, United States
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
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Boakye E, Grandhi GR, Dardari Z, Adhikari R, Soroosh G, Jha K, Dzaye O, Tasdighi E, Erhabor J, Kumar SJ, Whelton S, Blumenthal RS, Albert M, Rozanski A, Berman DS, Budoff MJ, Miedema MD, Nasir K, Rumberger JA, Shaw LJ, Blaha M. Cardiovascular risk stratification among individuals with obesity: The Coronary Artery Calcium Consortium. Obesity (Silver Spring) 2023; 31:2240-2248. [PMID: 37534563 PMCID: PMC10524261 DOI: 10.1002/oby.23832] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE The effectiveness of coronary artery calcification (CAC) for risk stratification in obesity, in which imaging is often limited because of a reduced signal to noise ratio, has not been well studied. METHODS Data from 9334 participants (mean age: 53.3 ± 9.7 years; 67.9% men) with BMI ≥ 30 kg/m2 from the CAC Consortium, a retrospectively assembled cohort of individuals with no prior cardiovascular diseases (CVD), were used. The predictive value of CAC for all-cause and cause-specific mortality was evaluated using multivariable-adjusted Cox proportional hazards and competing-risks regression. RESULTS Mean BMI was 34.5 (SD 4.4) kg/m2 (22.7% Class II and 10.8% Class III obesity), and 5461 (58.5%) had CAC. Compared with CAC = 0, those with CAC = 1-99, 100-299, and ≥300 Agatston units had higher rates (per 1000 person-years) of all-cause (1.97 vs. 3.5 vs. 5.2 vs. 11.3), CVD (0.4 vs. 1.1 vs. 1.5 vs. 4.2), and coronary heart disease (CHD) mortality (0.2 vs. 0.6 vs. 0.6 vs. 2.5), respectively, after mean follow-up of 10.8 ± 3.0 years. After adjusting for traditional cardiovascular risk factors, CAC ≥ 300 was associated with significantly higher risk of all-cause (hazard ratio [HR]: 2.05; 95% CI: 1.49-2.82), CVD (subdistribution HR: 3.48; 95% CI: 1.81-6.70), and CHD mortality (subdistribution HR: 5.44; 95% CI: 2.02-14.66), compared with CAC = 0. When restricting the sample to individuals with BMI ≥ 35 kg/m2 , CAC ≥ 300 remained significantly associated with the highest risk. CONCLUSIONS Among individuals with obesity, including moderate-severe obesity, CAC strongly predicts all-cause, CVD, and CHD mortality and may serve as an effective cardiovascular risk stratification tool to prioritize the allocation of therapies for weight management.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gowtham R Grandhi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rishav Adhikari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garshasb Soroosh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kunal Jha
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erfan Tasdighi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John Erhabor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sant J Kumar
- Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Seamus Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Albert
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai, St. Luke's Hospital, New York, New York, USA
| | - Daniel S Berman
- Departments of Imaging and Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - John A Rumberger
- Department of Cardiac Imaging, Princeton Longevity Center, Princeton, New Jersey, USA
| | - Leslee J Shaw
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Koweek L, Achenbach S, Berman DS, Carr JJ, Cury RC, Ghoshhajra B, Litmanovich D, McCollough CH, Taylor AJ, Truong QA, Wang J, Weigold WG, Arbab-Zadeh A, Abbara S, Chen MY. Standardized medical terminology for cardiac computed tomography 2023 update: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), American Association of Physicists in Medicine (AAPM), American College of Radiology (ACR), North American Society for Cardiovascular Imaging (NASCI) and Radiological Society of North America (RSNA) with endorsement by the Asian Society of Cardiovascular Imaging (ASCI), the European Association of Cardiovascular Imaging (EACI), and the European Society of Cardiovascular Radiology (ESCR). J Cardiovasc Comput Tomogr 2023; 17:345-354. [PMID: 37495455 DOI: 10.1016/j.jcct.2023.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023]
Abstract
Since the emergence of cardiac computed tomography (Cardiac CT) at the turn of the 21st century, there has been an exponential growth in research and clinical development of the technique, with contributions from investigators and clinicians from varied backgrounds: physics and engineering, informatics, cardiology, and radiology. However, terminology for the field is not unified. As a consequence, there are multiple abbreviations for some terms, multiple terms for some concepts, and some concepts that lack clear definitions and/or usage. In an effort to aid the work of all those who seek to contribute to the literature, clinical practice, and investigation of the field, the Society of Cardiovascular Computed Tomography updates a standard set of medical terms commonly used in clinical and research activities related to cardiac CT.
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Affiliation(s)
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität, Erlangen, Germany.
| | | | | | - Ricardo C Cury
- Miami Cardiac and Vascular Institute, Baptist Health of South Florida, USA.
| | | | | | | | | | | | | | | | | | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, USA.
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Budoff MJ, Kinninger A, Gransar H, Achenbach S, Al-Mallah M, Bax JJ, Berman DS, Cademartiri F, Callister TQ, Chang HJ, Chow BJW, Cury RC, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Leipsic J, Lin FY, Kim YJ, Marques H, Pontone G, Rubinshtein R, Shaw LJ, Villines TC, Min JK. When Does a Calcium Score Equate to Secondary Prevention?: Insights From the Multinational CONFIRM Registry. JACC Cardiovasc Imaging 2023; 16:1181-1189. [PMID: 37227328 DOI: 10.1016/j.jcmg.2023.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 11/23/2022] [Revised: 01/30/2023] [Accepted: 03/14/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Elevated coronary artery calcium (CAC) scores in subjects without prior atherosclerotic cardiovascular disease (ASCVD) have been shown to be associated with increased cardiovascular risk. OBJECTIVES The authors sought to determine at what level individuals with elevated CAC scores who have not had an ASCVD event should be treated as aggressively for cardiovascular risk factors as patients who have already survived an ASCVD event. METHODS The authors performed a cohort study comparing event rates of patients with established ASVCD to event rates in persons with no history of ASCVD and known calcium scores to ascertain at what level elevated CAC scores equate to risk associated with existing ASCVD. In the multinational CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry, the authors compared ASCVD event rates in persons without a history of myocardial infarction (MI) or revascularization (as categorized on CAC scores) to event rates in those with established ASCVD. They identified 4,511 individuals without known coronary artery disease (CAC) who were compared to 438 individuals with established ASCVD. CAC was categorized as 0, 1 to 100, 101 to 300, and >300. Cumulative major adverse cardiovascular events (MACE), MACE plus late revascularization, MI, and all-cause mortality incidence was assessed using the Kaplan-Meier method for persons with no ASCVD history by CAC level and persons with established ASCVD. Cox proportional hazards regression analysis was used to calculate HRs with 95% CIs, which were adjusted for traditional cardiovascular risk factors. RESULTS The mean age was 57.6 ± 12.4 years (56% male). In total, 442 of 4,949 (9%) patients experienced MACEs over a median follow-up of 4 years (IQR: 1.7-5.7 years). Incident MACEs increased with higher CAC scores, with the highest rates observed with CAC score >300 and in those with prior ASCVD. All-cause mortality, MACEs, MACE + late revascularization, and MI event rates were not statistically significantly different in those with CAC >300 compared with established ASCVD (all P > 0.05). Persons with a CAC score <300 had substantially lower event rates. CONCLUSIONS Patients with CAC scores >300 are at an equivalent risk of MACE and its components as those treated for established ASCVD. This observation, that those with CAC >300 have event rates comparable to those with established ASCVD, supplies important background for further study related to secondary prevention treatment targets in subjects without prior ASCVD with elevated CAC. Understanding the CAC scores that are associated with ASCVD risk equivalent to stable secondary prevention populations may be important for guiding the intensity of preventive approaches more broadly.
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Affiliation(s)
- Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-University of California, Los Angeles, Torrance, California, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
| | - April Kinninger
- Department of Medicine, Lundquist Institute at Harbor-University of California, Los Angeles, Torrance, California, USA
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephan Achenbach
- Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mouaz Al-Mallah
- Department of Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Jeroen J Bax
- CardioVascular Imaging Unit, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniel S Berman
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Filippo Cademartiri
- CardioVascular Imaging Unit, Leiden University Medical Center, Leiden, the Netherlands
| | - Tracy Q Callister
- Tennessee Heart and Vascular Institute, Hendersonville, Tennessee, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Korea
| | - Benjamin J W Chow
- Department of Radiology, University of Ottawa Heart Institute and University of Ottawa, Ontario, Canada
| | - Ricardo C Cury
- Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | - Joerg Hausleiter
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fay Y Lin
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Hugo Marques
- Department of Radiology, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | | | - Leslee J Shaw
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Todd C Villines
- Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA
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Hagiwara AM, Montano E, Tumurkhuu G, Bose M, Bernardo M, Berman DS, Wiens GC, Nelson MD, Wallace D, Wei J, Ishimori M, Merz CNB, Jefferies C. Reduced left ventricular function on cardiac MRI of SLE patients correlates with measures of disease activity and inflammation. medRxiv 2023:2023.08.24.23294127. [PMID: 37662185 PMCID: PMC10473799 DOI: 10.1101/2023.08.24.23294127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background Women with SLE have an elevated risk of cardiovascular disease. Many women with SLE frequently report chest pain in the absence of obstructive coronary artery disease (CAD) due to coronary microvascular dysfunction (CMD), a form of ischemia with no obstructive CAD. Echocardiographic studies have shown that SLE patients have reduced left ventricular (LV) function, which may also correlate with higher SLE disease activity scores. As such, we used cardiac magnetic resonance imaging (cMRI) to investigate the relationship between SLE, related inflammatory biomarkers, and cardiac function in female SLE patients. Methods We performed stress cMRI in women with SLE and chest pain with no obstructive CAD (n=13, all met ACR 1997 criteria,) and reference controls (n=22) using our published protocol. We evaluated LV function, tissue characterization (T1 mapping, ECV), and delayed enhancement, using CV142 software (Circle Cardiovascular Imaging Inc, Calgary, AB, Canada). Myocardial perfusion reserve index (MPRI) was calculated using our published protocol. SLEDAI and SLICC Damage Index (DI) were calculated per validated criteria. Serum samples were analyzed for inflammatory markers and autoantibodies. Wilcoxon rank-sum test was performed on clinical values with CMD and no CMD SLE subjects, and on cMRI values with all SLE subjects and controls. Correlation analysis was done on clinical values, and cMRI values on all SLE subjects. Results Overall, 40% of SLE subjects had MPRI values < 1.84, consistent with CMD. Compared to controls, SLE subjects had significantly lower LVEF, and higher LVESVi and LVMi. Corresponding to this, radial, longitudinal, and circumferential strain were significantly lower in the SLE subjects. In correlation analysis of serum inflammatory biomarkers to cMRI values in the SLE subjects, SLICC DI was related to worse cardiac function (lower radial, circumferential and longitudinal strain) and higher T1 time. Additionally, fasting insulin and ESR were negatively correlated with LVMi. Fasting insulin also negatively correlated with ECV. CRP had a positive association with LVESV index and CI and a negative association with longitudinal strain. Conclusions Among women with SLE with chest pain and no obstructive CAD, 40% have CMD. While evaluations of known inflammatory markers (such as CRP and ESR) predictably correlated with decreased cardiac function, our study found that decreased fasting insulin levels as a novel marker of diminished LV function. In addition, low insulin levels were observed to correlate with increased LVMi and ECV, suggesting a cardioprotective effect of insulin in SLE patients. We also noted that SLICC DI, an assessment of SLE damage, correlates with cardiac dysfunction in SLE. Our findings underline the potential of non-invasive cMRI as a tool for monitoring cardiovascular function in SLE, particularly in patients with high SLICC DI, ESR and CRP and low fasting insulin levels.
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Affiliation(s)
- Audrey M. Hagiwara
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Erica Montano
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Gantseg Tumurkhuu
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Moumita Bose
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
- Kao Autoimmunity Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marianne Bernardo
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel S. Berman
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center
- Department of Cardiology, Cedars-Sinai Medical Center
| | - Galen Cook Wiens
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
| | - Michael D. Nelson
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
- Applied Physiology and Advanced Imaging Laboratory, University of Texas at Arlington, Texas, USA
| | - Daniel Wallace
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
- David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA
| | - Janet Wei
- Department of Cardiology, Cedars-Sinai Medical Center
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
| | - Mariko Ishimori
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
- David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA
| | - C. Noel Bairey Merz
- Department of Cardiology, Cedars-Sinai Medical Center
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
| | - Caroline Jefferies
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
- Kao Autoimmunity Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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50
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van Rosendael SE, Bax AM, Lin FY, Achenbach S, Andreini D, Budoff MJ, Cademartiri F, Callister TQ, Chinnaiyan K, Chow BJW, Cury RC, DeLago AJ, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Raff GL, Rubinshtein R, Villines TC, Chang HJ, Berman DS, Min JK, Bax JJ, Shaw LJ, van Rosendael AR. Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary computed tomography. Eur Heart J Cardiovasc Imaging 2023; 24:1180-1189. [PMID: 37165981 PMCID: PMC10445263 DOI: 10.1093/ehjci/jead094] [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: 01/03/2023] [Revised: 03/21/2023] [Accepted: 04/05/2023] [Indexed: 05/12/2023] Open
Abstract
AIMS The totality of atherosclerotic plaque derived from coronary computed tomography angiography (CCTA) emerges as a comprehensive measure to assess the intensity of medical treatment that patients need. This study examines the differences in age onset and prognostic significance of atherosclerotic plaque burden between sexes. METHODS AND RESULTS From a large multi-center CCTA registry the Leiden CCTA score was calculated in 24 950 individuals. A total of 11 678 women (58.5 ± 12.4 years) and 13 272 men (55.6 ± 12.5 years) were followed for 3.7 years for major adverse cardiovascular events (MACE) (death or myocardial infarction). The age where the median risk score was above zero was 12 years higher in women vs. men (64-68 years vs. 52-56 years, respectively, P < 0.001). The Leiden CCTA risk score was independently associated with MACE: score 6-20: HR 2.29 (1.69-3.10); score > 20: HR 6.71 (4.36-10.32) in women, and score 6-20: HR 1.64 (1.29-2.08); score > 20: HR 2.38 (1.73-3.29) in men. The risk was significantly higher for women within the highest score group (adjusted P-interaction = 0.003). In pre-menopausal women, the risk score was equally predictive and comparable with men. In post-menopausal women, the prognostic value was higher for women [score 6-20: HR 2.21 (1.57-3.11); score > 20: HR 6.11 (3.84-9.70) in women; score 6-20: HR 1.57 (1.19-2.09); score > 20: HR 2.25 (1.58-3.22) in men], with a significant interaction for the highest risk group (adjusted P-interaction = 0.004). CONCLUSION Women developed coronary atherosclerosis approximately 12 years later than men. Post-menopausal women within the highest atherosclerotic burden group were at significantly higher risk for MACE than their male counterparts, which may have implications for the medical treatment intensity.
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Affiliation(s)
- Sophie E van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - A Maxim Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Fay Y Lin
- 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
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen Medizinische Klinik 2-Kardiologie und Angiologie, Ulmenweg 18, 91054 Erlangen, Germany
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA
| | | | - Tracy Q Callister
- Department of Cardiology, Tennessee Heart and Vascular Institute, 353 New Shackle Island Rd Hendersonville, TN 37075, USA
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, 3535 W 13 Mile Rd #742, Royal Oak, MI 48073, USA
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, 8900 N Kendall Dr, Miami, FL 33176, USA
| | - Augustin J DeLago
- Capitol Cardiology Associate, 7 Southwoods Blvd, Albany, NY 12211, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52 A, Fritz-Pregl-Straße 3, 6020 Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Lazarettstraße 36, 80636 München, Germany
| | - Joerg Hausleiter
- Department of Radiology, Medizinische Klinik I der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, 80336 München, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Yong-Jin Kim
- Department of Medicine, Seoul National University Hospital, Jongno-gu, Seoul 03080, South Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, 1081 Burrard Street Vancouver, BC V6Z 1Y6, Canada
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio (FTGM)-CNR, Pisa, Italy
| | - Hugo Marques
- UNICA, Cardiovascular Imaging Unit, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650 Lisboa, Portugal
- Católica Medical School, Estr. Octávio Pato, 2635-631 Rio de Mouro, Portugal
- Católica Biomedical Research Center, R. Q.ta Grande 6 2780, 2780-156 Oeiras, Portugal
| | - Pedro de Araújo Gonçalves
- UNICA, Cardiovascular Imaging Unit, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650 Lisboa, Portugal
- Nova Medical School, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Gianluca Pontone
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, 3535 W 13 Mile Rd #742, Royal Oak, MI 48073, USA
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Todd C Villines
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Daniel S Berman
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Leslee J Shaw
- 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
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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