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Cevik E, Tas A, Demirtakan ZG, Damman P, Alan Y, Broyd CJ, Ozcan A, Simsek DH, Sonsoz MR, Royen NV, Perera D, Davies JE, Umman S, Sezer M. Intracoronary electrocardiogram detects coronary microvascular dysfunction and ischemia in patients with no obstructive coronary arteries disease. Am Heart J 2024; 270:62-74. [PMID: 38278503 DOI: 10.1016/j.ahj.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is the leading cause of ischemia with no obstructive coronary arteries disease (INOCA) disease. Diagnosis of CMD relies on surrogate physiological indices without objective proof of ischemia. OBJECTIVES Intracoronary electrocardiogram (icECG) derived hyperemic indices may accurately and objectively detect CMD and reversible ischemia in related territory. METHODS INOCA patients with proven ischemia by myocardial perfusion scan (MPS) and completely normal coronary arteries underwent simultaneous intracoronary electrophysiological (icECG) and physiological (intracoronary Doppler) assessment in all 3 coronary arteries during rest and under adenosine induced hyperemia. RESULTS Sixty vessels in 21 patients were included in the final analysis. All patients had at least one vessel with abnormal CFR. 41 vessels had CMD (CFR < 2.5), of which 26 had increased microvascular resistance (structural CMD, HMR > 1.9 mmHg.cm-1.s) and 15 vessels had CMD (CFR < 2.5) with normal microvascular resistance (functional CMD, HMR <= 1.9 mmHg.cm-1.s). Only one-third of the patients (n = 7) had impaired CFR < 2.5 in all 3 epicardial arteries. Absolute ST shift between hyperemia and rest (∆ST) has shown the best diagnostic performance for ischemia (cut-off 0.10 mV, sensitivity: 95%, specificity: 72%, accuracy: 80%, AUC: 0.860) outperforming physiological indices (CFR: 0.623 and HMR: 0.653 DeLong's test P = .0002). CONCLUSIONS In INOCA patients, CMD involves coronary artery territories heterogeneously. icECG can accurately detect CMD causing perfusion abnormalities in patients with INOCA outperforming physiological CMD markers, by demonstrating actual ischemia instead of predicting the likelihood of inducible ischemia based on violated surrogate thresholds of blunted flow reserve or increased minimum microvascular resistance. CONDENSED ABSTRACT In 21 INOCA patients with coronary microvascular dysfunction (CMD) and myocardial perfusion scan proved ischemia, hyperemic indices of intracoronary electrocardiogram (icECG) have accurately detected vessel-specific CMD and resulting perfusion abnormalities & ischemia, outperforming invasive hemodynamic indices. Absolute ST shift between hyperemia and rest (∆ST) has shown the best classification performance for ischemia in no Obstructive Coronary Arteries (AUC: 0.860) outperforming Doppler derived CMD indices (CFR: 0.623 and HMR: 0.653 DeLong's test P = .0002).icECG can be used to diagnose CMD causing perfusion defects by demonstrating actual reversible ischemia at vessel-level during the initial CAG session, obviating the need for further costly ischemia tests. CLINICALTRIALS GOV: NCT05471739.
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Affiliation(s)
- Erdem Cevik
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Cardiology, Istanbul University, Istanbul, Turkey
| | - Ahmet Tas
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep G Demirtakan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Cardiology, Istanbul University, Istanbul, Turkey
| | - Peter Damman
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yaren Alan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Alp Ozcan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Duygu H Simsek
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet R Sonsoz
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Cardiology, Istanbul University, Istanbul, Turkey
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Divaka Perera
- King's College London, British Heart Foundation Centre of Research Excellence and National Institute for Health and Care Research Biomedical Research Centre at the School of Cardiovascular and Metabolic Medicine and Sciences, London, United Kingdom
| | - Justin E Davies
- Hammersmith Campus, Imperial College London, National Heart & Lung Institute, London, United Kingdom
| | - Sabahattin Umman
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Cardiology, Istanbul University, Istanbul, Turkey
| | - Murat Sezer
- Acibadem International Hospital, Istanbul, Turkey.
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Wang Y, Yin X. Modelling coronary flow and myocardial perfusion by integrating a structured-tree coronary flow model and a hyperelastic left ventricle model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107928. [PMID: 38000321 DOI: 10.1016/j.cmpb.2023.107928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND OBJECTIVE There is an increasing demand to establish integrated computational models that facilitate the exploration of coronary circulation in physiological and pathological contexts, particularly concerning interactions between coronary flow dynamics and myocardial motion. The field of cardiology has also demonstrated a trend toward personalised medicine, where these integrated models can be instrumental in integrating patient-specific data to improve therapeutic outcomes. Notably, incorporating a structured-tree model into such integrated models is currently absent in the literature, which presents a promising prospect. Thus, the goal here is to develop a novel computational framework that combines a 1D structured-tree model of coronary flow in human coronary vasculature with a 3D left ventricle model utilising a hyperelastic constitutive law, enabling the physiologically accurate simulation of coronary flow dynamics. METHODS We adopted detailed geometric information from previous studies of both coronary vasculature and left ventricle to construct the coronary flow model and the left ventricle model. The structured-tree model for coronary flow was expanded to encompass the effect of time-varying intramyocardial pressure on intramyocardial blood vessels. Simultaneously, the left ventricle model served as a robust foundation for the calculation of intramyocardial pressure and subsequent quantitative evaluation of myocardial perfusion. A one-way coupling framework between the two models was established to enable the evaluation and examination of coronary flow dynamics and myocardial perfusion. RESULTS Our predicted coronary flow waveforms aligned well with published experimental data. Our model precisely captured the phasic pattern of coronary flow, including impeded or even reversed flow during systole. Moreover, our assessment of coronary flow, considering both globally and regionally averaged intramyocardial pressure, demonstrated that elevated intramyocardial pressure corresponds to increased impeding effects on coronary flow. Furthermore, myocardial blood flow simulated from our model was comparable with MRI perfusion data at rest, showcasing the capability of our model to predict myocardial perfusion. CONCLUSIONS The integrated model introduced in this study presents a novel approach to achieving physiologically accurate simulations of coronary flow and myocardial perfusion. It holds promise for its clinical applicability in diagnosing insufficient myocardial perfusion.
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Affiliation(s)
- Yingjie Wang
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom.
| | - Xueqing Yin
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
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Nagy FT, Olajos D, Vattay B, Borzsák S, Boussoussou M, Deák M, Vecsey-Nagy M, Sipos B, Jermendy ÁL, Tóth GG, Nemes B, Merkely B, Szili-Török T, Ruzsa Z, Szilveszter B. Dynamic Perfusion Computed Tomography for the Assessment of Concomitant Coronary Artery Disease in Patients with a History of Percutaneous Transluminal Angioplasty for Chronic Limb-Threatening Ischemia-A Pilot Study. J Cardiovasc Dev Dis 2023; 10:443. [PMID: 37998501 PMCID: PMC10671941 DOI: 10.3390/jcdd10110443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI) is associated with high rates of long-term cardiovascular mortality. Exercise stress testing to detect obstructive coronary artery disease (CAD) can be difficult in this subset of patients due to inability to undergo exercise testing, presence of balanced ischemia and severe coronary artery calcification (CAC). AIM To test the feasibility of regadenoson stress dynamic perfusion computed tomography (DPCT) in CLTI patients. METHODS Between 2018 and 2023, coronary computed tomography angiography (CTA) and, in the case of a calcium score higher than 400, DPCT, were performed in 25 CLTI patients with a history of endovascular revascularization. RESULTS Of the 25 patients, 19 had a calcium score higher than 400, requiring DPCT image acquisition. Obstructive CAD could be ruled out in 10 of the 25 patients. Of the 15 CTA/DPCT+ patients, 13 proceeded to coronary angiography (CAG). Revascularization was necessary in all 13 patients. In these 13 patients, vessel-based sensitivity and specificity of coronary CTA/DPCT as compared to invasive evaluation was 75%, respectively. At follow-up (27 ± 21 months) there was no statistically significant difference in all-cause mortality between CTA/DPCT- positive and -negative patients (p = 0.065). CONCLUSIONS Despite a high prevalence of severe CAC, coronary CTA complemented by DPCT may be a feasible method to detect obstructive and functionally significant CAD in CLTI patients.
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Affiliation(s)
- Ferenc T. Nagy
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary; (F.T.N.); (D.O.)
| | - Dorottya Olajos
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary; (F.T.N.); (D.O.)
| | - Borbála Vattay
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Sarolta Borzsák
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Melinda Boussoussou
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Mónika Deák
- Bács-Kiskun County Hospital, 6725 Kecskemét, Hungary
| | - Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Barbara Sipos
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Ádám L. Jermendy
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Gábor G. Tóth
- Graz University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Tamás Szili-Török
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary; (F.T.N.); (D.O.)
| | - Zoltán Ruzsa
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary; (F.T.N.); (D.O.)
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
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Ohno Y, Ozawa Y, Nagata H, Bando S, Cong S, Takahashi T, Oshima Y, Hamabuchi N, Matsuyama T, Ueda T, Yoshikawa T, Takenaka D, Toyama H. Area-Detector Computed Tomography for Pulmonary Functional Imaging. Diagnostics (Basel) 2023; 13:2518. [PMID: 37568881 PMCID: PMC10416899 DOI: 10.3390/diagnostics13152518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
An area-detector CT (ADCT) has a 320-detector row and can obtain isotropic volume data without helical scanning within an area of nearly 160 mm. The actual-perfusion CT data within this area can, thus, be obtained by means of continuous dynamic scanning for the qualitative or quantitative evaluation of regional perfusion within nodules, lymph nodes, or tumors. Moreover, this system can obtain CT data with not only helical but also step-and-shoot or wide-volume scanning for body CT imaging. ADCT also has the potential to use dual-energy CT and subtraction CT to enable contrast-enhanced visualization by means of not only iodine but also xenon or krypton for functional evaluations. Therefore, systems using ADCT may be able to function as a pulmonary functional imaging tool. This review is intended to help the reader understand, with study results published during the last a few decades, the basic or clinical evidence about (1) newly applied reconstruction methods for radiation dose reduction for functional ADCT, (2) morphology-based pulmonary functional imaging, (3) pulmonary perfusion evaluation, (4) ventilation assessment, and (5) biomechanical evaluation.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan;
| | - Yoshiyuki Ozawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan;
| | - Shuji Bando
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Shang Cong
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Tomoki Takahashi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Yuka Oshima
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Nayu Hamabuchi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Takahiro Matsuyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Takeshi Yoshikawa
- Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi 673-0021, Hyogo, Japan
| | - Daisuke Takenaka
- Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi 673-0021, Hyogo, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
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Mushtaq S, Pontone G, Conte E, Trabattoni D, Galli S, Gili S, Troiano S, Teruzzi G, Baggiano A, Bonomi A, Mallia V, Marchetti D, Schillaci M, Melotti E, Belmonte M, Guaricci AI, Gigante C, Pepi M, Bartorelli AL, Andreini D. Diagnostic accuracy of subendocardial vs. transmural myocardial perfusion defect for the detection of in-stent restenosis or progression of coronary artery disease after percutaneous coronary intervention. J Cardiovasc Comput Tomogr 2023; 17:277-280. [PMID: 37248106 DOI: 10.1016/j.jcct.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/03/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The ADVANTAGE study demonstrated in a cohort of stented patients a diagnostic accuracy of stress myocardial CT perfusion (CTP) significantly higher than that of coronary CT angiography (CCTA) for the detection of in-stent restenosis (ISR) or CAD progression vs. quantitative coronary angiography (QCA). This is a pre-defined subanalysis of the ADVANTAGE aimed at assessing the difference in terms of diagnostic accuracy vs. QCA of a subendocardial vs. a transmural perfusion defect using static stress CTP. METHODS We enrolled consecutive patients who previously underwent coronary stenting and were referred for QCA. All patients underwent stress CTP and rest CTP + CCTA. The diagnostic accuracy of CCTA and CTP were evaluated in territory-based and patient-based analyses. We compared the diagnostic accuracy of "subendocardial" perfusion defect, defined as hypo-enhancement encompassing >25% but <50% of the transmural myocardial thickness within a specific coronary territory vs. "transmural" perfusion defect, defined as hypo-enhancement encompassing >50% of the transmural thickness. RESULTS In 150 patients (132 men, mean age 65.1 ± 9.1 years), the diagnostic accuracy of subendocardial vs. transmural perfusion defect in a vessel-based analysis was 93.5% vs. 87.7%, respectively (p < 0.0001). The sensitivity and specificity of subendocardial vs. transmural defect were 87.9% vs. 46.9% (p < 0.001) and 94.9% vs. 97.9% (p = 0.004), respectively. In a patient-based analysis, the diagnostic accuracy of the subendocardial vs. transmural approach was 86.6% vs. 68% (p < 0.0001). CONCLUSIONS This study shows that detection of a subendocardial perfusion defect as compared to a transmural defect is significantly more accurate to identify coronary territories with ISR or CAD progression.
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Affiliation(s)
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | | | | | | | | | | | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Vincenzo Mallia
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Davide Marchetti
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Matteo Schillaci
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Eleonora Melotti
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University Aldo Moro of Bari, Bari, Italy
| | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Antonio L Bartorelli
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
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Vattay B, Borzsák S, Boussoussou M, Vecsey-Nagy M, Jermendy ÁL, Suhai FI, Maurovich-Horvat P, Merkely B, Kolossváry M, Szilveszter B. Association between coronary plaque volume and myocardial ischemia detected by dynamic perfusion CT imaging. Front Cardiovasc Med 2022; 9:974805. [PMID: 36158821 PMCID: PMC9498180 DOI: 10.3389/fcvm.2022.974805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction We aimed to evaluate the relationship between quantitative plaque metrics derived from coronary CT angiography (CTA) and segmental myocardial ischemia using dynamic perfusion CT (DPCT). Methods In a prospective single-center study, patients with > 30% stenosis on rest CTA underwent regadenoson stress DPCT. 480 myocardium segments of 30 patients were analyzed. Quantitative plaque assessment included total plaque volume (PV), area stenosis, and remodeling index (RI). High-risk plaque (HRP) was defined as low-attenuation plaque burden > 4% or RI > 1.1. Absolute myocardial blood flow (MBF) and relative MBF (MBFi: MBF/75th percentile of all MBF values) were quantified. Linear and logistic mixed models correcting for intra-patient clustering and clinical factors were used to evaluate the association between total PV, area stenosis, HRP and MBF or myocardial ischemia (MBF < 101 ml/100 g/min). Results Median MBF and MBFi were 111 ml/100 g/min and 0.94, respectively. The number of ischemic segments were 164/480 (34.2%). Total PV of all feeding vessels of a given myocardial territory differed significantly between ischemic and non-ischemic myocardial segments (p = 0.001). Area stenosis and HRP features were not linked to MBF or MBFi (all p > 0.05). Increase in PV led to reduced MBF and MBFi after adjusting for risk factors including hypertension, diabetes, and statin use (per 10 mm3; β = −0.035, p < 0.01 for MBF; β = −0.0002, p < 0.01 for MBFi). Similarly, using multivariate logistic regression total PV was associated with ischemia (OR = 1.01, p = 0.033; per 10 mm3) after adjustments for clinical risk factors, area stenosis and HRP. Conclusion Total PV was independently associated with myocardial ischemia based on MBF, while area stenosis and HRP were not.
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Affiliation(s)
- Borbála Vattay
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Sarolta Borzsák
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Milán Vecsey-Nagy
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ádám L. Jermendy
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ferenc I. Suhai
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- *Correspondence: Bálint Szilveszter,
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Michallek F, Nakamura S, Kurita T, Ota H, Nishimiya K, Ogawa R, Shizuka T, Nakashima H, Wang Y, Ito T, Sakuma H, Dewey M, Kitagawa K. Fractal Analysis of Dynamic Stress CT-Perfusion Imaging for Detection of Hemodynamically Relevant Coronary Artery Disease. JACC Cardiovasc Imaging 2022; 15:1591-1601. [PMID: 36075619 DOI: 10.1016/j.jcmg.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Combined computed tomography-derived myocardial blood flow (CTP-MBF) and computed tomography angiography (CTA) has shown good diagnostic performance for detection of coronary artery disease (CAD). However, fractal analysis might provide additional insight into ischemia pathophysiology by characterizing multiscale perfusion patterns and, therefore, may be useful in diagnosing hemodynamically significant CAD. OBJECTIVES The purpose of this study was to investigate, in a multicenter setting, whether fractal analysis of perfusion improves detection of hemodynamically relevant CAD over myocardial blood flow quantification (CTP-MBF) using dynamic, 4-dimensional, dynamic stress myocardial computed tomography perfusion (CTP) imaging. METHODS In total, 7 centers participating in the prospective AMPLIFiED (Assessment of Myocardial Perfusion Linked to Infarction and Fibrosis Explored with Dual-source CT) study acquired CTP and CTA data in patients with suspected or known CAD. Hemodynamically relevant CAD was defined as ≥90% stenosis on invasive coronary angiography or fractional flow reserve <0.80. Both fractal analysis and CTP-MBF quantification were performed on CTP images and were combined with CTA results. RESULTS This study population included 127 participants, among them 61 patients, or 79 vessels, with CAD as per invasive reference standard. Compared with the combination of CTP-MBF and CTA, combined fractal analysis and CTA improved sensitivity on the per-patient level from 84% (95% CI: 72%-92%) to 95% (95% CI: 86%-99%; P = 0.01) and specificity from 70% (95% CI: 57%-82%) to 89% (95% CI: 78%-96%; P = 0.02). The area under the receiver-operating characteristic curve improved from 0.83 (95% CI: 0.75-0.90) to 0.92 (95% CI: 0.86-0.98; P = 0.01). CONCLUSIONS Fractal analysis constitutes a quantitative and pathophysiologically meaningful approach to myocardial perfusion analysis using dynamic stress CTP, which improved diagnostic performance over CTP-MBF when combined with anatomical information from CTA.
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Affiliation(s)
- Florian Michallek
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany.
| | - Satoshi Nakamura
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hideki Ota
- Department of Advanced MRI Collaborative Research, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Ogawa
- Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | | | - Hitoshi Nakashima
- National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Yining Wang
- Peking Union Medical College Hospital, Beijing, China
| | - Tatsuro Ito
- Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Marc Dewey
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan
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8
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Muscogiuri G, Chiesa M, Baggiano A, Spadafora P, De Santis R, Guglielmo M, Scafuri S, Fusini L, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini ME, Ricci F, Ariano FP, Spiritigliozzi L, Babbaro M, Mollace R, Maragna R, Giacari CM, Andreini D, Guaricci AI, Colombo GI, Rabbat MG, Pepi M, Sardanelli F, Pontone G. Diagnostic performance of deep learning algorithm for analysis of computed tomography myocardial perfusion. Eur J Nucl Med Mol Imaging 2022; 49:3119-3128. [PMID: 35194673 DOI: 10.1007/s00259-022-05732-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/12/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of a deep learning (DL) algorithm predicting hemodynamically significant coronary artery disease (CAD) by using a rest dataset of myocardial computed tomography perfusion (CTP) as compared to invasive evaluation. METHODS One hundred and twelve consecutive symptomatic patients scheduled for clinically indicated invasive coronary angiography (ICA) underwent CCTA plus static stress CTP and ICA with invasive fractional flow reserve (FFR) for stenoses ranging between 30 and 80%. Subsequently, a DL algorithm for the prediction of significant CAD by using the rest dataset (CTP-DLrest) and stress dataset (CTP-DLstress) was developed. The diagnostic accuracy for identification of significant CAD using CCTA, CCTA + CTP stress, CCTA + CTP-DLrest, and CCTA + CTP-DLstress was measured and compared. The time of analysis for CTP stress, CTP-DLrest, and CTP-DLStress was recorded. RESULTS Patient-specific sensitivity, specificity, NPV, PPV, accuracy, and area under the curve (AUC) of CCTA alone and CCTA + CTPStress were 100%, 33%, 100%, 54%, 63%, 67% and 86%, 89%, 89%, 86%, 88%, 87%, respectively. Patient-specific sensitivity, specificity, NPV, PPV, accuracy, and AUC of CCTA + DLrest and CCTA + DLstress were 100%, 72%, 100%, 74%, 84%, 96% and 93%, 83%, 94%, 81%, 88%, 98%, respectively. All CCTA + CTP stress, CCTA + CTP-DLRest, and CCTA + CTP-DLStress significantly improved detection of hemodynamically significant CAD compared to CCTA alone (p < 0.01). Time of CTP-DL was significantly lower as compared to human analysis (39.2 ± 3.2 vs. 379.6 ± 68.0 s, p < 0.001). CONCLUSION Evaluation of myocardial ischemia using a DL approach on rest CTP datasets is feasible and accurate. This approach may be a useful gatekeeper prior to CTP stress..
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Affiliation(s)
| | - Mattia Chiesa
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133, Milan, Italy
| | | | - Pierino Spadafora
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Rossella De Santis
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital "Policlinico Consorziale" of Bari, Bari, Italy
| | | | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, USA.,Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Francesco Sardanelli
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133, Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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9
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Kayaert P, Coeman M, Hanet C, Claeys MJ, Desmet W, De Pauw M, Haine S, Taeymans Y. Practice and long-term outcome of unprotected left main PCI: real-world data from a nationwide registry. Acta Cardiol 2022; 77:51-58. [PMID: 33683172 DOI: 10.1080/00015385.2021.1876402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly performed in significant left main (LM) lesions. Left untreated, the prognosis is poor, but PCI and coronary bypass surgery (CABG) behold risks as well. Additional long-term outcome data might guide future treatment decisions. METHODS Between 2012 and 2019, all 6783 patients who underwent LM PCI were prospectively enrolled in a national registry. Patients with prior CABG or prior LM PCI, and patients presenting in cardiogenic shock or after out-of-hospital cardiac arrest were excluded. From the remaining 5284 patients, baseline and procedural data as well as long-term survival were assessed. RESULTS The annual rate of LM PCI increased from 422 (2.2% of PCIs) in 2012 to 868 in 2018 (3.0%). By 2018, 71% of the interventional cardiologists performed at least 1 LM PCI a year, though only 5 on average. Use of transradial access (TRA) in LM PCI increased from 20.4% in 2012 to 59.5% in 2019. All-cause mortality was 6.0% at 30 days and 18.5% at a mean follow-up of 33.5 months. Independent predictors of higher long-term mortality were older age, diabetes, multivessel disease, an urgent indication, a suboptimal angiographical result, and non-exclusive use of drug-eluting stents. TRAand higher operator and centre LM PCI experience were independent predictors of a lower long-term mortality. CONCLUSION LM PCI is associated with high short- and long-term mortality. Use of TRA and higher expertise in LM PCI were associated with better survival.
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Affiliation(s)
- Peter Kayaert
- Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Mathieu Coeman
- Department of Cardiology, Jan Yperman Ziekenhuis, Ypres, Belgium
| | - Claude Hanet
- Department of Cardiology, Clinique Universitaire de l’université catholique de Louvain, Namur, Belgium
| | - Marc J. Claeys
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Walter Desmet
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - Michel De Pauw
- Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Steven Haine
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Yves Taeymans
- Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium
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10
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Kitagawa K, Nakamura S, Ota H, Ogawa R, Shizuka T, Kubo T, Yi Y, Ito T, Nagasawa N, Omori T, Nakamori S, Kurita T, Sugisawa J, Hatori N, Nakashima H, Wang Y, Kido T, Watanabe K, Matsumoto Y, Dohi K, Sakuma H. Diagnostic Performance of Dynamic Myocardial Perfusion Imaging Using Dual-Source Computed Tomography. J Am Coll Cardiol 2021; 78:1937-1949. [PMID: 34763770 DOI: 10.1016/j.jacc.2021.08.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/05/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Single-center studies indicated a high diagnostic accuracy of dynamic computed tomography perfusion (CTP) imaging in the diagnosis of coronary artery disease (CAD). OBJECTIVES This prospective multicenter study determined the diagnostic performance of combined coronary computed tomography angiography (CTA) and CTP for detecting hemodynamically significant CAD defined by invasive coronary angiography (ICA) with fractional flow reserve (FFR). METHODS Seven centers enrolled 174 patients with suspected or known CAD who were clinically referred for ICA. CTA and dynamic CTP were performed using dual-source CT before ICA. FFR was done as part of ICA in the case of 26% to 90% coronary diameter stenosis. Hemodynamically significant stenosis was defined as FFR of <0.8 or >90% stenosis on ICA. RESULTS The study protocol was completed in 157 participants, and hemodynamically significant stenosis was detected in 76 of 157 patients (48%) and 112 of 442 vessels (25%). According to receiver-operating characteristic curve analysis, adding dynamic CTP to CTA significantly increased the area under the curve from 0.65 (95% CI: 0.57-0.72) to 0.74 (95% CI: 0.66-0.81; P = 0.011) on the patient level, with decreased sensitivity (93% vs 72%; P < 0.001), improved specificity (36% vs 75%; P < 0.001), and improved overall accuracy (64% vs 74%; P < 0.001). CONCLUSIONS In this prospective multicenter study on dynamic CTP, the combination of anatomic assessment with coronary CTA and functional evaluation with dynamic CTP allowed more accurate identification of hemodynamically significant CAD compared with CTA alone. However, the clinical significance of this approach needs to be further investigated, including its usefulness in improving prognosis. (Assessment of Myocardial Perfusion Linked to Infarction and Fibrosis Explored With Dual-Source CT [AMPLIFiED]; UMIN000016353).
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Affiliation(s)
- Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan.
| | | | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Ryo Ogawa
- Department of Radiology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Takehito Shizuka
- Department of Cardiology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Tadahiro Kubo
- Department of Cardiovascular Medicine, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Yan Yi
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tatsuro Ito
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Nagasawa
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Taku Omori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shiro Nakamori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Hatori
- Department of Cardiology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Hitoshi Nakashima
- Department of Cardiovascular Medicine, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Kouki Watanabe
- Division of Cardiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, Shioya Hospital, International University of Health and Welfare, Yaita, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
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11
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Dewey M, Rochitte CE, Ostovaneh MR, Chen MY, George RT, Niinuma H, Kitagawa K, Laham R, Kofoed K, Nomura C, Sakuma H, Yoshioka K, Mehra VC, Jinzaki M, Kuribayashi S, Laule M, Paul N, Scholte AJ, Cerci R, Hoe J, Tan SY, Rybicki FJ, Matheson MB, Vavere AL, Arai AE, Miller JM, Cox C, Brinker J, Clouse ME, Di Carli M, Lima JAC, Arbab-Zadeh A. Prognostic value of noninvasive combined anatomic/functional assessment by cardiac CT in patients with suspected coronary artery disease - Comparison with invasive coronary angiography and nuclear myocardial perfusion imaging for the five-year-follow up of the CORE320 multicenter study. J Cardiovasc Comput Tomogr 2021; 15:485-491. [PMID: 34024757 DOI: 10.1016/j.jcct.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few data exist on long-term outcome in patients undergoing combined coronary CT angiography (CTA) and myocardial CT perfusion imaging (CTP) as well as invasive coronary angiography (ICA) and single photon emission tomography (SPECT). METHODS At 16 centers, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA within 60 days. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC). RESULTS Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA-CTP findings compared to ICA-SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: -0.03, 0.36). Abnormal results by combined CTA-CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA-SPECT (95% CI for difference: -0.05, 0.39). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI -4.6, 4.9). When MACE was restricted to cardiovascular death, myocardial infarction, or stroke, AUC for CTA-CTP was 71 vs. 60 by ICA-SPECT (difference 11.2; 95% CI -1.0, 19.7). CONCLUSIONS Combined CTA-CTP evaluation yields at least equal 5-year prognostic information as combined ICA-SPECT assessment in patients presenting with suspected coronary artery disease. Noninvasive cardiac CT assessment may eliminate the need for diagnostic cardiac catheterization in many patients. CLINICAL TRIAL REGISTRATION NCT00934037.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany
| | - Carlos E Rochitte
- InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil
| | - Mohammad R Ostovaneh
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Marcus Y Chen
- Cardiology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Richard T George
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Hiroyuki Niinuma
- Memorial Heart Center, Iwate Medical University, Morioka, Japan; Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Roger Laham
- Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass, USA
| | - Klaus Kofoed
- Department of Cardiology, Rigs Hospitalet, University of Copenhagen, Denmark
| | - Cesar Nomura
- Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | | | - Vishal C Mehra
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | | | | | - Michael Laule
- Department of Medicine/Cardiology, Charité Medical School-Humboldt, Berlin, Germany
| | - Narinder Paul
- Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rodrigo Cerci
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - John Hoe
- Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore
| | - Swee Yaw Tan
- Department of Cardiology, National Heart Centre, Singapore
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, OH, USA
| | - Matthew B Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Vavere
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Andrew E Arai
- Cardiology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Julie M Miller
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeffrey Brinker
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Melvin E Clouse
- Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass, USA
| | - Marcelo Di Carli
- Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - João A C Lima
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Armin Arbab-Zadeh
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA.
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12
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Chen W, Ortiz-Leon XA, Posada-Martinez EL, Pereira J, Dewar ML, Darr U, Geirsson A, Sugeng L, Zhu Q. Acute changes of left ventricular function during surgical revascularization by 3D speckle tracking. Echocardiography 2021; 38:623-631. [PMID: 33740279 DOI: 10.1111/echo.15040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Detecting early impact of coronary artery bypass grafting (CABG) on left ventricular (LV) function is important because such measures may contribute to meaningful improvement in clinical outcomes. We aimed to gain knowledge about acute changes of LV performance during surgical revascularization using three-dimensional speckle tracking echocardiography (3D STE). METHODS Thirty-five patients scheduled for CABG surgery who underwent intraoperative transesophageal echocardiography (TEE) were enrolled (mean age 68.9 ± 7.3 years). TEE was performed before and after surgery, as well as before and after grafting. 3D LV ejection fraction (LVEF), tissue motion annular displacement (TMAD) of the mitral valves, 3D global longitudinal strain (GLS), global circumferential strain (GCS), twist, and torsion were quantified. Regional longitudinal strain (LS) was calculated based on coronary perfusion territories in a 16-segment LV model. RESULTS Despite the absence of change in TMAD and 3D LVEF, 3D GLS (-18.6 ± 4.3% at baseline vs -16.0 ± 4.0% after surgery, P = .01) was significantly decreased, followed with no significant effect on GCS, twist, and torsion during surgery. 3D GLS correlated significantly with 3D LVEF (r between -0.34 and -0.51, P < .05 for all) under the whole operation. Territorial LS did not increase immediately after surgery. CONCLUSION 3D speckle tracking imaging allows for detailed and direct evaluation of myocardial deformation, though impaired LV longitudinal function is still apparent immediately after surgery. GLS is more sensitive to an acute reduction in LV function than conventional parameters, which can be potentially useful for serial monitoring of functional recovery.
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Affiliation(s)
- Wanwen Chen
- Department of Cardiology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Xochitl A Ortiz-Leon
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Jason Pereira
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael L Dewar
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Umer Darr
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Qingbing Zhu
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
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13
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Kayaert P, Coeman M, Gevaert S, De Pauw M, Haine S. Physiology-Based Revascularization of Left Main Coronary Artery Disease. J Interv Cardiol 2021; 2021:4218769. [PMID: 33628144 PMCID: PMC7892248 DOI: 10.1155/2021/4218769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 01/10/2023] Open
Abstract
It is of critical importance to correctly assess the significance of a left main lesion. Underestimation of significance beholds the risk of inappropriate deferral of revascularization, whereas overestimation may trigger major but unnecessary interventions. This article addresses the invasive physiological assessment of left main disease and its role in deciding upon revascularization. It mainly focuses on the available evidence for fractional flow reserve and instantaneous wave-free ratio, their interpretation, and limitations. We also discuss alternative invasive physiological indices and imaging, as well as the link between physiology, ischemia, and prognosis.
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Affiliation(s)
- Peter Kayaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Mathieu Coeman
- Department of Cardiology, Jan Yperman Ziekenhuis, Ypres, Belgium
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Steven Haine
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
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14
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de Groot C, Beukema JC, Langendijk JA, van der Laan HP, van Luijk P, van Melle JP, Muijs CT, Prakken NHJ. Radiation-Induced Myocardial Fibrosis in Long-Term Esophageal Cancer Survivors. Int J Radiat Oncol Biol Phys 2021; 110:1013-1021. [PMID: 33577960 DOI: 10.1016/j.ijrobp.2021.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/09/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Radiation-induced cardiac toxicity is a potential lethal complication. The aim of this study was to assess whether there is a dose-dependent relationship between radiation dose and myocardial fibrosis in patients who received neoadjuvant chemoradiation (nCRT) for esophageal cancer (EC). METHODS AND MATERIALS Forty patients with EC treated with a transthoracic esophagectomy with (n = 20) or without (n = 20) nCRT (CROSS study regimen) were included. Cardiovascular magnetic resonance imaging (1.5 Tesla) for left ventricular (LV) function, late gadolinium enhancement, and T1 mapping were performed. Extracellular volume (ECV), as a surrogate for collagen burden, was measured for all LV segments separately. The dose-response relationship between ECV and mean radiation dose per LV myocardial segment was evaluated using a mixed-model analysis. RESULTS Seventeen nCRT and 16 control patients were suitable for analysis. The mean time after treatment was 67.6 ± 8.1 (nCRT) and 122 ± 35 (controls) months (P = .02). In nCRT patients, we found a significantly higher mean global ECV of 28.2% compared with 24.0% in the controls (P < .001). After nCRT, LV myocardial segments with elevated ECV had received significantly higher radiation doses. In addition, a linear dose-effect relation was found with a 0.136% point increase of ECV for each Gy (P < .001). There were no differences in LV function measures and late gadolinium enhancement between both groups. CONCLUSIONS Myocardial ECV was significantly higher in long-term EC survivors after nCRT compared with surgery only. Moreover, this ECV increase was linear with the radiation dose per LV segment, indicating radiation-induced myocardial fibrosis.
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Affiliation(s)
- Crystal de Groot
- Department of Radiation Oncology, Isala Hospital, Zwolle, Netherlands; Department of Radiation Oncology, University Medical Center, Groningen, Netherlands.
| | - Jannet C Beukema
- Department of Radiation Oncology, University Medical Center, Groningen, Netherlands
| | | | | | - Peter van Luijk
- Department of Radiation Oncology, University Medical Center, Groningen, Netherlands
| | - Joost P van Melle
- Department of Cardialogy, University Medical Center, Groningen, Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center, Groningen, Netherlands
| | - Niek H J Prakken
- Department of Radiology, University Medical Center, Groningen, Netherlands
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15
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Jeon WK, Park J, Koo BK, Suh M, Yang S, Kim HY, Lee JM, Kim KJ, Choi JH, Lim HS, Paeng JC, Hwang D, Kim HS. Anatomical attributes of clinically relevant diagonal branches in patients with left anterior descending coronary artery bifurcation lesions. EUROINTERVENTION 2020; 16:e715-e723. [PMID: 31719001 DOI: 10.4244/eij-d-19-00534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study aimed to investigate the anatomical attributes determining myocardial territory of diagonal branches and to develop prediction models for clinically relevant branches using myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA). METHODS AND RESULTS The amount of ischaemia and subtended myocardial mass of diagonal branches was quantified using MPI by percent ischaemic myocardium (%ischaemia) and CCTA by percent fractional myocardial mass (%FMM), respectively. In 49 patients with isolated diagonal branch disease, the mean %ischaemia by MPI was 6.8±4.0%, whereas in patients with total occlusion or severe disease of all diagonal branches it was 8.4±3.3%. %ischaemia was different according to the presence of non-diseased diagonal branches and dominant left circumflex artery (LCx). In the CCTA cohort (306 patients, 564 diagonal branches), mean %FMM was 5.9±4.4% and 86 branches (15.2%) had %FMM ≥10%. %FMM was different according to LCx dominance, number of branches, vessel size, and relative dominance between two diagonal branches. The diagnostic accuracy of prediction models for %FMM ≥10% based on logistic regression and decision tree was 0.92 (95% CI: 0.85-0.96) and 0.91 (95% CI: 0.84-0.96), respectively. There was no difference in the diagnostic performance of models with and without size criterion. CONCLUSIONS LCx dominance, number of branches, vessel size, and dominance among diagonal branches determined the myocardial territory of diagonal branches. Clinical application of prediction models based on these anatomical attributes can help to determine the clinically relevant diagonal branches in the cardiac catheterisation laboratory. CLINICAL TRIAL REGISTRATION NCT03935542
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Affiliation(s)
- Won Kyeong Jeon
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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16
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de Knegt MC, Rossi A, Petersen SE, Wragg A, Khurram R, Westwood M, Saberwal B, Mathur A, Nieman K, Bamberg F, Jensen MT, Pugliese F. Stress myocardial perfusion with qualitative magnetic resonance and quantitative dynamic computed tomography: comparison of diagnostic performance and incremental value over coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2020:jeaa270. [PMID: 33029616 DOI: 10.1093/ehjci/jeaa270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/23/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS Assessment of haemodynamically significant coronary artery disease (CAD) using cardiovascular magnetic resonance (CMR) imaging perfusion or dynamic stress myocardial perfusion imaging by computed tomography (CT perfusion) may aid patient selection for invasive coronary angiography (ICA). We evaluated the diagnostic performance and incremental value of qualitative CMR perfusion and quantitative CT perfusion complementary to cardiac computed tomography angiography (CCTA) for the diagnosis of haemodynamically significant CAD using fractional flow reserve (FFR) and quantitative coronary angiography (QCA) as reference standard. METHODS AND RESULTS CCTA, qualitative visual CMR perfusion, visual CT perfusion, and quantitative relative myocardial blood flow (CT-MBF) were performed in patients with stable angina pectoris. FFR was measured in coronary vessels with stenosis visually estimated between 30% and 90% diameter reduction on ICA. Haemodynamically significant CAD was defined as FFR <0.80, or QCA ≥80% in those cases where FFR could not be performed. A total of 218 vessels from 93 patients were assessed. An optimal cut-off of 0.72 for relative CT-MBF was determined. The diagnostic performances (area under the receiver-operating characteristics curves, 95% CI) of visual CMR perfusion (0.84, 0.77-0.90) and relative CT-MBF (0.86, 0.81-0.92) were comparable and outperformed visual CT perfusion (0.64, 0.57-0.71). In combination with CCTA ≥50%, CCTA + visual CMR perfusion (0.91, 0.86-0.96), CCTA + relative CT-MBF (0.92, 0.88-0.96), and CCTA + visual CT perfusion (0.82, 0.75-0.90) improved discrimination compared with CCTA alone (all P < 0.05). CONCLUSION Visual CMR perfusion and relative CT-MBF outperformed visual CT perfusion and provided incremental discrimination compared with CCTA alone for the diagnosis of haemodynamically significant CAD.
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Affiliation(s)
- Martina C de Knegt
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Alexia Rossi
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Steffen E Petersen
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Andrew Wragg
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Ruhaid Khurram
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Mark Westwood
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Bunny Saberwal
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Anthony Mathur
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Magnus T Jensen
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark
| | - Francesca Pugliese
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
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Song J, Tang T, Caudrelier JM, Bélec J, Chan J, Lacasse P, Aldosary G, Nair V. Dose-sparing effect of deep inspiration breath hold technique on coronary artery and left ventricle segments in treatment of breast cancer. Radiother Oncol 2020; 154:101-109. [PMID: 32950530 DOI: 10.1016/j.radonc.2020.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/21/2020] [Accepted: 09/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The risk of radiation-induced cardiac injury remains a challenging problem in the treatment of breast cancer. Certain cardiac structures receive higher doses than others, which results in variable frequencies of radiation-induced injuries across these structures. Radiation dose can be reduced using the deep inspiration breath hold (DIBH) technique. We aimed to investigate the dose reductions from DIBH in individual cardiac segments. MATERIALS AND METHODS A dosimetric analysis was performed on left-sided breast cancer patients who underwent breast-conserving surgery and whole breast irradiation. Radiation doses to the cardiac structures were compared between the DIBH and free-breathing (FB) techniques and the dose reductions with DIBH were correlated to the lung expansion. RESULTS For the 75 patients included in our study, DIBH effectively reduced doses to the heart, left lung, left anterior descending coronary artery (LAD) and left ventricle (LV), but the degree of dose reductions was variable across different structures. The absolute dose reductions were greatest in the distal LAD (14.4 Gy) and apical LV (12.1 Gy) segments, compared with the other LAD (middle 9.7 Gy, proximal 1.6 Gy) and LV (anterior 5.3 Gy, lateral 2.9 Gy, septal 2.0 Gy, inferior 0.2 Gy) segments. Left lung expansion was significantly correlated with the dose reductions in the LAD (Spearman's rank correlation coefficient, ρ, 0.304) and LV (ρ, 0.420) segments. CONCLUSIONS Our study demonstrates the dose-sparing effects of DIBH in various cardiac structures, especially the distal LAD and apical LV segments. The large dose reductions seen in the distal LAD and apical LV segments could potentially translate into clinical benefit of reduced cardiac toxicity, as these structures have been previously shown to receive the highest doses and are associated with radiation-induced injury.
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Affiliation(s)
- Jiheon Song
- Division of Radiation Oncology, The Ottawa Hospital, Canada.
| | - Terence Tang
- Faculty of Medicine, University of Ottawa, Canada
| | | | - Jason Bélec
- Department of Medical Physics, The Ottawa Hospital, Canada
| | - Jessica Chan
- Division of Radiation Oncology, The Ottawa Hospital, Canada
| | | | | | - Vimoj Nair
- Division of Radiation Oncology, The Ottawa Hospital, Canada
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18
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Podlesnikar T, Pizarro G, Fernández-Jiménez R, Montero-Cabezas JM, Greif N, Sánchez-González J, Bucciarelli-Ducci C, Marsan NA, Fras Z, Bax JJ, Fuster V, Ibáñez B, Delgado V. Left ventricular functional recovery of infarcted and remote myocardium after ST-segment elevation myocardial infarction (METOCARD-CNIC randomized clinical trial substudy). J Cardiovasc Magn Reson 2020; 22:44. [PMID: 32522198 PMCID: PMC7288440 DOI: 10.1186/s12968-020-00638-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We aimed to evaluate the effect of early intravenous metoprolol treatment, microvascular obstruction (MVO), intramyocardial hemorrhage (IMH) and adverse left ventricular (LV) remodeling on the evolution of infarct and remote zone circumferential strain after acute anterior ST-segment elevation myocardial infarction (STEMI) with feature-tracking cardiovascular magnetic resonance (CMR). METHODS A total of 191 patients with acute anterior STEMI enrolled in the METOCARD-CNIC randomized clinical trial were evaluated. LV infarct zone and remote zone circumferential strain were measured with feature-tracking CMR at 1 week and 6 months after STEMI. RESULTS In the overall population, the infarct zone circumferential strain significantly improved from 1 week to 6 months after STEMI (- 8.6 ± 9.0% to - 14.5 ± 8.0%; P < 0.001), while no changes in the remote zone strain were observed (- 19.5 ± 5.9% to - 19.2 ± 3.9%; P = 0.466). Patients who received early intravenous metoprolol had significantly more preserved infarct zone circumferential strain compared to the controls at 1 week (P = 0.038) and at 6 months (P = 0.033) after STEMI, while no differences in remote zone strain were observed. The infarct zone circumferential strain was significantly impaired in patients with MVO and IMH compared to those without (P < 0.001 at 1 week and 6 months), however it improved between both time points regardless of the presence of MVO or IMH (P < 0.001). In patients who developed adverse LV remodeling (defined as ≥ 20% increase in LV end-diastolic volume) remote zone circumferential strain worsened between 1 week and 6 months after STEMI (P = 0.036), while in the absence of adverse LV remodeling no significant changes in remote zone strain were observed. CONCLUSIONS Regional LV circumferential strain with feature-tracking CMR allowed comprehensive evaluation of the sequelae of an acute STEMI treated with primary percutaneous coronary intervention and demonstrated long-lasting cardioprotective effects of early intravenous metoprolol. TRIAL REGISTRATION ClinicalTrials.gov, NCT01311700. Registered 8 March 2011 - Retrospectively registered.
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Affiliation(s)
- Tomaž Podlesnikar
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
- Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia
- Internal Medicine Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gonzalo Pizarro
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- Ruber Juan Bravo Hospital Universidad Europea, Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jose M Montero-Cabezas
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Nina Greif
- Faculty of Medicine University of Maribor, Maribor, Slovenia
| | | | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol NHS Trust, Bristol, UK
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Zlatko Fras
- Internal Medicine Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
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Long-Term Clinical Outcomes for Non-ST Elevation Acute Coronary Syndrome Patients with High-Risk Angiographic Findings Undergoing Percutaneous Coronary Intervention. J Interv Cardiol 2020; 2020:2139617. [PMID: 32489330 PMCID: PMC7229566 DOI: 10.1155/2020/2139617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 11/18/2022] Open
Abstract
Objective We aim to evaluate the long-term prognosis of non-ST elevation acute coronary syndrome (NSTE-ACS) patients with high-risk coronary anatomy (HRCA). Background Coronary disease severity is important for therapeutic decision-making and prognostication among patients presenting with NSTE-ACS. However, long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with HRCA is still unknown. Method NSTE-ACS patients undergoing PCI in Fuwai Hospital in 2013 were prospectively enrolled and subsequently divided into HRCA and low-risk coronary anatomy (LRCA) groups according to whether angiography complies with the HRCA definition. HRCA was defined as left main disease >50%, proximal LAD lesion >70%, or 2- to 3- vessel disease involving the LAD. Prognosis impact on 2-year and 5-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results Out of 4,984 enrolled patients with NSTE-ACS, 3,752 patients belonged to the HRCA group, while 1,232 patients belonged to the LRCA group. Compared with the LRCA group, patients in the HRCA group had worse baseline characteristics including higher age, more comorbidities, and worse angiographic findings. Patients in the HRCA group had higher incidence of unplanned revascularization (2 years: 9.7% vs. 5.1%, p < 0.001; 5 years: 15.4% vs. 10.3%, p < 0.001), 2-year MACCE (13.1% vs. 8.8%, p < 0.001), and 5-year death/MI/revascularization/stroke (23.0% vs. 18.4%, p = 0.001). Kaplan–Meier survival analysis showed similar results. After adjusting for confounding factors, HRCA is independently associated with higher risk of revascularization (2 years: HR = 1.636, 95% CI: 1.225–2.186; 5 years: HR = 1.460, 95% CI: 1.186–1.798), 2-year MACCE (HR = 1.275, 95% CI = 1.019–1.596) and 5-year death/MI/revascularization/stroke (HR = 1.183, 95% CI: 1.010–1.385). Conclusion In our large cohort of Chinese patients, HRCA is an independent risk factor for long-term unplanned revascularization and MACCE.
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20
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Malkasian S, Hubbard L, Abbona P, Dertli B, Kwon J, Molloi S. Vessel-specific coronary perfusion territories using a CT angiogram with a minimum cost path technique and its direct comparison to the American Heart Association 17-segment model. Eur Radiol 2020; 30:3334-3345. [PMID: 32072257 DOI: 10.1007/s00330-020-06697-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/10/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study compared the accuracy of an automated, vessel-specific minimum cost path (MCP) myocardial perfusion territory assignment technique as compared with the standard American Heart Association 17-segment (AHA) model. METHODS Six swine (42 ± 9 kg) were used to evaluate the accuracy of the MCP technique and the AHA method. In each swine, a dynamic acquisition, comprised of twenty consecutive whole heart volume scans, was acquired with a computed tomography scanner, following peripheral injection of contrast material. From this acquisition, MCP and AHA perfusion territories were determined, for the left (LCA) and right (RCA) coronary arteries. Each animal underwent additional dynamic acquisitions, consisting of twenty consecutive volume scans, following direct intracoronary contrast injection into the LCA or RCA. These images were used as the reference standard (REF) LCA and RCA perfusion territories. The MCP and AHA techniques' perfusion territories were then quantitatively compared with the REF perfusion territories. RESULTS The myocardial mass of MCP perfusion territories (MMCP) was related to the mass of reference standard perfusion territories (MREF) by MMCP = 0.99MREF + 0.39 g (r = 1.00; R2 = 1.00). The mass of AHA perfusion territories (MAHA) was related to MREF by MAHA = 0.81MREF + 5.03 g (r = 0.99; R2 = 0.98). CONCLUSION The vessel-specific MCP myocardial perfusion territory assignment technique more accurately quantifies LCA and RCA perfusion territories as compared with the current standard AHA 17-segment model. Therefore, it can potentially provide a more comprehensive and patient-specific evaluation of coronary artery disease. KEY POINTS • The minimum cost path (MCP) technique accurately determines left and right coronary artery perfusion territories, as compared with the American Heart Association 17-segment (AHA) model. • The minimum cost path (MCP) technique could be applied to cardiac computed-tomography angiography images to accurately determine patient-specific left and right coronary artery perfusion territories. • The American Heart Association 17-segment (AHA) model often fails to accurately determine left and right coronary artery perfusion territories, especially in the inferior and inferoseptal walls of the left ventricular myocardium.
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Affiliation(s)
- Shant Malkasian
- Department of Radiological Sciences, Medical Sciences I, B-14, University of California, Irvine, CA, 92697, USA
| | - Logan Hubbard
- Department of Radiological Sciences, Medical Sciences I, B-14, University of California, Irvine, CA, 92697, USA
| | - Pablo Abbona
- Department of Radiological Sciences, Medical Sciences I, B-14, University of California, Irvine, CA, 92697, USA
| | - Brian Dertli
- Department of Radiological Sciences, Medical Sciences I, B-14, University of California, Irvine, CA, 92697, USA
| | - Jungnam Kwon
- Department of Radiological Sciences, Medical Sciences I, B-14, University of California, Irvine, CA, 92697, USA
| | - Sabee Molloi
- Department of Radiological Sciences, Medical Sciences I, B-14, University of California, Irvine, CA, 92697, USA.
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Andreini D, Mushtaq S, Pontone G, Conte E, Collet C, Sonck J, D’Errico A, Di Odoardo L, Guglielmo M, Baggiano A, Trabattoni D, Ravagnani P, Montorsi P, Teruzzi G, Olivares P, Fabbiocchi F, De Martini S, Calligaris G, Annoni A, Mancini ME, Formenti A, Magatelli M, Consiglio E, Muscogiuri G, Lombardi F, Fiorentini C, Bartorelli AL, Pepi M. CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression. JACC Cardiovasc Imaging 2020; 13:732-742. [DOI: 10.1016/j.jcmg.2019.05.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 11/28/2022]
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22
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Diagnostic Accuracy of Perfusional Computed Tomography in Moderate Coronary Stenosis: Comparison With Fractional Flow Reserve. Crit Pathw Cardiol 2020; 19:9-13. [PMID: 31899707 DOI: 10.1097/hpc.0000000000000200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coronary computed tomography with myocardial perfusion imaging (CCTA-MPI) provides data on coronary anatomy and perfusion and may be useful in the assessment of ischemic coronary artery disease (CAD). Management of angiographically intermediate coronary lesions is challenging, and coronary fractional flow reserve (FFR) evaluation is recommended to assess whether these lesions are functionally significant. Our aim was to evaluate the diagnostic accuracy of CCTA-MPI in patients with stable CAD and at least 1 angiographically intermediate coronary lesion submitted to FFR. In this single-center prospective study, patients with stable CAD and at least 1 moderate coronary stenosis (50%-70% by visual estimation) were referred for CCTA-MPI (64-row multidetector) assessment before coronary FFR evaluation. Patients with severe coronary obstructions (≥70%) were excluded. The significance level adopted for all tests was 5%. Twenty-eight patients (mean age 60 ± SD years, 54% women) with 33 intermediate coronary obstructions were enrolled. Ten patients (30%) had functionally significant coronary obstructions characterized by FFR ≤0.8. The sensitivity, specificity, and accuracy of CCTA-MPI for the detection of functionally significant coronary obstructions were 30%, 100%, and 78.8%, respectively. CCTA-MPI positive predictive value was 100%, whereas negative predictive value was 76.7%. Correlation coefficient between tests was 0.48 (P = 0.005). On a novel approach to evaluate intermediate coronary lesions, accuracy of CCTA-MPI was 78.8%. The positive predictive value of an abnormal CCTA-MPI on this population was 100%, suggesting that CCTA-MPI may have a role in the assessment of patients with anatomically identified intermediate coronary lesions.
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23
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Schuijf JD, Matheson MB, Ostovaneh MR, Arbab-Zadeh A, Kofoed KF, Scholte AJHA, Dewey M, Steveson C, Rochitte CE, Yoshioka K, Cox C, Di Carli MF, Lima JAC. Ischemia and No Obstructive Stenosis (INOCA) at CT Angiography, CT Myocardial Perfusion, Invasive Coronary Angiography, and SPECT: The CORE320 Study. Radiology 2020; 294:61-73. [DOI: 10.1148/radiol.2019190978] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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24
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De Rubeis G, Napp AE, Schlattmann P, Geleijns J, Laule M, Dreger H, Kofoed K, Sørgaard M, Engstrøm T, Tilsted HH, Boi A, Porcu M, Cossa S, Rodríguez-Palomares JF, Xavier Valente F, Roque A, Feuchtner G, Plank F, Štěchovský C, Adla T, Schroeder S, Zelesny T, Gutberlet M, Woinke M, Károlyi M, Karády J, Donnelly P, Ball P, Dodd J, Hensey M, Mancone M, Ceccacci A, Berzina M, Zvaigzne L, Sakalyte G, Basevičius A, Ilnicka-Suckiel M, Kuśmierz D, Faria R, Gama-Ribeiro V, Benedek I, Benedek T, Adjić F, Čanković M, Berry C, Delles C, Thwaite E, Davis G, Knuuti J, Pietilä M, Kepka C, Kruk M, Vidakovic R, Neskovic AN, Lecumberri I, Diez Gonzales I, Ruzsics B, Fisher M, Dewey M, Francone M. Pilot study of the multicentre DISCHARGE Trial: image quality and protocol adherence results of computed tomography and invasive coronary angiography. Eur Radiol 2019; 30:1997-2009. [PMID: 31844958 DOI: 10.1007/s00330-019-06522-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/20/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To implement detailed EU cardiac computed tomography angiography (CCTA) quality criteria in the multicentre DISCHARGE trial (FP72007-2013, EC-GA 603266), we reviewed image quality and adherence to CCTA protocol and to the recommendations of invasive coronary angiography (ICA) in a pilot study. MATERIALS AND METHODS From every clinical centre, imaging datasets of three patients per arm were assessed for adherence to the inclusion/exclusion criteria of the pilot study, predefined standards for the CCTA protocol and ICA recommendations, image quality and non-diagnostic (NDX) rate. These parameters were compared via multinomial regression and ANOVA. If a site did not reach the minimum quality level, additional datasets had to be sent before entering into the final accepted database (FADB). RESULTS We analysed 226 cases (150 CCTA/76 ICA). The inclusion/exclusion criteria were not met by 6 of the 226 (2.7%) datasets. The predefined standard was not met by 13 of 76 ICA datasets (17.1%). This percentage decreased between the initial CCTA database and the FADB (multinomial regression, 53 of 70 vs 17 of 75 [76%] vs [23%]). The signal-to-noise ratio and contrast-to-noise ratio of the FADB did not improve significantly (ANOVA, p = 0.20; p = 0.09). The CTA NDX rate was reduced, but not significantly (initial CCTA database 15 of 70 [21.4%]) and FADB 9 of 75 [12%]; p = 0.13). CONCLUSION We were able to increase conformity to the inclusion/exclusion criteria and CCTA protocol, improve image quality and decrease the CCTA NDX rate by implementing EU CCTA quality criteria and ICA recommendations. KEY POINTS • Failure to meet protocol adherence in cardiac CTA was high in the pilot study (77.6%). • Image quality varies between sites and can be improved by feedback given by the core lab. • Conformance with new EU cardiac CT quality criteria might render cardiac CTA findings more consistent and comparable.
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Affiliation(s)
- Gianluca De Rubeis
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Adriane E Napp
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Peter Schlattmann
- Department of Statistics, Informatics and Data Science, Jena University Hospital, Jena, Germany
| | - Jacob Geleijns
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Michael Laule
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Henryk Dreger
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Klaus Kofoed
- Department of Radiology, Rigshospitalet Region Hovedstaden, Rigshospitalet 9, 2100, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet Region Hovedstaden, Rigshospitalet 9, 2100, Copenhagen, Denmark
| | - Mathias Sørgaard
- Department of Cardiology, Rigshospitalet Region Hovedstaden, Rigshospitalet 9, 2100, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet Region Hovedstaden, Rigshospitalet 9, 2100, Copenhagen, Denmark
| | - Hans Henrik Tilsted
- Department of Cardiology, Rigshospitalet Region Hovedstaden, Rigshospitalet 9, 2100, Copenhagen, Denmark
| | - Alberto Boi
- Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, CA, Italy
| | - Michele Porcu
- Department of Radiology, Azienda Ospedaliera Universitaria di Cagliari, AOU di Cagliari - Polo di Monserrato, 09042, Monserrato, CA, Italy
| | - Stefano Cossa
- Department of Radiology, Azienda Ospedaliera Brotzu, Cagliari, CA, Italy
| | - José F Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig de Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Filipa Xavier Valente
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig de Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Albert Roque
- Department of Radiology, Hospital Universitari Vall d´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig de Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Gudrun Feuchtner
- Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Fabian Plank
- Department of Cardiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Cyril Štěchovský
- Department of Cardiology, University Hospital Motol, Vuvalu 84, 150 06, Prague 5, Czech Republic
| | - Theodor Adla
- Department of Radiology, University Hospital Motol, Vuvalu 84, 150 06, Prague 5, Czech Republic
| | - Stephen Schroeder
- Department of Cardiology, ALB FILS KLINIKEN GmbH, Eichertstrasse 3, 73035, Goeppingen, Germany
| | - Thomas Zelesny
- Department of Radiology, ALB FILS KLINIKEN GmbH, Eichertstrasse 3, 73035, Goeppingen, Germany
| | - Matthias Gutberlet
- Department of Radiology, University of Leipzig Heart Centre, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Michael Woinke
- Department of Cardiology, University of Leipzig Heart Centre, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Mihály Károlyi
- MTA-SE Cardiovascular Imaging Center, Heart and Vascular Center, Semmelweis University, Varosmajor u 68, Budapest, 1122, Hungary
| | - Júlia Karády
- Department of Cardiology, Southeastern Health and Social Care Trust, Upper Newtownards Road Ulster, Belfast, BT16 1RH, UK
| | - Patrick Donnelly
- Department of Cardiology, Southeastern Health and Social Care Trust, Upper Newtownards Road Ulster, Belfast, BT16 1RH, UK
| | - Peter Ball
- Department of Radiology, Southeastern Health and Social Care Trust, Upper Newtownards Road Ulster, Belfast, BT16 1RH, UK
| | - Jonathan Dodd
- Department of Radiology, St. Vincent's University Hospital and National University of Ireland, Belfield Campus, 4, Dublin, Ireland
| | - Mark Hensey
- Department of Cardiology, St. Vincent's University Hospital, Belfield Campus, 4, Dublin, Ireland
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Andrea Ceccacci
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Marina Berzina
- Department of Cardiology, Paul Stradins Clinical University Hospital, Pilsoņu Street 13, Riga, 1002, Latvia
| | - Ligita Zvaigzne
- Department of Radiology, Paul Stradins Clinical University Hospital, Pilsoņu Street 13, Riga, 1002, Latvia
| | - Gintare Sakalyte
- Department of Cardiology, Lithuanian University of Health Sciences, Eivelniu 2, 50009, Kaunas, Lithuania
| | - Algidas Basevičius
- Department of Radiology, Lithuanian University of Health Sciences, Eivelniu 2, 50009, Kaunas, Lithuania
| | - Małgorzata Ilnicka-Suckiel
- Department of Cardiology, Wojewodzki Szpital Specjalistyczny We Wroclawiu, Ul. Henryka Michala Kamienskiego, 51124, Wroclaw, Poland
| | - Donata Kuśmierz
- Department of Radiology, Wojewodzki Szpital Specjalistyczny We Wroclawiu, Ul. Henryka Michala Kamienskiego, 51124, Wroclaw, Poland
| | - Rita Faria
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Rua Conceicao Fernandes, 4434 502, Vila Nova de Gaia, Portugal
| | - Vasco Gama-Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Rua Conceicao Fernandes, 4434 502, Vila Nova de Gaia, Portugal
| | - Imre Benedek
- Department of Cardiology, Cardio Med Medical Center, 22 decembrie 1989, 540156, Targu-Mures, Romania
| | - Teodora Benedek
- Department of Cardiology, Cardio Med Medical Center, 22 decembrie 1989, 540156, Targu-Mures, Romania
| | - Filip Adjić
- Radiology Department Imaging Center, Institute of Cardiovascular Diseases of Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Novi Sad, 212014, Serbia
| | - Milenko Čanković
- Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Novi Sad, 212014, Serbia
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place 126, Glasgow, G12 8TA, UK
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place 126, Glasgow, G12 8TA, UK
| | - Erica Thwaite
- Department of Radiology, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Gershan Davis
- Department of Cardiology, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20120, Turku, Finland
| | - Mikko Pietilä
- Heart Centre, Turku University Hospital, Kiinamyllynkatu 4-8, FI 20120, Turku, Finland
| | - Cezary Kepka
- Department of Radiology, The Institute of Cardiology in Warsaw, Ul. Alpejska 42, 04-628, Warsaw, Poland
| | - Mariusz Kruk
- Department of Cardiology, The Institute of Cardiology in Warsaw, Ul. Alpejska 42, 04-628, Warsaw, Poland
| | - Radosav Vidakovic
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade-Zemun, 11080, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade-Zemun, 11080, Serbia
| | - Iñigo Lecumberri
- Department of Radiology, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Spain
| | - Ignacio Diez Gonzales
- Department of Cardiology, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Spain
| | - Balazs Ruzsics
- Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Prescot Street, Liverpool, L7 8XP, UK
| | - Mike Fisher
- Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Prescot Street, Liverpool, L7 8XP, UK
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marco Francone
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy. .,Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, V.le Regina Elena, 324 00161, Rome, Italy.
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25
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Pontone G, De Cecco C, Baggiano A, Guaricci AI, Guglielmo M, Leiner T, Lima J, Maurovich-Horvat P, Muscogiuri G, Nance JW, Schoepf UJ. Design of CTP-PRO study (impact of stress Cardiac computed Tomography myocardial Perfusion on downstream resources and PROgnosis in patients with suspected or known coronary artery disease: A multicenter international study). Int J Cardiol 2019; 292:253-257. [DOI: 10.1016/j.ijcard.2019.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/25/2022]
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Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease. JACC Cardiovasc Imaging 2019; 12:1487-1497. [DOI: 10.1016/j.jcmg.2018.08.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 11/23/2022]
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Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia. JACC Cardiovasc Imaging 2019; 12:1367-1376. [DOI: 10.1016/j.jcmg.2018.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/16/2018] [Accepted: 05/24/2018] [Indexed: 12/21/2022]
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Gifft K, Dohrmann M, Eniezat M, Enezate T. Effect of infarct site on the clinical endpoints of thrombolytic-treated ST-elevation myocardial infarction. Am J Emerg Med 2019; 38:79-82. [PMID: 31005391 DOI: 10.1016/j.ajem.2019.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Some studies suggest better outcomes after the use of thrombolytics in inferior ST-elevation myocardial infarction (STEMI) compared to other locations. The goal of this study is to compare the clinical endpoints of thrombolytic-treated STEMI based on coronary artery distribution. METHODS The study population was extracted from the 2014 Nationwide Readmissions Data using the International Classification of Diseases, Ninth Revision, Clinical Modifications codes for STEMI, thrombolytic infusion, and complications of STEMI. Primary study endpoints included in-hospital all-cause mortality, length of hospital stay (LOS), cardiogenic shock, and mechanical complications of STEMI. RESULTS A principal diagnosis of thrombolytic-treated STEMI was identified for in 1231 patients (mean age 61.5 years; 26.5% female). Four hundred and thirty-one STEMIs occurred in the left anterior descending (LAD) artery distribution, 124 in the left circumflex (LCX) artery distribution, and 676 in the right coronary artery (RCA) distribution. In comparison to the LAD and LCX distributions, thrombolytic-treated STEMIs in the RCA distribution were associated with lower mortality (6.5% with LAD, 5.7% with LCX, and 3.6% with RCA; p = 0.02), fewer cardiogenic shock (12.3% with LAD, 12.1% with LCX, and 7.7% with RCA; p = 0.01), and shorter LOS (4.5 days with LAD, 3.9 with LCX, and 3.6 days with RCA; p < 0.01). Mechanical complications showed no significant difference based on coronary distribution (2.3% with LAD, 3.2% with LCX, and 1.2% with RCA; p = 0.17). CONCLUSIONS Thrombolytic-treated STEMIs in the RCA distribution were associated with lower in-hospital all-cause mortality, cardiogenic shock, and shorter LOS. Mechanical complications were not different based on coronary distribution.
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Affiliation(s)
- Kristina Gifft
- Department of General Medicine, University of Missouri Health Care, Columbia, MO, USA
| | - Mary Dohrmann
- Division of Cardiovascular Medicine, University of Missouri Health Care, Columbia, MO, USA
| | - Mohammad Eniezat
- Medical School of Jordan University of Science and Technology, Irbid, Jordan
| | - Tariq Enezate
- Division of Cardiovascular Medicine, University of Missouri Health Care, Columbia, MO, USA.
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Song YB, Arbab-Zadeh A, Matheson MB, Ostovaneh MR, Vavere AL, Dewey M, Rochitte C, Niinuma H, Laham R, Schuijf JD, Cox C, Brinker J, di Carli M, Lima JA, Miller JM. Contemporary Discrepancies of Stenosis Assessment by Computed Tomography and Invasive Coronary Angiography. Circ Cardiovasc Imaging 2019; 12:e007720. [DOI: 10.1161/circimaging.118.007720] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.B.S.)
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Matthew B. Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.B.M., C.C.)
| | - Mohammad R. Ostovaneh
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Andrea L. Vavere
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Marc Dewey
- Department of Radiology, Charité Medical School, Humboldt, Berlin, Germany (M.D.)
| | - Carlos Rochitte
- Department of Medicine, InCor Heart Institute, University of Sao Paulo Medical School, Brazil (C.R.)
| | - Hiroyuki Niinuma
- Department of Medicine, Division of Cardiology, Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N.)
| | - Roger Laham
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (R.L.)
| | | | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.B.M., C.C.)
| | - Jeffrey Brinker
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Marcelo di Carli
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.d.C.)
| | - João A.C. Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Julie M. Miller
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
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Pontone G, Andreini D, Guaricci AI, Baggiano A, Fazzari F, Guglielmo M, Muscogiuri G, Berzovini CM, Pasquini A, Mushtaq S, Conte E, Calligaris G, De Martini S, Ferrari C, Galli S, Grancini L, Ravagnani P, Teruzzi G, Trabattoni D, Fabbiocchi F, Lualdi A, Montorsi P, Rabbat MG, Bartorelli AL, Pepi M. Incremental Diagnostic Value of Stress Computed Tomography Myocardial Perfusion With Whole-Heart Coverage CT Scanner in Intermediate- to High-Risk Symptomatic Patients Suspected of Coronary Artery Disease. JACC Cardiovasc Imaging 2019; 12:338-349. [DOI: 10.1016/j.jcmg.2017.10.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 12/13/2022]
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Diagnostic accuracy of simultaneous evaluation of coronary arteries and myocardial perfusion with single stress cardiac computed tomography acquisition compared to invasive coronary angiography plus invasive fractional flow reserve. Int J Cardiol 2018; 273:263-268. [DOI: 10.1016/j.ijcard.2018.09.065] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/16/2018] [Accepted: 09/19/2018] [Indexed: 11/18/2022]
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Malkasian S, Hubbard L, Dertli B, Kwon J, Molloi S. Quantification of vessel-specific coronary perfusion territories using minimum-cost path assignment and computed tomography angiography: Validation in a swine model. J Cardiovasc Comput Tomogr 2018; 12:425-435. [PMID: 30042078 DOI: 10.1016/j.jcct.2018.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/25/2018] [Accepted: 06/15/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND As combined morphological and physiological assessment of coronary artery disease (CAD) is necessary to reliably resolve CAD severity, the objective of this study was to validate an automated minimum-cost path assignment (MCP) technique which enables accurate, vessel-specific assignment of the left (LCA) and right (RCA) coronary perfusion territories using computed tomography (CT) angiography data for both left and right ventricles. METHODS Six swine were used to validate the MCP technique. In each swine, a dynamic acquisition comprised of twenty consecutive volume scans was acquired with a 320-slice CT scanner following peripheral injection of contrast material. From this acquisition the MCP technique was used to automatically assign LCA and RCA perfusion territories for the left and right ventricles, independently. Each animal underwent another dynamic CT acquisition following direct injection of contrast material into the LCA or RCA. Using this acquisition, reference standard LCA and RCA perfusion territories were isolated from the myocardial blush. The accuracy of the MCP technique was evaluated by quantitatively comparing the MCP-derived LCA and RCA perfusion territories to these reference standard territories. RESULTS All MCP perfusion territory masses (MassMCP) and all reference standard perfusion territory masses (MassRS) in the left ventricle were related by MassMCP = 0.99MassRS+0.35 g (r = 1.00). MassMCP and MassRS in the right ventricle were related by MassMCP = 0.94MassRS+0.39 g (r = 0.96). CONCLUSION The MCP technique was validated in a swine animal model and has the potential to be used for accurate, vessel-specific assignment of LCA and RCA perfusion territories in both the left and right ventricular myocardium using CT angiography data.
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Affiliation(s)
- Shant Malkasian
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, 92697, USA
| | - Logan Hubbard
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, 92697, USA
| | - Brian Dertli
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, 92697, USA
| | - Jungnam Kwon
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, 92697, USA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, 92697, USA.
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Andreini D, Mushtaq S, Pontone G, Conte E, Sonck J, Collet C, Guglielmo M, Baggiano A, Trabattoni D, Galli S, Montorsi P, Ferrari C, Fabbiocchi F, De Martini S, Annoni A, Mancini ME, Formenti A, Magatelli M, Resta M, Consiglio E, Muscogiuri G, Fiorentini C, Bartorelli AL, Pepi M. Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study. J Cardiovasc Comput Tomogr 2018; 12:411-417. [PMID: 29933938 DOI: 10.1016/j.jcct.2018.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/04/2018] [Accepted: 06/15/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent studies demonstrated a significant improvement in the diagnostic performance of coronary CT angiography (CCTA) for the evaluation of in-stent restenosis (ISR). However, coronary stent assessment is still challenging, especially because of beam-hardening artifacts due to metallic stent struts and high atherosclerotic burden of non-stented segments. Adenosine-stress myocardial perfusion assessed by CT (CTP) recently demonstrated to be a feasible and accurate tool for evaluating the functional significance of coronary stenoses in patients with suspected coronary artery disease (CAD). Yet, scarce data are available on the performance of CTP in patients with previous stent implantation. AIM OF THE STUDY We aim to assess the diagnostic performance of CCTA alone, CTP alone and CCTA plus CTP performed with a new scanner generation using quantitative invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as standard of reference. METHODS We will enroll 300 consecutive patients with previous stent implantation, referred for non-emergent and clinically indicated invasive coronary angiography (ICA) due to suspected ISR or progression of CAD in native coronary segments. All patients will be subjected to stress myocardial CTP and a rest CCTA. The first 150 subjects will undergo static CTP scan, while the following 150 patients will undergo dynamic CTP scan. Measurement of invasive FFR will be performed during ICA when clinically indicated. RESULTS The primary study end points will be: 1) assessment of the diagnostic performance (diagnostic rate, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. ICA as standard of reference in a territory-based and patient-based analysis; 2) assessment of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. invasive FFR as standard of reference in a territory-based analysis. CONCLUSIONS The ADVANTAGE study aims to provide an answer to the intriguing question whether the combined anatomical and functional assessment with CCTA plus CTP may have higher diagnostic performance as compared to CCTA alone in identifying stented patients with significant ISR or CAD progression.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
| | | | | | | | - Jeroen Sonck
- Department of Interventional Cardiology, CHVZ, UZ Brussel, Belgium
| | - Carlos Collet
- Department of Cardiology, University of Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | - Marta Resta
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Jia X, Heiberg E, Ripa MS, Engblom H, Halvorsen S, Arheden H, Atar D, Clemmensen P, Birnbaum Y. Correlation of ST changes in leads V4-V6 to area of ischemia by CMR in inferior STEMI. SCAND CARDIOVASC J 2018; 52:189-195. [PMID: 29595340 DOI: 10.1080/14017431.2018.1458145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We aim to determine the correlation between ST-segment changes in leads V4-V6 and the extent of myocardial injury by cardiac magnetic resonance (CMR) in patients with inferior ST elevation (STE) myocardial infarction (iSTEMI). DESIGN Admission electrocardiogram and CMR data from the MITOCARE trial were used. Differences in mean myocardium at risk, infarct size, ejection fraction and myocardial segment involvement by CMR were compared in patients with first iSTEMI with STE, ST depression (STD) or no ST changes (NST) in V4-V6. Myocardial segment involvement was further evaluated by comparing proportion of patients in each group with ≥25% and ≥50% segment involvement. RESULTS Fifty-four patients were included. Patients with STE (n = 22) and STD (n = 16) in V4-V6 had significantly lower ejection fraction compared to NST (n = 16) (48% vs 48% vs 54%, p = .02). STE showed more apical, apical lateral and mid-inferolateral involvement but less basal inferior involvement than NST. STD exhibited greater basal inferoseptal involvement compared to STE. There were more patients with STE that had ≥25% and ≥50% apical lateral involvement compared with STD and NST groups. Patients with STD were more likely to have ≥25% and ≥50% basal inferoseptal involvement compared with STE and NST groups. CONCLUSION Our study suggests that in iSTEMI, ST changes in the precordial leads V4-V6 correlates with greater myocardial injury and distribution of myocardium at risk.
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Affiliation(s)
- Xiaoming Jia
- a Department of Medicine, Section of Cardiology , Baylor College of Medicine , Houston , TX , USA
| | - Einar Heiberg
- b Department of Clinical Physiology , Lund University and Lund University Hospital , Lund , Sweden
| | - Maria Sejersten Ripa
- c Department of Cardiology, The Heart Centre , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Henrik Engblom
- b Department of Clinical Physiology , Lund University and Lund University Hospital , Lund , Sweden
| | - Sigrun Halvorsen
- d Department of Cardiology, Division of Medicine , Oslo University Hospital and Institute of Clinical Sciences, University of Oslo , Oslo , Norway
| | - Håkan Arheden
- b Department of Clinical Physiology , Lund University and Lund University Hospital , Lund , Sweden
| | - Dan Atar
- d Department of Cardiology, Division of Medicine , Oslo University Hospital and Institute of Clinical Sciences, University of Oslo , Oslo , Norway
| | - Peter Clemmensen
- e Department of Medicine, Division of Cardiology , Nykøbing Falster Hospital , Nykøbing Falster , Denmark.,f Institute of Regional Health Research , University of Southern Denmark , Odense , Denmark.,g Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
| | - Yochai Birnbaum
- a Department of Medicine, Section of Cardiology , Baylor College of Medicine , Houston , TX , USA
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35
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Rief M, Chen MY, Vavere AL, Kendziora B, Miller JM, Bandettini WP, Cox C, George RT, Lima J, Di Carli M, Plotkin M, Zimmermann E, Laule M, Schlattmann P, Arai AE, Dewey M. Coronary Artery Disease: Analysis of Diagnostic Performance of CT Perfusion and MR Perfusion Imaging in Comparison with Quantitative Coronary Angiography and SPECT-Multicenter Prospective Trial. Radiology 2017; 286:461-470. [PMID: 28956734 DOI: 10.1148/radiol.2017162447] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose To compare the diagnostic performance of stress myocardial computed tomography (CT) perfusion with that of stress myocardial magnetic resonance (MR) perfusion imaging in the detection of coronary artery disease (CAD). Materials and Methods All patients gave written informed consent prior to inclusion in this institutional review board-approved study. This two-center substudy of the prospective Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) multicenter trial included 92 patients (mean age, 63.1 years ± 8.1 [standard deviation]; 73% male). All patients underwent perfusion CT and perfusion MR imaging with either adenosine or regadenoson stress. The predefined reference standards were combined quantitative coronary angiography (QCA) and single-photon emission CT (SPECT) or QCA alone. Results from coronary CT angiography were not included, and diagnostic performance was evaluated with the Mantel-Haenszel test stratified by disease status. Results The prevalence of CAD was 39% (36 of 92) according to QCA and SPECT and 64% (59 of 92) according to QCA alone. When compared with QCA and SPECT, per-patient diagnostic accuracy of perfusion CT and perfusion MR imaging was 63% (58 of 92) and 75% (69 of 92), respectively (P = .11); sensitivity was 92% (33 of 36) and 83% (30 of 36), respectively (P = .45); and specificity was 45% (25 of 56) and 70% (39 of 56), respectively (P < .01). When compared with QCA alone, diagnostic accuracy of CT perfusion and MR perfusion imaging was 82% (75 of 92) and 74% (68 of 92), respectively (P = .27); sensitivity was 90% (53 of 59) and 69% (41 of 59), respectively (P < .01); and specificity was 67% (22 of 33) and 82% (27 of 33), respectively (P = .27). Conclusion This multicenter study shows that the diagnostic performance of perfusion CT is similar to that of perfusion MR imaging in the detection of CAD. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Matthias Rief
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Marcus Y Chen
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Andrea L Vavere
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Benjamin Kendziora
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Julie M Miller
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - W Patricia Bandettini
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Christopher Cox
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Richard T George
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - João Lima
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Marcelo Di Carli
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Michail Plotkin
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Elke Zimmermann
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Michael Laule
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Peter Schlattmann
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Andrew E Arai
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Marc Dewey
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
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36
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Chen MY, Rochitte CE, Arbab-Zadeh A, Dewey M, George RT, Miller JM, Niinuma H, Yoshioka K, Kitagawa K, Sakuma H, Laham R, Vavere AL, Cerci RJ, Mehra VC, Nomura C, Kofoed KF, Jinzaki M, Kuribayashi S, Scholte AJ, Laule M, Tan SY, Hoe J, Paul N, Rybicki FJ, Brinker JA, Arai AE, Matheson MB, Cox C, Clouse ME, Di Carli MF, Lima JAC. Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging versus Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events: The CORE320 Multicenter Study. Radiology 2017; 284:55-65. [PMID: 28290782 DOI: 10.1148/radiol.2017161565] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial perfusion imaging. Materials and Methods This study was approved by all institutional review boards, and written informed consent was obtained. Between November 2009 and July 2011, 381 participants clinically referred for ICA and aged 45-85 years were enrolled in the Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) prospective multicenter diagnostic study. All images were analyzed in blinded independent core laboratories, and a panel of physicians adjudicated all adverse events. MACE was defined as revascularization (>30 days after index ICA), myocardial infarction, or cardiac death; hospitalization for chest pain or congestive heart failure; or arrhythmia. Late MACE was defined similarly, except for patients who underwent revascularization within the first 182 days after ICA, who were excluded. Comparisons of 2-year survival (time to MACE) used standard Kaplan-Meier curves and restricted mean survival times bootstrapped with 2000 replicates. Results An MACE (49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia) occurred in 51 of 379 patients (13.5%). The 2-year MACE-free rates for combined CT angiography and CT perfusion findings were 94% negative for coronary artery disease (CAD) versus 82% positive for CAD and were similar to combined ICA and single photon emission CT findings (93% negative for CAD vs 77% positive for CAD, P < .001 for both). Event-free rates for CT angiography and CT perfusion versus ICA and single photon emission CT for either positive or negative results were not significantly different for MACE or late MACE (P > .05 for all). The area under the receiver operating characteristic curve (AUC) for combined CT angiography and CT perfusion (AUC = 68; 95% confidence interval [CI]: 62, 75) was similar (P = .36) to that for combined ICA and single photon emission CT (AUC = 71; 95% CI: 65, 79) in the identification of MACE at 2-year follow-up. Conclusion Combined CT angiography and CT perfusion enables similar prediction of 2-year MACE, late MACE, and event-free survival similar to that enabled by ICA and single photon emission CT. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Marcus Y Chen
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Carlos E Rochitte
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Armin Arbab-Zadeh
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Marc Dewey
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Richard T George
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Julie M Miller
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Hiroyuki Niinuma
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Kunihiro Yoshioka
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Kakuya Kitagawa
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Hajime Sakuma
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Roger Laham
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Andrea L Vavere
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Rodrigo J Cerci
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Vishal C Mehra
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Cesar Nomura
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Klaus F Kofoed
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Masahiro Jinzaki
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Sachio Kuribayashi
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Arthur J Scholte
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Michael Laule
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Swee Yaw Tan
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - John Hoe
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Narinder Paul
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Frank J Rybicki
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Jeffrey A Brinker
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Andrew E Arai
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Matthew B Matheson
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Christopher Cox
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Melvin E Clouse
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - Marcelo F Di Carli
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
| | - João A C Lima
- From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.)
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37
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Penagaluri A, Higgins AY, Vavere AL, Miller JM, Arbab-Zadeh A, Betoko A, Steveson C, Zimmermann E, Cox C, Rochitte CE, Dewey M, Kofoed KF, Niinuma H, Di Carli MF, Lima JA, Chen MY. Computed Tomographic Perfusion Improves Diagnostic Power of Coronary Computed Tomographic Angiography in Women. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005189. [DOI: 10.1161/circimaging.116.005189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/26/2016] [Indexed: 11/16/2022]
Abstract
Background—
Coronary computed tomographic angiography (CTA) and myocardial perfusion imaging (CTP) is a validated approach for detection and exclusion of flow-limiting coronary artery disease (CAD), but little data are available on gender-specific performance of these modalities. In this study, we aimed to evaluate the diagnostic accuracy of combined coronary CTA and CTP in detecting flow-limiting CAD in women compared with men.
Methods and Results—
Three hundred and eighty-one patients who underwent both CTA-CTP and single-photon emission computed tomography myocardial perfusion imaging preceding invasive coronary angiography as part of the CORE320 multicenter study (Coronary Artery Evaluation Using 320-row Multidetector Computed Tomography Angiography and Myocardial Perfusion) were included in this ancillary study. All 4 image modalities were analyzed in blinded, independent core laboratories. Prevalence of flow-limiting CAD defined by invasive coronary angiography equal to 50% or greater with an associated single-photon emission computed tomography myocardial perfusion imaging defect was 45% (114/252) and 23% (30/129) in males and females, respectively. Patient-based diagnostic accuracy defined by the area under the receiver operating curve for detecting flow-limiting CAD by CTA alone in females was 0.83 (0.75–0.89) and for CTA-CTP was 0.92 (0.86–0.97;
P
=0.003) compared with men where the area under the receiver operating curve for detecting flow-limiting CAD by CTA alone was 0.82 (0.77–0.87) and for CTA-CTP was 0.84 (0.80–0.89;
P
=0.29).
Conclusions—
The combination of CTA-CTP was performed similarly in men and women for identifying flow-limiting coronary stenosis; however, in women, CTP had incremental value over CTA alone, which was not the case in men.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00934037.
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Affiliation(s)
- Ashritha Penagaluri
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Angela Y. Higgins
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Andrea L. Vavere
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Julie M. Miller
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Armin Arbab-Zadeh
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Aisha Betoko
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Chloe Steveson
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Elke Zimmermann
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Christopher Cox
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Carlos E. Rochitte
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Marc Dewey
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Klaus F. Kofoed
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Hiroyuki Niinuma
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Marcelo F. Di Carli
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - João A.C. Lima
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
| | - Marcus Y. Chen
- From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of
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Pontone G, Andreini D, Guaricci AI, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Trabattoni D, Ferrari C, Calligaris G, Teruzzi G, Fabbiocchi F, Lualdi A, Montorsi P, Bartorelli AL, Pepi M. Rationale and design of the PERFECTION (comparison between stress cardiac computed tomography PERfusion versus Fractional flow rEserve measured by Computed Tomography angiography In the evaluation of suspected cOroNary artery disease) prospective study. J Cardiovasc Comput Tomogr 2016; 10:330-4. [DOI: 10.1016/j.jcct.2016.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/19/2016] [Indexed: 11/15/2022]
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Nudi F, Schillaci O, Neri G, Pinto A, Procaccini E, Vetere M, Frati G, Tomai F, Biondi-Zoccai G. Prognostic impact of location and extent of vessel-related ischemia at myocardial perfusion scintigraphy in patients with or at risk for coronary artery disease. J Nucl Cardiol 2016; 23:274-84. [PMID: 25827620 DOI: 10.1007/s12350-015-0077-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myocardial perfusion scintigraphy (MPS) has an established diagnostic and prognostic role in patients with or at risk for coronary artery disease, with ischemia severity and extent having already been identified as key predictors. Whether this is affected by the location of myocardial ischemia is uncertain. We aimed at comparing the prognostic outlook of patients undergoing MPS according to the site of ischemia. METHODS Our institutional database was queried for subjects undergoing MPS, without myocardial necrosis or recent revascularization. We focused on the prognostic impact of location of vessel-related ischemia (VRI) at MPS, distinguishing four mutually exclusive groups: single-VRI involving left anterior descending (LAD), single-VRI not involving LAD, multi-VRI involving LAD, and multi-VRI not involving LAD. The primary outcome was the long-term (>1 year) rate of death or myocardial infarction (D/MI). RESULTS A total of 13,254 patients were included. Moderate or severe VRI occurred in 2,627 (20%) patients. Clinical outcomes were significantly different among the groups of patients with moderate or severe VRI, including death, cardiac death, non-fatal myocardial infarction or their composites (overall P < .001). Specifically, and excluding subjects undergoing revascularization as first follow-up event, D/MI occurred in 8.4% of patients with single-VRI involving LAD, 5.5% of subjects with single-VRI not involving LAD, 16.5% of those with multi-VRI involving LAD, and 7.3% of patients with multi-VRI not involving LAD (overall P < .001). Even at incremental multivariable Cox proportional analysis, hierarchical VRI was independently associated with an increased risk of D/MI [hazard ratio = 1.17 (1.04-1.08) for each class increment, P = .010]. CONCLUSIONS Location and extent of myocardial ischemia at MPS according to the VRI concept have a hierarchical predictive impact, with multi-VRI involving LAD being significantly and independently more prognostically ominous than other types of VRI.
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Affiliation(s)
- Francesco Nudi
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy.
- ETISAN, Rome, Italy.
| | - Orazio Schillaci
- Institute of Nuclear Medicine, Tor Vergata University, Rome, Italy
| | - Giandomenico Neri
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
| | - Annamaria Pinto
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
- Ostia Radiologica, Rome, Italy
| | - Enrica Procaccini
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
- Ostia Radiologica, Rome, Italy
| | - Maurizio Vetere
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
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Kishi S, Magalhães TA, Cerci RJ, Matheson MB, Vavere A, Tanami Y, Kitslaar PH, George RT, Brinker J, Miller JM, Clouse ME, Lemos PA, Niinuma H, Reiber JHC, Rochitte CE, Rybicki FJ, Di Carli MF, Cox C, Lima JAC, Arbab-Zadeh A. Total coronary atherosclerotic plaque burden assessment by CT angiography for detecting obstructive coronary artery disease associated with myocardial perfusion abnormalities. J Cardiovasc Comput Tomogr 2016; 10:121-7. [PMID: 26817414 DOI: 10.1016/j.jcct.2016.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/08/2015] [Accepted: 01/11/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Total atherosclerotic plaque burden assessment by CT angiography (CTA) is a promising tool for diagnosis and prognosis of coronary artery disease (CAD) but its validation is restricted to small clinical studies. We tested the feasibility of semi-automatically derived coronary atheroma burden assessment for identifying patients with hemodynamically significant CAD in a large cohort of patients with heterogenous characteristics. METHODS This study focused on the CTA component of the CORE320 study population. A semi-automated contour detection algorithm quantified total coronary atheroma volume defined as the difference between vessel and lumen volume. Percent atheroma volume (PAV = [total atheroma volume/total vessel volume] × 100) was the primary metric for assessment (n = 374). The area under the receiver operating characteristic curve (AUC) determined the diagnostic accuracy for identifying patients with hemodynamically significant CAD defined as ≥50% stenosis by quantitative coronary angiography and associated myocardial perfusion abnormality by SPECT. RESULTS Of 374 patients, 139 (37%) had hemodynamically significant CAD. The AUC for PAV was 0.78 (95% confidence interval [CI] 0.73-0.83) compared with 0.84 [0.79-0.88] by standard expert CTA interpretation (p = 0.02). Accuracy for both CTA (0.91 [0.87, 0.96]) and PAV (0.86 [0.81-0.91]) increased after excluding patients with history of CAD (p < 0.01 for both). Bland-Altman analysis revealed good agreement between two observers (bias of 280.2 mm(3) [161.8, 398.7]). CONCLUSIONS A semi-automatically derived index of total coronary atheroma volume yields good accuracy for identifying patients with hemodynamically significant CAD, though marginally inferior to CTA expert reading. These results convey promise for rapid, reliable evaluation of clinically relevant CAD.
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Affiliation(s)
- Satoru Kishi
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tiago A Magalhães
- Department of Medicine, Division of Cardiology, Catholic University of Paraná (PUC-PR), Brazil
| | - Rodrigo J Cerci
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew B Matheson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea Vavere
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yutaka Tanami
- Department of Radiology, Keio University, Tokyo, Japan
| | - Pieter H Kitslaar
- Division of Image Processing, Department of Radiology, Leiden University Medical Center / Medis Medical Imaging Systems, Leiden, The Netherlands
| | - Richard T George
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Brinker
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie M Miller
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melvin E Clouse
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Pedro A Lemos
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Hiroyuki Niinuma
- Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Johan H C Reiber
- Division of Image Processing, Department of Radiology, Leiden University Medical Center / Medis Medical Imaging Systems, Leiden, The Netherlands
| | - Carlos E Rochitte
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Frank J Rybicki
- The Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Marcelo F Di Carli
- Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Christopher Cox
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joao A C Lima
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Armin Arbab-Zadeh
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Arbab-Zadeh A, Di Carli MF, Cerci R, George RT, Chen MY, Dewey M, Niinuma H, Vavere AL, Betoko A, Plotkin M, Cox C, Clouse ME, Arai AE, Rochitte CE, Lima JAC, Brinker J, Miller JM. Accuracy of Computed Tomographic Angiography and Single-Photon Emission Computed Tomography-Acquired Myocardial Perfusion Imaging for the Diagnosis of Coronary Artery Disease. Circ Cardiovasc Imaging 2016; 8:e003533. [PMID: 26467105 DOI: 10.1161/circimaging.115.003533] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Establishing the diagnosis of coronary artery disease (CAD) in symptomatic patients allows appropriately allocating preventative measures. Single-photon emission computed tomography (CT)-acquired myocardial perfusion imaging (SPECT-MPI) is frequently used for the evaluation of CAD, but coronary CT angiography (CTA) has emerged as a valid alternative. METHODS AND RESULTS We compared the accuracy of SPECT-MPI and CTA for the diagnosis of CAD in 391 symptomatic patients who were prospectively enrolled in a multicenter study after clinical referral for cardiac catheterization. The area under the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of CTA and SPECT-MPI for identifying patients with CAD defined as the presence of ≥1 coronary artery with ≥50% lumen stenosis by quantitative coronary angiography. Sensitivity to identify patients with CAD was greater for CTA than SPECT-MPI (0.92 versus 0.62, respectively; P<0.001), resulting in greater overall accuracy (area under the receiver operating characteristic curve, 0.91 [95% confidence interval, 0.88-0.94] versus 0.69 [0.64-0.74]; P<0.001). Results were similar in patients without previous history of CAD (area under the receiver operating characteristic curve, 0.92 [0.89-0.96] versus 0.67 [0.61-0.73]; P<0.001) and also for the secondary end points of ≥70% stenosis and multivessel disease, as well as subgroups, except for patients with a calcium score of ≥400 and those with high-risk anatomy in whom the overall accuracy was similar because CTA's superior sensitivity was offset by lower specificity in these settings. Radiation doses were 3.9 mSv for CTA and 9.8 for SPECT-MPI (P<0.001). CONCLUSIONS CTA is more accurate than SPECT-MPI for the diagnosis of CAD as defined by conventional angiography and may be underused for this purpose in symptomatic patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00934037.
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Affiliation(s)
- Armin Arbab-Zadeh
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Marcelo F Di Carli
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
| | - Rodrigo Cerci
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Richard T George
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Marcus Y Chen
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Marc Dewey
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Hiroyuki Niinuma
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Andrea L Vavere
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Aisha Betoko
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Michail Plotkin
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Christopher Cox
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Melvin E Clouse
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Andrew E Arai
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Carlos E Rochitte
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Joao A C Lima
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Jeffrey Brinker
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Julie M Miller
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
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Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification: The CORE320 study. Int J Cardiol 2015; 201:570-7. [DOI: 10.1016/j.ijcard.2015.05.110] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/13/2015] [Accepted: 05/14/2015] [Indexed: 11/20/2022]
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Kühl JT, George RT, Mehra VC, Linde JJ, Chen M, Arai AE, Di Carli M, Kitagawa K, Dewey M, Lima JAC, Kofoed KF. Endocardial-epicardial distribution of myocardial perfusion reserve assessed by multidetector computed tomography in symptomatic patients without significant coronary artery disease: insights from the CORE320 multicentre study. Eur Heart J Cardiovasc Imaging 2015; 17:779-87. [PMID: 26341292 DOI: 10.1093/ehjci/jev206] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/02/2015] [Indexed: 12/15/2022] Open
Abstract
AIM Previous animal studies have demonstrated differences in perfusion and perfusion reserve between the subendocardium and subepicardium. 320-row computed tomography (CT) with sub-millimetre spatial resolution allows for the assessment of transmural differences in myocardial perfusion reserve (MPR) in humans. We aimed to test the hypothesis that MPR in all myocardial layers is determined by age, gender, and cardiovascular risk profile in patients with ischaemic symptoms or equivalent but without obstructive coronary artery disease (CAD). METHODS AND RESULTS A total of 149 patients enrolled in the CORE320 study with symptoms or signs of myocardial ischaemia and absence of significant CAD by invasive coronary angiography were scanned with static rest and stress CT perfusion. Myocardial attenuation densities were assessed at rest and during adenosine stress, segmented into 3 myocardial layers and 13 segments. MPR was higher in the subepicardium compared with the subendocardium (124% interquartile range [45, 235] vs. 68% [22,102], P < 0.001). Moreover, MPR in the septum was lower than in the inferolateral and anterolateral segments of the myocardium (55% [19, 104] vs. 89% [37, 168] and 124% [54, 270], P < 0.001). By multivariate analysis, high body mass index was significantly associated with reduced MPR in all myocardial layers when adjusted for cardiovascular risk factors (P = 0.02). CONCLUSION In symptomatic patients without significant coronary artery stenosis, distinct differences in endocardial-epicardial distribution of perfusion reserve may be demonstrated with static CT perfusion. Low MPR in all myocardial layers was observed specifically in obese patients.
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Affiliation(s)
- Jørgen Tobias Kühl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2012, The Heart Centre, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Richard T George
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Vishal C Mehra
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jesper J Linde
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2012, The Heart Centre, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Marcus Chen
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew E Arai
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Marc Dewey
- Charitè Medical School, Humboldt, Berlin, Germany
| | - Joao A C Lima
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2012, The Heart Centre, Blegdamsvej 9, 2100 Copenhagen, Denmark Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Tanami Y, Jinzaki M, Kishi S, Matheson M, Vavere AL, Rochitte CE, Dewey M, Chen MY, Clouse ME, Cox C, Kuribayashi S, Lima JAC, Arbab-Zadeh A. Lack of association between epicardial fat volume and extent of coronary artery calcification, severity of coronary artery disease, or presence of myocardial perfusion abnormalities in a diverse, symptomatic patient population: results from the CORE320 multicenter study. Circ Cardiovasc Imaging 2015; 8:e002676. [PMID: 25752899 DOI: 10.1161/circimaging.114.002676] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Epicardial fat may play a role in the pathogenesis of coronary artery disease (CAD). We explored the relationship of epicardial fat volume (EFV) with the presence and severity of CAD or myocardial perfusion abnormalities in a diverse, symptomatic patient population. METHODS AND RESULTS Patients (n=380) with known or suspected CAD who underwent 320-detector row computed tomographic angiography, nuclear stress perfusion imaging, and clinically driven invasive coronary angiography for the CORE320 international study were included. EFV was defined as adipose tissue within the pericardial borders as assessed by computed tomography using semiautomatic software. We used linear and logistic regression models to assess the relationship of EFV with coronary calcium score, stenosis severity by quantitative coronary angiography, and myocardial perfusion abnormalities by single photon emission computed tomography (SPECT). Median EFV among patients (median age, 62.6 years) was 102 cm(3) (interquartile range: 53). A coronary calcium score of ≥1 was present in 83% of patients. Fifty-nine percent of patients had ≥1 coronary artery stenosis of ≥50% by quantitative coronary angiography, and 49% had abnormal myocardial perfusion results by SPECT. There were no significant associations between EFV and coronary artery calcium scanning, presence severity of ≥50% stenosis by quantitative coronary angiography, or abnormal myocardial perfusion by SPECT. CONCLUSIONS In a diverse population of symptomatic patients referred for invasive coronary angiography, we did not find associations of EFV with the presence and severity of CAD or with myocardial perfusion abnormalities. The clinical significance of quantifying EFV remains uncertain but may relate to the pathophysiology of acute coronary events rather than the presence of atherosclerotic disease.
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Affiliation(s)
- Yutaka Tanami
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Masahiro Jinzaki
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Satoru Kishi
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Matthew Matheson
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Andrea L Vavere
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Carlos E Rochitte
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Marc Dewey
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Marcus Y Chen
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Melvin E Clouse
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Christopher Cox
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Sachio Kuribayashi
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Joao A C Lima
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Armin Arbab-Zadeh
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.).
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Magalhães TA, Kishi S, George RT, Arbab-Zadeh A, Vavere AL, Cox C, Matheson MB, Miller JM, Brinker J, Di Carli M, Rybicki FJ, Rochitte CE, Clouse ME, Lima JAC. Combined coronary angiography and myocardial perfusion by computed tomography in the identification of flow-limiting stenosis - The CORE320 study: An integrated analysis of CT coronary angiography and myocardial perfusion. J Cardiovasc Comput Tomogr 2015; 9:438-45. [PMID: 25977111 DOI: 10.1016/j.jcct.2015.03.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/09/2015] [Accepted: 03/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The combination of coronary CT angiography (CTA) and myocardial CT perfusion (CTP) is gaining increasing acceptance, but a standardized approach to be implemented in the clinical setting is necessary. OBJECTIVES To investigate the accuracy of a combined coronary CTA and myocardial CTP comprehensive protocol compared to coronary CTA alone, using a combination of invasive coronary angiography and single photon emission CT as reference. METHODS Three hundred eighty-one patients included in the CORE320 trial were analyzed in this study. Flow-limiting stenosis was defined as the presence of ≥50% stenosis by invasive coronary angiography with a related perfusion defect by single photon emission CT. The combined CTA + CTP definition of disease was the presence of a ≥50% stenosis with a related perfusion defect. All data sets were analyzed by 2 experienced readers, aligning anatomic findings by CTA with perfusion defects by CTP. RESULTS Mean patient age was 62 ± 6 years (66% male), 27% with prior history of myocardial infarction. In a per-patient analysis, sensitivity for CTA alone was 93%, specificity was 54%, positive predictive value was 55%, negative predictive value was 93%, and overall accuracy was 69%. After combining CTA and CTP, sensitivity was 78%, specificity was 73%, negative predictive value was 64%, positive predictive value was 0.85%, and overall accuracy was 75%. In a per-vessel analysis, overall accuracy of CTA alone was 73% compared to 79% for the combination of CTA and CTP (P < .0001 for difference). CONCLUSIONS Combining coronary CTA and myocardial CTP findings through a comprehensive protocol is feasible. Although sensitivity is lower, specificity and overall accuracy are higher than assessment by coronary CTA when compared against a reference standard of stenosis with an associated perfusion defect.
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Affiliation(s)
- Tiago A Magalhães
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Brazil; Department of Radiology, Division of Cardiovascular CT/MR, Heart Hospital (HCOR), São Paulo, Sao Paulo, Brazil
| | - Satoru Kishi
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Richard T George
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Armin Arbab-Zadeh
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Andrea L Vavere
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew B Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Julie M Miller
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Jeffrey Brinker
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Marcelo Di Carli
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Frank J Rybicki
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Carlos E Rochitte
- Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Brazil; Department of Radiology, Division of Cardiovascular CT/MR, Heart Hospital (HCOR), São Paulo, Sao Paulo, Brazil
| | - Melvin E Clouse
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - João A C Lima
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography. Eur Radiol 2015; 25:2115-24. [DOI: 10.1007/s00330-015-3604-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/30/2014] [Accepted: 01/15/2015] [Indexed: 01/15/2023]
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Pursnani A, Lee AM, Mayrhofer T, Ahmed W, Uthamalingam S, Ferencik M, Puchner SB, Bamberg F, Schlett CL, Udelson J, Hoffmann U, Ghoshhajra BB. Early resting myocardial computed tomography perfusion for the detection of acute coronary syndrome in patients with coronary artery disease. Circ Cardiovasc Imaging 2015; 8:e002404. [PMID: 25752898 PMCID: PMC5996992 DOI: 10.1161/circimaging.114.002404] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 02/03/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acute rest single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) has high predictive value for acute coronary syndrome (ACS) in emergency department patients. Prior studies have shown excellent agreement between rest/stress computed tomography perfusion (CTP) and SPECT-MPI, but the value of resting CTP (rCTP) in acute chest pain triage remains unclear. We sought to determine the diagnostic accuracy of early rCTP, incremental value beyond obstructive coronary artery disease (CAD; ≥50% stenosis), and compared early rCTP to late stress SPECT-MPI in patients with CAD presenting with suspicion of ACS to the emergency department. METHODS AND RESULTS In this prespecified subanalysis of 183 patients (58.1±10.2 years; 33% women), we included patients with any CAD by coronary computed tomography angiography (CCTA) from Rule Out Myocardial Infarction Using Computer-Assisted Tomography I. rCTP was assessed semiquantitatively, blinded to CAD interpretation. Overall, 31 had ACS and 48 had abnormal rCTP. Sensitivity and specificity of rCTP for ACS were 48% (95% confidence interval [CI], 30%-67%) and 78% (95% CI, 71%-85%), respectively. rCTP predicted ACS (adjusted odds ratio, 3.40 [95% CI, 1.37-8.42]; P=0.008) independently of obstructive CAD, and sensitivity for ACS increased from 77% (95% CI, 59%-90%) for obstructive CAD to 90% (95% CI, 74%-98%) with addition of rCTP (P=0.05). In a subgroup undergoing late rest/stress SPECT-MPI (n=81), CCTA/rCTP had noninferior discriminatory value to CCTA/SPECT-MPI (area under the curve, 0.88 versus 0.90; P=0.64) using a noninferiority margin of 10%. CONCLUSIONS Early rCTP provides incremental value beyond obstructive CAD to detect ACS. CCTA/rCTP is noninferior to CCTA/SPECT-MPI to discriminate ACS and presents an attractive alternative to triage patients presenting with acute chest pain. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00990262.
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Affiliation(s)
- Amit Pursnani
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
| | - Ashley M Lee
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Thomas Mayrhofer
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Waleed Ahmed
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Shanmugam Uthamalingam
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Maros Ferencik
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Stefan B Puchner
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Fabian Bamberg
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Christopher L Schlett
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - James Udelson
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Udo Hoffmann
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Brian B Ghoshhajra
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
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Kishi S, Magalhaes TA, George RT, Dewey M, Laham RJ, Niinuma H, Friedman LA, Cox C, Tanami Y, Schuijf JD, Vavere AL, Kitagawa K, Chen MY, Nomura CH, Brinker JA, Rybicki FJ, Di Carli MF, Arbab-Zadeh A, Lima JAC. Relationship of left ventricular mass to coronary atherosclerosis and myocardial ischaemia: the CORE320 multicenter study. Eur Heart J Cardiovasc Imaging 2014; 16:166-76. [PMID: 25368207 DOI: 10.1093/ehjci/jeu217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIMS The aim of this study was to investigate the association of left ventricular mass (LVM) with coronary atherosclerosis and myocardial infarction (MI). METHODS AND RESULTS Patients (n = 338) underwent 320 × 0.5 mm detector row coronary computed tomography (CT) angiography, invasive coronary angiography (ICA), and single-photon emission CT (SPECT) myocardial perfusion imaging. Quantitative coronary atheroma volume was obtained from the CT images for the entire coronary tree (19-segment model) with an arterial contour detection algorithm. Normalized total atheroma volume (NormTAV) was analysed to reflect quantitative total atheroma volume. LVM was measured on myocardial CT images and indexed to height to the power of 2.7 (LVMi). Patients with obstructive coronary artery disease (CAD) were defined as those with ≥50% diameter stenosis by quantitative ICA. Abnormal perfusion defect was defined as ≥1 abnormal myocardial segment by SPECT. The association of LVMi with coronary atherosclerosis and myocardial perfusion defect on SPECT at the patient level was determined with uni- and multivariable linear and logistic regression analyses. Obstructive CAD was present in 60.0% of enrolled patients. LVMi was independently associated with abnormal summed rest score [SRS; odds ratio (OR), 1.07; 95% confidence interval (CI), 1.03-1.09] and summed stress score (OR, 1.04; 95% CI, 1.01-1.07). An increase in LVMi was also independently associated with that in NormTAV (coefficient, 10.44; 95% CI, 1.50-19.39) and SRS ≥1 (OR, 1.05; 95% CI, 1.01-1.10), even after adjusting for cardiovascular risk factors in patients without previous MI. CONCLUSIONS LVM was independently associated with the presence of coronary artery atherosclerosis and MI.
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Affiliation(s)
- Satoru Kishi
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Blalock 524, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Tiago A Magalhaes
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Blalock 524, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Richard T George
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Blalock 524, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Marc Dewey
- Department of Radiology, Charité Medical School, Humboldt-Universität zu Berline and Freie Universität zu Berlin, Berlin, Germany
| | - Roger J Laham
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hiroyuki Niinuma
- Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | | | - Christopher Cox
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yutaka Tanami
- Department of Radiology, Keio University, Tokyo, Japan
| | - Joanne D Schuijf
- Toshiba Medical Systems Europe B.V., Zoetermeer, The Netherlands
| | - Andrea L Vavere
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Blalock 524, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Marcus Y Chen
- Advanced Cardiovascular Imaging Group, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cesar H Nomura
- Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jeffrey A Brinker
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Blalock 524, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Frank J Rybicki
- Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Marcelo F Di Carli
- Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Armin Arbab-Zadeh
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Blalock 524, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Blalock 524, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Nagy AI, Sahlen A, Manouras A, Henareh L, da Silva C, Gunyeli E, Apor AA, Merkely B, Winter R. Combination of contrast-enhanced wall motion analysis and myocardial deformation imaging during dobutamine stress echocardiography. Eur Heart J Cardiovasc Imaging 2014; 16:88-95. [DOI: 10.1093/ehjci/jeu171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Nudi F, Pinto A, Procaccini E, Neri G, Vetere M, Tomai F, Gaspardone A, Biondi-Zoccai G, Schillaci O. A novel clinically relevant segmentation method and corresponding maximal ischemia score to risk-stratify patients undergoing myocardial perfusion scintigraphy. J Nucl Cardiol 2014; 21:807-18. [PMID: 24890378 DOI: 10.1007/s12350-014-9877-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 02/12/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myocardial perfusion scintigraphy (MPS) represents a key prognostic tool, but its predictive yield is far from perfect. We developed a novel clinically relevant segmentation method and a corresponding maximal ischemia score (MIS) in order to risk-stratify patients undergoing MPS. METHODS Patients referred for MPS were identified, excluding those with evidence of myocardial necrosis or prior revascularization. A seven-region segmentation approach was adopted for left ventricular myocardium, with a corresponding MIS distinguishing five groups (no, minimal, mild, moderate, or severe ischemia). The association between MIS and clinical events was assessed at 1 year and at long-term follow-up. RESULTS A total of 8,714 patients were included, with a clinical follow-up of 31 ± 20 months. Unadjusted analyses showed that subjects with a higher MIS were significantly different for several baseline and test data, being older, having lower ejection fraction, and achieving lower workloads (P < .05 for all). Adverse outcomes were also more frequent in patients with higher levels of ischemia, including cardiac death, myocardial infarction (MI), and their composites (P < .05 for all). Differences in adverse events remained significant even after extensive multivariable adjustment (hazard ratio for each MIS increment = 1.57 [1.29-1.90], P < .001 for cardiac death; 1.19 [1.04-1.36], P = .013 for MI; 1.23 [1.09-1.39], P = .001 for cardiac death/MI). CONCLUSIONS Our novel segmentation method and corresponding MIS efficiently yield satisfactory prognostic information.
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Affiliation(s)
- Francesco Nudi
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy,
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