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Yu C, Meier S, Bestawros D, Sun D, Trieu J, Yong ASC, Wong CCY, Yiannikas J, Kritharides L, Beltrame JF, Naoum C. Role of Cardiac Magnetic Resonance Imaging and Troponin T in Definitive Diagnosis of Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA). Can J Cardiol 2023; 39:936-944. [PMID: 37080291 DOI: 10.1016/j.cjca.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND It is unknown whether the degree of high-sensitivity troponin T (hsTropT) elevation in patients with suspected myocardial infarction without obstructive coronary arteries (MINOCA) presentations can help predict the likelihood of an abnormal cardiac magnetic resonance (CMR) scan. In this study we describe the diagnostic utility of CMR in patients with MINOCA and assesses the effect of peak hsTropT levels at presentation on CMR diagnostic yield. METHODS Records of consecutive patients (n = 1407) referred for CMR at a tertiary referral hospital between January 2016 and September 2021 were reviewed. A total of 70 patients met the criteria of MINOCA including ischemic chest pain, elevated peak hsTropT, and nonobstructive coronary artery disease (< 50% stenosis). The peak hsTropT levels within 72 hours of admission were identified. CMR images were generated using a 3.0 T Siemens scanner. Predictors of having an abnormal CMR were evaluated. RESULTS CMR established a diagnosis in 71% (n = 50) of patients, with the most common CMR diagnosis being myopericarditis (n = 27; 39%). Time to CMR was an independent predictor of a normal CMR scan (odds ratio, 0.98; 95% confidence interval, 0.97-0.999). Peak hsTropT had a high diagnostic accuracy for identifying patients with an abnormal CMR scan (area under the receiver operator characteristic curve, 0.81; P < 0.001). The optimal hsTropT cutoff was 166 ng/L, with 72% sensitivity and specificity. A troponin value ≥ 166 ng/L was independently predictive of an abnormal CMR scan (odds ratio, 4.76; 95% confidence interval, 1.32-17.11). CONCLUSIONS HsTropT and early CMR imaging are independently predictive of an abnormal CMR scan in patients with MINOCA. Additionally, the use of a hsTropT cutoff provides incremental predictive value to clinical parameters and time to CMR scanning in determining an abnormal scan.
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Affiliation(s)
- Christopher Yu
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Silvan Meier
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Dina Bestawros
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - David Sun
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Joseph Trieu
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Andy S C Yong
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher C Y Wong
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John F Beltrame
- Cardiology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher Naoum
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
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Holmes L, Lui I, Lilburn P, Naoum C, Kritharides L, Ridley L, Morgan L. Bronchiectasis is associated with coronary artery calcification even in never smokers. Respirology 2023. [PMID: 37253637 DOI: 10.1111/resp.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Lewis Holmes
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Isaac Lui
- Department of Radiology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Paul Lilburn
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia
- University of New South Wales, Kensington, NSW, Australia
| | - Christopher Naoum
- Department of Cardiology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Repatriation General Hospital, Concord, NSW, Australia
- The University of Sydney, Camperdown, NSW, Australia
| | - Lloyd Ridley
- Department of Radiology, Concord Repatriation General Hospital, Concord, NSW, Australia
- The University of Sydney, Camperdown, NSW, Australia
| | - Lucy Morgan
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia
- The University of Sydney, Camperdown, NSW, Australia
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3
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Rubenis I, Naoum C, Yiannikas J. Multivessel Giant Coronary Artery Aneurysms Incidentally Demonstrated During Angiography for Acute Myocardial Infarction. JACC Case Rep 2022; 4:1421-1423. [PMID: 36388720 PMCID: PMC9664013 DOI: 10.1016/j.jaccas.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
Giant coronary artery aneurysms are a rare manifestation of coronary artery disease and are defined by an aneurysmal diameter of >20 mm. Multimodal invasive and noninvasive imaging is required for accurate assessment We describe a case of multivessel giant coronary artery aneurysms noted during angiography for myocardial infarction. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Imants Rubenis
- Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Christopher Naoum
- Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia,University of Sydney, Sydney, New South Wales, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia,University of Sydney, Sydney, New South Wales, Australia,Address for correspondence: A/Prof John Yiannikas, Department of Cardiology, Concord Repatriation General Hospital, Hospital Road, Concord, New South Wales 2137, Australia.
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Ratwatte S, Day M, Ridley LJ, Fung C, Naoum C, Yiannikas J. Cardiac manifestations of IgG4-related disease: a case series. Eur Heart J Case Rep 2022; 6:ytac153. [PMID: 35481260 PMCID: PMC9036079 DOI: 10.1093/ehjcr/ytac153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/17/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
IgG4-related disease (IgG4-RD) is an autoimmune condition affecting almost every organ system, with an early inflammatory phase and later fibrotic consequences. Vascular manifestations, particularly, large-vessel involvement in IgG4-RD, are well described. However, important IgG4-related effects on medium-sized arteries and the pericardium are less well recognized. These less frequently reported cardiovascular effects of IgG4-RD include coronary artery stenosis, pericardial disease, cardiac masses, and valvular heart disease.
Case summary
This case series focuses on three patients that demonstrate the cardiovascular effects of IgG4-RD and the pitfalls and importance of early diagnosis. Cases 1 and 2 presented with cardiac manifestations prior to more typical organ systems being affected which led to a delay in diagnosis. Case 1 presented with an acute myocardial infarction secondary to IgG4-RD of the coronary arteries and Case 2 presented with pericarditis which progressed to pericardial constriction due to IgG4-RD. Case 3 already had a diagnosis of IgG4-RD from a prior renal biopsy which raised the index of suspicion that his pericardial disease and thoracic mass were also related to IgG4-RD.
Discussion
Cardiac manifestations of IgG4-RD remain under-recognized and include coronary artery and pericardial disease. These manifestations often precede more typical manifestations in other organ systems. Recognizing cardiac manifestations of IgG4-RD on cardiac imaging can raise clinical suspicion and act as a catalyst to ascertain a confirmatory diagnosis. Early diagnosis and treatment are crucial to prevent potentially fatal outcomes and irreversible fibrosis.
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Affiliation(s)
- Seshika Ratwatte
- Department of Cardiology, Concord Repatriation and General Hospital, Hospital Road, Concord, NSW 2139, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Martin Day
- Department of Cardiology, Concord Repatriation and General Hospital, Hospital Road, Concord, NSW 2139, Australia
| | - Lloyd John Ridley
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Radiology, Concord Repatriation and General Hospital, Concord, NSW, Australia
| | - Caroline Fung
- Department of Anatomical Pathology, Concord Repatriation and General Hospital, Concord, NSW, Australia
| | - Christopher Naoum
- Department of Cardiology, Concord Repatriation and General Hospital, Hospital Road, Concord, NSW 2139, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Repatriation and General Hospital, Hospital Road, Concord, NSW 2139, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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5
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Indraratna P, Naoum C, Ben Zekry S, Gransar H, Blanke P, Sellers S, Achenbach S, Al-Mallah MH, Andreini D, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim Y, Maffei E, Marques H, Gonçalves PDA, Pontone G, Raff GL, Rubinshtein R, Villines TC, Lin FY, Shaw LJ, Narula J, Bax JJ, Leipsic JA. Aspirin and Statin Therapy for Nonobstructive Coronary Artery Disease: Five-year Outcomes from the CONFIRM Registry. Radiol Cardiothorac Imaging 2022; 4:e210225. [PMID: 35506137 PMCID: PMC9059243 DOI: 10.1148/ryct.210225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/09/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
Purpose In this cohort study, 5-year data from the Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry (ie, CONFIRM) were examined to identify associations of baseline aspirin and statin use with mortality, major adverse cardiovascular events (MACE), and myocardial infarction (MI) in individuals without substantial (≥50%) stenosis. Materials and Methods In this prospective cohort study, all participants in the registry underwent coronary CT angiography and were classified as having no detectable coronary plaque or having nonobstructive coronary artery disease (CAD) (1%-49% stenosis). Participants with obstructive (≥50%) stenosis were excluded from analysis. The study commenced in June 2003 and was completed in March 2016. All unadjusted and risk-adjusted analyses utilized the Cox proportional hazard model with hospital sites modeled using shared frailty. Results A total of 6386 participants with no detectable plaque or with nonobstructive CAD were included (mean age, 56.0 years ± 13.3 [SD], 52% men). The mean follow-up period was 5.66 years ± 1.10. Nonobstructive CAD (n = 2815, 44% of all participants included in the study) was associated with a greater risk of all-cause mortality (10.6% [298 of 2815] vs 4.8% [170 of 3571], P < .001) compared to those without CAD (n = 3571, 56%). Baseline aspirin and statin use was documented for 1415 and 1429 participants, respectively, with nonobstructive CAD, and for 1560 and 1565 participants without detectable plaque, respectively. In individuals with nonobstructive CAD, baseline aspirin use was not associated with a reduction in MACE (10.9% [102 of 936] vs 14.7% [52 of 355], P = .06), all-cause mortality (9.6% [95 of 991] vs 10.9% [46 of 424], P = .468), or MI (4.4% [41 of 936] vs 6.2% [22 of 355], P = .18). On multivariate risk-adjusted analysis, baseline statin use was associated with a lower rate of MACE (hazard ratio, 0.59; 95% CI: 0.40, 0.87; P = .007). Neither therapy improved clinical outcomes for participants with no detectable plaque. Conclusion In participants with nonobstructive CAD, baseline use of statins, but not of aspirin, was associated with improved clinical outcomes. Neither therapy was associated with benefit in participants without plaque.Keywords: Aspirin, Statin, Coronary Artery Disease, CT Angiography, Nonobstructive Coronary Artery DiseaseClinical trial registration no. NCT01443637 Supplemental material is available for this article. © RSNA, 2022See also the commentary by Canan and Navar in this issue.
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Affiliation(s)
- Praveen Indraratna
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Christopher Naoum
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Sagit Ben Zekry
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Heidi Gransar
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Philipp Blanke
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Stephanie Sellers
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Stephan Achenbach
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Mouaz H. Al-Mallah
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Daniele Andreini
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Daniel S. Berman
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Matthew J. Budoff
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Filippo Cademartiri
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Tracy Q. Callister
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Hyuk-Jae Chang
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Kavitha Chinnaiyan
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Benjamin J. W. Chow
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Ricardo C. Cury
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Augustin DeLago
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Gudrun Feuchtner
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Martin Hadamitzky
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Joerg Hausleiter
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Philipp A. Kaufmann
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Yong‐Jin Kim
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Erica Maffei
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Hugo Marques
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Pedro de Araújo Gonçalves
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Gianluca Pontone
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Gilbert L. Raff
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Ronen Rubinshtein
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Todd C. Villines
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Fay Y. Lin
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Leslee J. Shaw
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Jagat Narula
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Jeroen J. Bax
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
| | - Jonathon A. Leipsic
- From the Department of Radiology, University of British Columbia,
1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (P.I., S.B.Z., P.B., S.S.,
J.A.L.); Department of Cardiology, Concord Hospital, Sydney, Australia (C.N.);
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, Calif (H.G.,
D.S.B.); Department of Cardiology, Friedrich-Alexander-University,
Erlangen-Nuremberg, Germany (S.A.); Department of Cardiology, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex (M.H.A.); Department of
Radiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy (D.A., G.P.);
Department of Medicine, Los Angeles Biomedical Research Institute, Los Angeles,
Calif (M.J.B.); Department of Radiology, Cardiovascular Imaging Center, SDN
IRCCS, Naples, Italy (F.C.); Department of Cardiology, Tennessee Heart and
Vascular Institute, Henderson, Tenn (T.Q.C.); Division of Cardiology, Severance
Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei
University College of Medicine, Yonsei University Health System, Seoul, South
Korea (H.J.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak,
Mich (K.C., G.L.R.); Department of Medicine and Radiology, University of Ottawa,
Ottawa, Canada (B.J.W.C.); Department of Radiology, Miami Cardiac and Vascular
Institute, Miami, Fla (R.C.C.); Department of Cardiology, Capitol Cardiology
Associates, Albany, NY (A.D.); Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria (G.F.); Department of Radiology and Nuclear
Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of
Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität
München, Munich, Germany (J.H.); Department of Nuclear Medicine,
University Hospital, University of Zurich, Zurich, Switzerland (P.A.K.);
Department of Internal Medicine, Seoul National University Hospital, Seoul,
South Korea (Y.J.K.); Department of Radiology, Area Vasta 1/ASUR Marche, Fano,
Italy (E.M.); Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
(H.M., P.d.A.G.); Department of Cardiology, Lady Davis Carmel Medical Center,
The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel (R.R.); Department of Medicine, University of Virginia
Health System, Charlottesville, Va (T.C.V.); Department of Radiology, New
York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (F.Y.L.,
L.J.S.); Department of Cardiology, Mount Sinai Hospital, New York, NY (J.N.);
and Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.)
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6
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Yu C, Ng ACC, Ridley L, Anjaria M, Meier S, Yiannikas J, Kritharides L, Naoum C. Incidentally identified coronary artery calcium on non-contrast CT scan of the chest predicts major adverse cardiac events among hospital inpatients. Open Heart 2021; 8:openhrt-2021-001695. [PMID: 34635575 PMCID: PMC8506889 DOI: 10.1136/openhrt-2021-001695] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Coronary artery calcium (CAC) identified on non-gated CT scan of the chest is predictive of major adverse cardiac events (MACE) in multiple studies with guidelines therefore recommending the routine reporting of incidental CAC. These studies have been limited however to the outpatient setting. We aimed to determine the prognostic utility of incidentally identified CAC on CT scan of the chest among hospital inpatients. METHODS AND RESULTS Consecutive patients (n=740) referred for inpatient non-contrast CT scan of the chest at a tertiary referral hospital (January 2011 to March 2017) were included (n=280) if they had no known history of coronary artery disease, active malignancy or died within 30 days of admission. Scans were assessed for the presence of CAC by visual assessment and quantified by Agatston scoring. Median age was 69 years (IQR: 54-82) and 51% were male with a median CAC score of 7 (IQR 0-205). MACE occurred in 140 (50%) patients at 3.5 years median follow-up including 98 deaths. Half of all events occurred within 18 months. Visible CAC was associated with increased MACE (HR) 6.0 (95% CI: 3.7 to 9.7) compared with patients with no visible CAC. This finding persisted after adjusting for cardiovascular risk factors HR 2.4 (95% CI: 1.3 to 4.3) and with both absolute CAC score and CAC score ≥50th percentile. CONCLUSION Incidental CAC identified on CT scan of the chest among hospital inpatients provides prognostic information that is independent of cardiovascular risk factors. These patients may benefit from aggressive risk factor modification given the high event rate in the short term.
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Affiliation(s)
- Christopher Yu
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Austin C C Ng
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Lloyd Ridley
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mekhala Anjaria
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Silvan Meier
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Department of Cardiology, Municipal Hospital Triemli, Zurich, Zürich, Switzerland
| | - John Yiannikas
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Naoum
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia .,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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7
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Snir A, Wilson MK, Ju AL, Wong S, Khor L, Naoum C, Wong K, Keech A, Celermajer DS, Ng MK. Novel pressure-regulated deployment strategy for improving the safety and efficacy of balloon-expandable transcatheter aortic valves. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The optimal method for balloon-expandable transcatheter heart valve (THV) deployment remains unknown. Current implantation protocols are volume-dependent and rely on ad-hoc filling of the deployment apparatus without accounting for annular wall tension during prosthesis expansion, predisposing patients to inconsistent clinical outcomes. During THV deployment, the annular wall tension exerted by the expanding prosthesis is determined by prosthesis diameter and balloon pressure (Laplace's Law).
Objective
We proposed and tested a novel method for balloon-expandable THV deployment, aimed at controlling balloon pressure and the resulting annular wall tension to allow optimal prosthesis-annulus apposition while preventing significant tissue injury.
Methods
330 consecutive patients with severe native aortic stenosis who underwent balloon-expandable THV implantation between 2015–2020 were included. 106 patients were considered high-risk for annular rupture. THVs were deployed until reaching a pre-determined balloon pressure; 4–4.5atm in earlier cases to establish experience and safety, later increasing to 5–6.5atm in most cases. Post-dilatation was performed to reduce >mild angiographic regurgitation (PVR). Using a biomechanical model, annular wall stress (tension) was estimated for each case and assessed against recorded rates of post-dilatation, ≥mild paravalvular regurgitation (PVR) on TTE, new PPM or LBBB and annular rupture.
Results
Patients with wall stress >3MPa (n=184) had reduced post-dilatation rate (p<0.001) and final PVR (≥mild, p=0.014). Annular rupture occurred in 2/3 high-risk cases with wall stress >3.5MPa; no rupture occurred in 102 high-risk cases with wall stress ≤3.5MPa. Based on these results, we defined target deployment wall stress levels (3–3.5MPa) and associated deployment pressure per THV size. Patients within this target range (n=136) had 8.1% new PPM, 12.5% new LBBB, 12.7% mild PVR with no cases of ≥moderate PVR. Importantly, there was an inconsistent relationship between deployment balloon volume and resulting annular wall stress.
Conclusion
Pressure-regulated THV deployment is a simple, easily reproducible, safe and effective method, regardless of high-risk anatomical complexities.
Funding Acknowledgement
Type of funding sources: None. Annular wall stress and PVRModel, stress vs volume and new strategy
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Affiliation(s)
- A Snir
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - M K Wilson
- Macquarie University Hospital, Sydney, Australia
| | - A L Ju
- University of Sydney, Faculty of Engineering, Sydney, Australia
| | - S Wong
- Macquarie University Hospital, Sydney, Australia
| | - L Khor
- Macquarie University Hospital, Sydney, Australia
| | - C Naoum
- Macquarie University Hospital, Sydney, Australia
| | - K Wong
- Royal Prince Alfred Hospital, Sydney, Australia
| | - A Keech
- Royal Prince Alfred Hospital, Sydney, Australia
| | | | - M K Ng
- Royal Prince Alfred Hospital, Sydney, Australia
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8
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Meier S, Yu C, Raju H, Naoum C. Incidental diagnosis of arrhythmogenic right ventricular cardiomyopathy on coronary computed tomography angiography in a septuagenarian. Eur Heart J 2021; 42:1117. [PMID: 33167003 DOI: 10.1093/eurheartj/ehaa749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Silvan Meier
- Department of Cardiology, Concord Hospital and The University of Sydney, Hospital Road, Concord NSW 2139, Australia.,Department of Cardiology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zürich, Switzerland
| | - Christopher Yu
- Department of Cardiology, Concord Hospital and The University of Sydney, Hospital Road, Concord NSW 2139, Australia
| | - Hariharan Raju
- Department of Cardiology, Concord Hospital and The University of Sydney, Hospital Road, Concord NSW 2139, Australia.,Department of Cardiology, Macquarie University Hospital, Macquarie University, NSW 2109 New South Wales, Australia
| | - Christopher Naoum
- Department of Cardiology, Concord Hospital and The University of Sydney, Hospital Road, Concord NSW 2139, Australia.,Department of Cardiology, Macquarie University Hospital, Macquarie University, NSW 2109 New South Wales, Australia
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9
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Snir A, Wilson M, Ju A, Wong S, Khor K, Naoum C, Wong K, Keech A, Celermajer D, Ng M. Novel Pressure-Regulated Deployment Strategy for Improving the Safety and Efficacy of Balloon-Expandable Transcatheter Aortic Valves. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Snir A, Khor L, Wong S, Naoum C, Wilson M, Ng M. A novel pressure-regulated deployment strategy for improving the safety and efficacy of balloon-expandable transcatheter aortic valves. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Annular rupture is a catastrophic complication of Transcatheter Aortic Valve Implantation, more commonly seen with balloon expandable valves. Size selection and deployment of these valves often presents a serious challenge as prosthesis oversizing increases the risk of rupture, while undersizing results in greater paravalvular regurgitation (PVR). Current deployment protocols are volume-regulated and susceptible to undesired prosthesis over or under-expansion. Laplace's Law demonstrates that the stress exerted on the aortic wall is determined by both the valve area and internal pressure during deployment. Yet the issue of balloon pressure during deployment has been thus far ignored.
Purpose
In this feasibility study, we aimed to develop a novel pressure-regulated deployment method that allows optimising apposition between valve and annulus, while preventing significant tissue injury and rupture.
Methods
We analysed a cohort of 278 consecutive patients with severe aortic stenosis and intermediate-severe surgical risk who underwent TAVI using Sapien 3 valves. This included 88 patients (32%) considered at high risk of annular rupture based on accepted factors such as moderate-severe subannular calcification. A pressure gauge was connected to the apparatus and in each case the valve was deployed until reaching a pre-determined pressure limit. In earlier cases lower pressures of 4–4.5atm were used to establish safety, while in later cases pressure limit was increased to maximum of 7atm. In some patients post-dilatation was performed to improve angiographic regurgitation. Using a biomechanical application of Laplace's Law, the estimated annular wall stress was calculated for each case and assessed against recorded complications such as annular rupture, PPM insertion, new LBBB and PVR on post-procedure TTE. Based on these analyses we then determined the optimal pressure limit for each available valve size.
Results
Distribution of deployment pressures and associated estimated wall stress are shown in attached Figure. 1 case of annular rupture (0.4%) occurred in high risk patient at 3.81MPa. Wall stress levels >3.0MPa were associated with reduced rates of post dilatation (13% vs 37%, p<0.001) and ≥mild PVR (10.7% vs 20%, p=0.093). In patients (148) with estimated wall stress between 3–3.8MPa rates of new PPM and LBBB were 7.4% and 8.1%, respectively. Greater wall stress was not associated with increased new PPM/LBBB risk. Therefore, we suggest the optimal deployment pressure limit to minimise risk of rupture, rates of post-dilatation and clinically significant PVR is: 6atm for 23mm valves, 5.5atm for 26mm valves and 5atm for 29mm valves.
Conclusion
Pressure-regulated deployment strategy is a reproducible, safe and effective method for balloon expandable TAVI, alleviating concerns of valve oversizing in high risk patients. Further trials are needed to validate this novel method and compare it with current volume-regulated techniques.
Abstract Figures
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Snir
- Macquarie University Hospital, Sydney, Australia
| | - L Khor
- Macquarie University Hospital, Sydney, Australia
| | - S.C.E Wong
- Gold Coast Hospital, Gold Coast, Australia
| | - C Naoum
- Macquarie University Hospital, Sydney, Australia
| | - M.K Wilson
- Macquarie University Hospital, Sydney, Australia
| | - M.K.C Ng
- Royal Prince Alfred Hospital, Sydney, Australia
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11
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Meier S, Yu C, Sun D, Trieu J, Sum W, Yiannikas J, Kritharides L, Naoum C. 318 Diagnostic Utility of Cardiac Magnetic Resonance (CMRI) in Patients with Myocardial Infarction without Obstructive Coronary Arteries (MINOCA). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Meier S, Davis B, Yu C, Yung G, Kritharides L, Naoum C. 330 Echocardiographic Parameters Predictive of a Positive 99mTc-PYP Scan in Patients with Suspected Cardiac ATTR-Amyloidosis. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Stocker TJ, Deseive S, Leipsic J, Hadamitzky M, Chen MY, Rubinshtein R, Heckner M, Bax JJ, Fang XM, Grove EL, Lesser J, Maurovich-Horvat P, Otton J, Shin S, Pontone G, Marques H, Chow B, Nomura CH, Tabbalat R, Schmermund A, Kang JW, Naoum C, Atkins M, Martuscelli E, Massberg S, Hausleiter J. Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 (PROTECTION VI). Eur Heart J 2019; 39:3715-3723. [PMID: 30165629 DOI: 10.1093/eurheartj/ehy546] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/22/2018] [Indexed: 01/12/2023] Open
Abstract
Aims Advances of cardiac computed tomography angiography (CTA) have been developed for dose reduction, but their efficacy in clinical practice is largely unknown. This study was designed to evaluate radiation dose exposure and utilization of dose-saving strategies for contrast-enhanced cardiac CTA in daily practice. Methods and results Sixty one hospitals from 32 countries prospectively enrolled 4502 patients undergoing cardiac CTA during one calendar month in 2017. Computed tomography angiography scan data and images were analysed in a central core lab and compared with a similar dose survey performed in 2007. Linear regression analysis was performed to identify independent predictors associated with dose. The most frequent indication for cardiac CTA was the evaluation of coronary artery disease in 89% of patients. The median dose-length product (DLP) of coronary CTA was 195 mGy*cm (interquartile range 110-338 mGy*cm). When compared with 2007, the DLP was reduced by 78% (P < 0.001) without an increase in non-diagnostic coronary CTAs (1.7% in 2007 vs. 1.9% in 2017 surveys, P = 0.55). A 37-fold variability in median DLP was observed between the hospitals with lowest and highest DLP (range of median DLP 57-2090 mGy*cm). Independent predictors for radiation dose of coronary CTA were: body weight, heart rate, sinus rhythm, tube voltage, iterative image reconstruction, and the selection of scan protocols. Conclusion This large international radiation dose survey demonstrates considerable reduction of radiation exposure in coronary CTA during the last decade. However, the large inter-site variability in radiation exposure underlines the need for further site-specific training and adaptation of contemporary cardiac scan protocols.
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Affiliation(s)
- Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | | | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, USA
| | | | - Mathias Heckner
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - John Lesser
- Minneapolis Heart Institute at Abbott Northwestern Hosptial, Minneapolis, USA
| | | | - James Otton
- Spectrum Radiology Liverpool, Sydney, Australia
| | - Sanghoon Shin
- National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
| | | | - Hugo Marques
- UNICA (cardiovascular CT and MRI Unit), Hospital da Luz, Lisboa, Portugal
| | - Benjamin Chow
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | | | - Axel Schmermund
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt, Germany
| | | | | | | | | | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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14
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Gnanenthiran SR, Naoum C, Leipsic JA, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufman PA, Kim YJ, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Raff GL, Rubinshtein R, Shaw LJ, Villines TC, Gransar H, Lu Y, Jones EC, Peña JM, Lin FY, Kritharides L, Min JK. Long-term prognostic utility of computed tomography coronary angiography in older populations. Eur Heart J Cardiovasc Imaging 2019; 20:1279-1286. [DOI: 10.1093/ehjci/jez067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/29/2019] [Accepted: 03/19/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (≥70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations.
Methods and results
From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age <70 years (n = 7198) vs. ≥70 years (n = 1786). The severity of CAD was classified according to: (i) maximal stenosis degree per vessel: none, non-obstructive (1–49%), or obstructive (>50%); (ii) segment involvement score (SIS): number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 ± 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both <70 years [non-obstructive hazard ratio (HR) confidence interval (CI): 1.70 (1.19–2.41); one-vessel: 1.65 (1.03–2.67); two-vessel: 2.24 (1.21–4.15); three-vessel/left main: 4.12 (2.27–7.46), P < 0.001] and ≥70 years [non-obstructive: 1.84 (1.15–2.95); one-vessel: HR (CI): 2.28 (1.37–3.81); two-vessel: 2.36 (1.33–4.19); three-vessel/left main: 2.41 (1.33–4.36), P = 0.014]. Similarly, SIS was predictive of mortality in both <70 years [SIS 1–3: 1.57 (1.10–2.24); SIS ≥4: 2.42 (1.65–3.57), P < 0.001] and ≥70 years [SIS 1–3: 1.73 (1.07–2.79); SIS ≥4: 2.45 (1.52–3.93), P < 0.001]. CCTA findings similarly predicted long-term major adverse cardiovascular outcomes (MACE) (all-cause mortality, myocardial infarction, and late revascularization) in both groups compared with patients with no CAD.
Conclusion
The presence and extent of CAD is a meaningful stratifier of long-term mortality and MACE in patients aged <70 years and ≥70 years old. The presence of obstructive and non-obstructive disease and the burden of atherosclerosis determined by SIS remain important predictors of prognosis in older populations.
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Affiliation(s)
| | - Christopher Naoum
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremburg, Germany
| | - Mouaz H Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | | | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, ON, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-UniversitätMönchen, Munich, Germany
| | - Philipp A Kaufman
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland and University of Zurich, 8091, Switzerland
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Todd C Villines
- Cardiology Service, Walter Reed National Military Center, Bethesda, Maryland, United States of America
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Erica C Jones
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jessica M Peña
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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15
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Snir A, Wong S, Khor L, Naoum C, Wilson M, Ng M. Safety and Efficacy of Pressure Regulated Deployment of Balloon-expandable Transcatheter Aortic Valve Implantation (TAVI). Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Gnanenthiran SR, Naoum C, Hanzek D, Pogrebizhsky Z, Martin D, Kritharides L, Yiannikas J. Feeding Induces Left Atrial Compression and Impedes Cardiac Filling in Patients With Large Hiatal Hernia. J Am Soc Echocardiogr 2018; 32:375-384. [PMID: 30473406 DOI: 10.1016/j.echo.2018.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with large hiatal hernias (HH) frequently experience postprandial dyspnea. The aim of this study was to evaluate whether feeding induced cardiac compression in these patients using echocardiography. METHODS Transthoracic echocardiography was performed during fasting and 30 min after feeding (300 g rice pudding) in patients with HHs (n = 32; mean age, 72 ± 9 years). A subset of patients (n = 15; mean age, 76 ± 6 years) were evaluated postoperatively. RESULTS Preoperatively, feeding decreased left atrial (LA) volumes (maximal 27.4 ± 11.3 vs 19.2 ± 9.7 mL/m2, P < .001; minimal 13.1 ± 7.0 vs 6.9 ± 5.1 mL/m2, P < .001), and increased LA inflow velocities (systolic wave 0.62 ± 0.14 vs 0.77 ± 0.17 m/sec, P < .01; diastolic wave 0.46 ± 0.13 vs 0.59 ± 0.13 m/sec, P < .01), mitral inflow velocities (E wave 0.79 ± 0.17 vs 0.94 ± 0.19 m/sec, P < .01; A wave 0.93 ± 0.20 vs 1.05 ± 0.22 m/sec, P < .01), and E/E' ratio (12.1 ± 2.7 vs 13.7 ± 3.9, P < .01). Cardiac output (6.3 ± 1.6 vs 7.24 ± 2.0 L, P < .01) increased postprandially by marked heart rate augmentation (68.8 ± 7.0 vs 84.2 ± 8.4 beats/min, P < .01), with modest stroke volume increase (88.5 ± 16.7 vs 94.3 ± 19.5 mL, P = .03). After HH surgery, feeding did not change LA volumes (maximal 52.9 ± 13.6 vs 53.4 ± 12.5 mL, P = .89; minimal 28.6 ± 12.2 vs 27.4 ± 8.7 mL, P = .59) or E/E' ratio (10.9 ± 2.1 vs 11.3 ± 2.3) and induced more modest alterations in LA inflow (systolic wave 0.58 ± 0.17 vs 0.68 ± 0.16 m/sec, P = .01; diastolic wave 0.41 ± 0.12 vs 0.47 ± 0.13 m/sec, P = .01) and mitral inflow (E wave 0.69 ± 0.15 vs 0.80 ± 0.13 m/sec, P < .01; A wave 0.92 ± 0.13 vs 1.01 ± 0.18 m/sec, P = .02). Postoperatively, feeding increased cardiac output by substantial stroke volume augmentation (81.9 ± 16.5 vs 90.8 ± 16.0 mL, P = .01), with only modest increase in heart rate (69.8 ± 9.1 vs 75.9 ± 10.5 beats/min, P < .01). CONCLUSIONS Feeding produces marked LA compression in patients with HHs, inducing compensatory exaggerated responses in cardiac inflow and hemodynamic status. These compensatory mechanisms improve postoperatively following resolution of LA compression, likely explaining the debility noted preoperatively.
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Affiliation(s)
| | - Christopher Naoum
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Dianna Hanzek
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Zoya Pogrebizhsky
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - David Martin
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia.
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17
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Weir-McCall JR, Blanke P, Naoum C, Delgado V, Bax JJ, Leipsic J. Mitral Valve Imaging with CT: Relationship with Transcatheter Mitral Valve Interventions. Radiology 2018; 288:638-655. [DOI: 10.1148/radiol.2018172758] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan R. Weir-McCall
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Philipp Blanke
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Christopher Naoum
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Victoria Delgado
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Jeroen J. Bax
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Jonathon Leipsic
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
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Gnanenthiran SR, Naoum C, Leipsic JA, Kritharides L, Min JK. P2487Long term prognostic utility of CT Coronary Angiography (CTCA) in older populations. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - C Naoum
- Concord General Repatriation Hospital, Sydney, Australia
| | - J A Leipsic
- University of British Columbia, Department of Medicine and Radiology, Vancouver, Canada
| | - L Kritharides
- Concord General Repatriation Hospital, Sydney, Australia
| | - J K Min
- Weill Cornell Medical College, Department of Radiology, New York, United States of America
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Naoum C, Kritharides L, Falk GL, Martin D, Yiannikas J. Left atrial compression and right ventricular outflow tract diameter on echocardiography are independently associated with exercise capacity in patients with large hiatal hernia. Echocardiography 2018; 35:592-602. [PMID: 29790224 DOI: 10.1111/echo.13835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Large hiatal hernia (HH) is often associated with left atrial (LA) compression, anteroposterior cardiac compression (manifesting as reduced right ventricular outflow tract (RVOT) diameter), and left ventricular (LV) compression (manifesting as systolic paradoxical outward motion (LV-PM) of the posterobasal LV segment). Exercise impairment, also common in this population, improves following HH surgery. We aimed to identify echocardiographic parameters independently associated with exercise impairment due to HH-mediated cardiogenic compression. METHODS Patients with a large HH (>30% intra-thoracic stomach, n = 163) referred for cardiac evaluation were included. Echocardiographic parameters were retrospectively analyzed in relation to HH-related LA compression severity and the presence of LV-PM. Echocardiographic parameters independently associated with exercise capacity were identified by multivariable analysis. RESULTS Mean baseline metabolic equivalents were reduced (70 ± 28% predicted). Moderate-severe LA compression and LV-PM were present in 91 of 163 (56%) and 65 of 162 (40%) patients, respectively. Patients with moderate-severe LA compression and LV-PM had decreased LA and LV dimensions. Moderate-severe LA compression was also associated with reduced RVOT diameter while LV-PM predicted a greater reduction in LV volumes. LA compression and RVOT diameter were independently associated with baseline exercise capacity and increased following HH surgery performed in a subgroup (n = 72, LA diameter: 14 ± 5 vs 20 ± 4 mm/m2 ; RVOT diameter: 17 ± 3 vs 19 ± 3 mm/m2 , P < .001 for both). Conversely, LV-PM was not independently associated with exercise capacity. CONCLUSION Hiatal hernia-related cardiac compression reduces LA and RVOT dimensions. These parameters are independently associated with baseline exercise capacity and improve following HH surgery. LV-PM is associated with decreased LV volumes but not exercise capacity in this population.
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Affiliation(s)
- Christopher Naoum
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Gregory L Falk
- Department of Upper GI Surgery, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - David Martin
- Department of Upper GI Surgery, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
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Gnanenthiran SR, Naoum C, Kilborn MJ, Yiannikas J. Posterior cardiac compression from a large hiatal hernia-A novel cause of ventricular tachycardia. HeartRhythm Case Rep 2018; 4:362-366. [PMID: 30116709 PMCID: PMC6093081 DOI: 10.1016/j.hrcr.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/29/2018] [Accepted: 05/14/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Christopher Naoum
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Michael J Kilborn
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
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Yu C, Anjaria M, Ridley L, Ng A, Yiannikas J, Kritharides L, Naoum C. Incidental Coronary Artery Calcium on Non–Gated Chest Computed Tomography in Hospital Inpatients Reclassifies Cardiovascular Risk. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chan W, Wang Z, Bird S, Yu C, Ridley L, Ho-Shon K, Magnussen J, Naoum C. Clinical Audit of Contemporary Radiation Doses in a University Hospital Coronary Computed Tomography Angiography Practice. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abeid S, Yu C, Ho-Shon K, Magnussen J, Yong A, Naoum C. The Relationship Between Extra-Coronary Calcification and Coronary Artery Lesion Characteristics. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gnanenthiran S, Naoum C, Achenbach S, Al-Mallah M, Andrieni D, Bax J, Berman D, Budoff M, Cademartiri F, Callister T, Chang H, Chinnaiyan K, Chow B, Cury R, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufman P, Maffei Y, Marques H, Pontone G, Raff G, Rubenshtein R, Shaw L, Villines T, Gransar H, Jones E, Pena J, Lin F, Leipsic J, Kritharides L, Min J. Atherosclerotic Plaque Burden Determined by Computed Tomography Coronary Angiography is Predictive of Long-Term Major Adverse Cardiovascular Events in Older Populations. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Yu C, Ng A, Anjaria M, Ridley L, Yiannikas J, Kritharides L, Naoum C. Incidental Coronary Calcium on Non–Gated Chest Computed Tomography in Hospital Inpatients is Predictive of All-Cause Mortality. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Redwood E, Chow V, Naoum C, Kritharides L, Ng A. Impact of Handheld Cardiac Ultrasound Device on the Workflow in a Tertiary Institution: A Pilot Study Experience. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gnanenthiran S, Naoum C, Khor L, Kilborn M, Yiannikas J. 4990Large hiatal hernia induced left ventricular dyskinesis - a novel cause of ventricular tachycardia. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx495.4990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Naoum C, Kritharides L, Gnanenthiran SR, Martin D, Falk GL, Yiannikas J. Valsalva maneuver exacerbates left atrial compression in patients with large hiatal hernia. Echocardiography 2017; 34:1305-1314. [PMID: 28722185 DOI: 10.1111/echo.13628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Hiatal hernia (HH) can cause left atrial (LA) compression and impair LA filling. We evaluated the cardiac effects of preload reduction and abdominal strain induced by Valsalva maneuver (VM) in large HH patients. METHODS LA and left ventricular (LV) dimensions were measured using 2D transthoracic echocardiography at rest and during VM in HH patients (n=55, 70±10 years) and controls (n=22, 67±6 years). Biplane LV volumes (n=39) and mitral inflow pulse-wave Doppler parameters (n=27) were also evaluated. In HH patients, resting LA compression was graded qualitatively (none-mild or moderate-severe). RESULTS In both controls and HH patients, VM significantly decreased LA (controls, 19±2 vs 16±3 mm/m2 ; HH, 16±5 vs 9±5 mm/m2 ) and LV diameters (22±3 vs 19±3 mm/m2 ; 21±3 vs 17±3 mm/m2 ) and LV volume (38±8 vs 26±10 mL/m2 ; 31±8 vs 19±9 mL/m2 ) (P<.001 for all). VM decreased LA diameter significantly more in HH patients than controls (-42% vs -16%, P<.001). HH patients with none-mild resting LA compression exhibited significantly greater LA diameter reduction than controls (-38±23% vs -16±13% P=.0003) despite similar resting LA diameters. LV volumes were similarly decreased by VM in HH patients and controls irrespective of resting LA compression severity indicating relative preservation of LV filling. LA diameter correlated inversely with early diastolic filling velocity during VM in HH patients (R=-.43, P=.03) but not controls (R=.18, P=.43). CONCLUSION VM can markedly exacerbate LA compression in HH patients; however, LV filling is relatively less affected possibly due to augmented early diastolic filling. Conditions associated with decreased preload and increased intra-abdominal pressure may exacerbate the cardiac effects of large HH.
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Affiliation(s)
- Christopher Naoum
- Department of Cardiology, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sonali R Gnanenthiran
- Department of Cardiology, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - David Martin
- Department of Upper Gastrointestinal Surgery, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Gregory L Falk
- Department of Upper Gastrointestinal Surgery, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Moore BM, Ng HB, Naoum C, Simmons L, Cartwright BL, Wilson MK, Ng MK. Transcatheter Mitral Valve Replacement With a Novel Dual Stent Bioprosthesis. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004841. [DOI: 10.1161/circinterventions.116.004841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Benjamin M. Moore
- From the Royal Prince Alfred Hospital (B.M.M., H.K.B.N., L.S., B.L.C., M.K.W., M.K.C.N.) and Concord Hospital (C.N.), University of Sydney, New South Wales, Australia
| | - H.K. Bernard Ng
- From the Royal Prince Alfred Hospital (B.M.M., H.K.B.N., L.S., B.L.C., M.K.W., M.K.C.N.) and Concord Hospital (C.N.), University of Sydney, New South Wales, Australia
| | - Christopher Naoum
- From the Royal Prince Alfred Hospital (B.M.M., H.K.B.N., L.S., B.L.C., M.K.W., M.K.C.N.) and Concord Hospital (C.N.), University of Sydney, New South Wales, Australia
| | - Lisa Simmons
- From the Royal Prince Alfred Hospital (B.M.M., H.K.B.N., L.S., B.L.C., M.K.W., M.K.C.N.) and Concord Hospital (C.N.), University of Sydney, New South Wales, Australia
| | - Bruce L. Cartwright
- From the Royal Prince Alfred Hospital (B.M.M., H.K.B.N., L.S., B.L.C., M.K.W., M.K.C.N.) and Concord Hospital (C.N.), University of Sydney, New South Wales, Australia
| | - Michael K. Wilson
- From the Royal Prince Alfred Hospital (B.M.M., H.K.B.N., L.S., B.L.C., M.K.W., M.K.C.N.) and Concord Hospital (C.N.), University of Sydney, New South Wales, Australia
| | - Martin K.C. Ng
- From the Royal Prince Alfred Hospital (B.M.M., H.K.B.N., L.S., B.L.C., M.K.W., M.K.C.N.) and Concord Hospital (C.N.), University of Sydney, New South Wales, Australia
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Naoum C, Berman DS, Ahmadi A, Blanke P, Gransar H, Narula J, Shaw LJ, Kritharides L, Achenbach S, Al-Mallah MH, Andreini D, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow B, Cury RC, DeLago A, Dunning A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Maffei E, Marquez H, Pontone G, Raff G, Rubinshtein R, Villines TC, Min J, Leipsic J. Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.004896. [PMID: 28292858 DOI: 10.1161/circimaging.116.004896] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 01/04/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age- and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use. METHODS AND RESULTS Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years). The relationship between SIS age-sex percentiles (SIS%) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups (≤50th, 51-75th, and >75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age-sex percentiles were well fitted to second-order polynomial curves (men: R2=0.86±0.12; women: R2=0.86±0.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the ≤50th, 51-75th, and >75th SIS% groups. Annualized event rates were higher among patients with greater CAD burden (2.1% [95% confidence interval: 1.7%-2.7%], 3.9% [95% confidence interval: 3.0%-5.1%], and 7.2% [95% confidence interval: 5.4%-9.6%] in ≤50th, 51-75th, and >75th SIS% groups, respectively; P<0.001). Adjusted MACE risk was significantly increased among patients in SIS% groups above the median compared with patients below the median (hazard ratio [95% confidence interval]: 1.9 [1.3-2.8] for 51-75th SIS% group and 3.4 [2.3-5.0] for >75th SIS% group; P<0.01 for both). CONCLUSIONS We have developed clinically pragmatic age- and sex-specific nomograms of CAD prevalence using coronary computed tomography angiography findings. Global plaque burden measured using SIS% is predictive of cardiac events independent of traditional risk assessment. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01443637.
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Affiliation(s)
- Christopher Naoum
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Daniel S Berman
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Amir Ahmadi
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Philipp Blanke
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Heidi Gransar
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Jagat Narula
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Leslee J Shaw
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Leonard Kritharides
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Stephan Achenbach
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Mouaz H Al-Mallah
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Daniele Andreini
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Matthew J Budoff
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Filippo Cademartiri
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Tracy Q Callister
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Hyuk-Jae Chang
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Kavitha Chinnaiyan
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Benjamin Chow
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Ricardo C Cury
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Augustin DeLago
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Allison Dunning
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Gudrun Feuchtner
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Martin Hadamitzky
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Joerg Hausleiter
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Philipp A Kaufmann
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Yong-Jin Kim
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Erica Maffei
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Hugo Marquez
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Gianluca Pontone
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Gilbert Raff
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Ronen Rubinshtein
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Todd C Villines
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - James Min
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.)
| | - Jonathon Leipsic
- From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.).
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Mak GJ, Blanke P, Ong K, Naoum C, Thompson CR, Webb JG, Moss R, Boone R, Ye J, Cheung A, Munt B, Leipsic J, Grewal J. Three-Dimensional Echocardiography Compared With Computed Tomography to Determine Mitral Annulus Size Before Transcatheter Mitral Valve Implantation. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004176. [PMID: 27307549 DOI: 10.1161/circimaging.115.004176] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previously, through the use of computed tomography (CT), it has been proposed that D-shaped versus saddle-shaped mitral annulus (MA) segmentation is more biomechanically appropriate to determine transcatheter mitral valve implantation size and eligibility. METHODS AND RESULTS Forty-one patients with severe mitral regurgitation being considered for transcatheter mitral valve implantation who had undergone cardiac CT and 3-dimensional transesophageal echocardiography (3D-TEE) were retrospectively evaluated. A standardized segmentation protocol for the D-shaped MA was developed using Philips Q-Laboratory mitral valve quantification software. MA dimensions were compared using Spearman's rank correlation and Bland-Altman analysis. Inter- and intraobserver agreement was quantified by intraclass correlation coefficient and Bland-Altman analysis. Mean age was 77±14 years; 71% male (n=29); mitral regurgitation pathogenesis was functional in 54% (n=22) and myxomatous in 46% (n=19). Mean MA area and circumference by 3D-TEE and CT were 11.3±2.7 versus 11.4±3.0 (P=0.67) and 124.1±15.6 versus 123.9±15.5 (P=0.79), respectively, with excellent correlation between modalities (r=0.84 and r=0.86; P<0.0001) and no systematic bias (-0.20±1.8 cm(2) [-3.7 cm(2); 3.3 cm(2)], 0.37±9 mm [-18.0 mm; 17.27 mm]). Mean septal-to-lateral and inter-trigone distances by 3D-TEE and CT were 33.2±4.7 versus 32.5±4.4 (P=0.24) and 31.7±3.5 versus 32.6±3.6 (P=0.06), respectively, with good correlation (r=0.69 and r=0.71; P<0.0001) and no systematic bias (0.77±3.8 mm [-6.7 mm; 8.2 mm], -1.5±3.1 mm [-4.6 mm; 7.6 mm]). There was excellent intra- and interobserver agreement according to intraclass correlation coefficients >0.90 for all parameters. CONCLUSIONS Similar to cardiac CT, 3D-TEE allows for D-shaped MA segmentation with no systematic difference in MA dimensions between modalities. This study supports the utilization of 3D-TEE as a complementary tool to CT assessment of the D-shaped MA to determine transcatheter mitral valve implantation size.
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Affiliation(s)
- George J Mak
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Kevin Ong
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Christopher Naoum
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | | | - John G Webb
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Robert Moss
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Robert Boone
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jian Ye
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Anson Cheung
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Brad Munt
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jonathon Leipsic
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jasmine Grewal
- From the St Paul's Hospital, University of British Columbia, Vancouver, Canada.
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Sulaiman N, Soon J, Park JK, Naoum C, Kueh SH, Blanke P, Murphy D, Ellis J, Hague CJ, Leipsic J. Comparison of low-dose coronary artery calcium scoring using low tube current technique and hybrid iterative reconstruction vs. filtered back projection. Clin Imaging 2017; 43:19-23. [DOI: 10.1016/j.clinimag.2017.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/17/2017] [Accepted: 01/31/2017] [Indexed: 01/07/2023]
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Blanke P, Park JK, Grayburn P, Naoum C, Ong K, Kohli K, Norgaard BL, Webb JG, Popma J, Boshell D, Sorajja P, Muller D, Leipsic J. Left ventricular access point determination for a coaxial approach to the mitral annular landing zone in transcatheter mitral valve replacement. J Cardiovasc Comput Tomogr 2017; 11:281-287. [PMID: 28396198 DOI: 10.1016/j.jcct.2017.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/22/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To facilitate coaxial device deployment in transcatheter mitral valve replacement (TMVR), a coaxial approach to the mitral annular plane is needed. We sought to establish a method to determine an 'orthogonal' left ventricular (LV) access point for transapical TMVR and to quantitatively characterize its location in patients with severe mitral regurgitation using cardiac computed tomography. METHODS Cardiac CT data sets of 54 patients with moderate-severe mitral regurgitation evaluated for potential TMVR were analyzed. The D-shaped mitral annular contour was segmented and a 2-dimensional annular plane was derived, allowing for subsequent definition of the perpendicularly oriented mitral annular trajectory. The 'orthogonal' LV access point was defined as the transection point of mitral trajectory with the LV epicardial surface. The location of the access point was quantified by its epicardial distance from the true apex and by the rotational offset from a 3-chamber view. RESULTS LV access points orthogonal to the mitral annular plane were most frequently located in the anterolateral (n = 22, 40.7%) and anterior (n = 16, 29.6%), less frequently anteroseptal (n = 6, 11.1%) and inferolateral (n = 5, 9.3%) ventricular segment; none inferior or inferoseptal. The mean distance to the LV apex was 17.6 ± 7.7 mm. The mean forward rotational offset from the 3-chamber view was 96.4 ± 43.4°, relating to a mean forward rotational offset of 6.4 ± 43.4° in regard to a hypothetical, secondary 90° x-plane view. No significant difference between patients with degenerative mitral valve disease or functional mitral regurgitation was observed. CONCLUSION The location of the LV access point that provides an orthogonal trajectory to the mitral annular plane exhibits relevant inter-individual variability. It is commonly not identical with the true apex, and frequently localized in the anterolateral or anterior ventricular segments.
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Affiliation(s)
- Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - Jong K Park
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Paul Grayburn
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, United States
| | - Christopher Naoum
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kevin Ong
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | | | - John G Webb
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Paul Sorajja
- Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN, United States
| | | | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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Blanke P, Pibarot P, Hahn R, Weissman N, Kodali S, Thourani V, Parvataneni R, Dvir D, Naoum C, Nørgaard BL, Douglas P, Jaber W, Khalique OK, Jilaihawi H, Mack M, Smith C, Leon M, Webb J, Leipsic J. Computed Tomography–Based Oversizing Degrees and Incidence of Paravalvular Regurgitation of a New Generation Transcatheter Heart Valve. JACC Cardiovasc Interv 2017; 10:810-820. [DOI: 10.1016/j.jcin.2017.02.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 11/27/2022]
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Blanke P, Naoum C, Dvir D, Bapat V, Ong K, Muller D, Cheung A, Ye J, Min JK, Piazza N, Theriault-Lauzier P, Webb J, Leipsic J. Predicting LVOT Obstruction in Transcatheter Mitral Valve Implantation. JACC Cardiovasc Imaging 2017; 10:482-485. [DOI: 10.1016/j.jcmg.2016.01.005] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 11/15/2022]
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Kueh SH, Naoum C. Update on the clinical utility of coronary computed tomographic angiography in stable angina pectoris. Minerva Cardiol Angiol 2017; 65:201-213. [DOI: 10.23736/s0026-4725.17.04277-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Naoum C, Blanke P, Cavalcante JL, Leipsic J. Cardiac Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Mitral and Tricuspid Valve Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005331. [DOI: 10.1161/circimaging.116.005331] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transcatheter interventions to treat mitral and tricuspid valve disease are becoming increasingly available because of the growing number of elderly patients with significant comorbidities or high operative risk. Thorough clinical and imaging evaluation in these patients is essential. The latter involves both characterization of the mechanism and severity of valvular disease as well as determining the hemodynamic consequences and extent of ventricular remodeling, which is an important predictor of future outcomes. Moreover, an assessment of the suitability and risk of complications associated with device-specific therapies is also an important component of the preprocedural evaluation in this cohort. Although echocardiography including 2-dimensional and 3-dimensional methods has an important role in the initial assessment and procedural guidance, cross-sectional imaging, including both computed tomographic imagning and cardiac magnetic resonance imaging, is increasingly being integrated into the evaluation of mitral and tricuspid valve disease. In this review, we discuss the role of cross-sectional imaging in mitral and tricuspid valve disease, primarily valvular regurgitation assessment, with an emphasis on the preprocedural evaluation and implications for transcatheter interventions.
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Affiliation(s)
- Christopher Naoum
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Philipp Blanke
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - João L. Cavalcante
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Jonathon Leipsic
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
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Blanke P, Soon J, Dvir D, Park JK, Naoum C, Kueh SH, Wood DA, Norgaard BL, Selvakumar K, Ye J, Cheung A, Webb JG, Leipsic J. Computed tomography assessment for transcatheter aortic valve in valve implantation: The vancouver approach to predict anatomical risk for coronary obstruction and other considerations. J Cardiovasc Comput Tomogr 2016; 10:491-499. [PMID: 27697505 DOI: 10.1016/j.jcct.2016.09.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/17/2016] [Accepted: 09/23/2016] [Indexed: 12/24/2022]
Abstract
Valve-in-valve implantation of a transcatheter heart valve into a failed bioprosthetic heart valve has emerged as a treatment alternative to repeat conventional surgery. This requires careful pre-procedural assessment using non-invasive imaging to identify patients at risk for procedure related adverse events, such as ostial coronary occlusion. Herein we report how to comprehensively assess aortic root anatomy using computed tomography prior to transcatheter valve implantation for failed bioprosthetic aortic valves.
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Affiliation(s)
- Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jeanette Soon
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Danny Dvir
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jong K Park
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Naoum
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Shaw-Hua Kueh
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - David A Wood
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Kapilan Selvakumar
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jian Ye
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Anson Cheung
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
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Bilbey N, Blanke P, Naoum C, Arepalli CD, Norgaard BL, Leipsic J. Potential impact of clinical use of noninvasive FFRCT on radiation dose exposure and downstream clinical event rate. Clin Imaging 2016; 40:1055-60. [DOI: 10.1016/j.clinimag.2016.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/05/2016] [Accepted: 05/20/2016] [Indexed: 11/25/2022]
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Blanke P, Naoum C, Ahmadi A, Cheruvu C, Soon J, Arepalli C, Gransar H, Achenbach S, Berman DS, Budoff MJ, Callister TQ, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Rubinshtein R, Marquez H, DeLago A, Villines TC, Hadamitzky M, Hausleiter J, Shaw LJ, Kaufmann PA, Cury RC, Feuchtner G, Kim YJ, Maffei E, Raff G, Pontone G, Andreini D, Chang HJ, Chow BW, Min J, Leipsic J. Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus. JACC Cardiovasc Imaging 2016; 9:1280-1288. [PMID: 27568114 DOI: 10.1016/j.jcmg.2015.12.027] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/22/2015] [Accepted: 12/30/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The goal of this study was to determine the long-term prognostic value of coronary computed tomography angiography (CTA) among patients with diabetes mellitus (DM) compared with nondiabetic subjects. BACKGROUND The long-term prognostic value of coronary CTA in patients with DM is not well established. METHODS Patients enrolled in the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry with 5-year follow-up data were identified. The extent and severity of coronary artery disease (CAD) were analyzed at baseline coronary CTA and in relation to outcomes between diabetic and nondiabetic patients. CAD according to coronary CTA was defined as none (0% stenosis), nonobstructive (1% to 49% stenosis), or obstructive (≥50% stenosis). Time to death (and in a subgroup, time to major adverse cardiovascular event) was estimated by using multivariable Cox proportional hazards models. RESULTS A total of 1,823 patients were identified as having DM with 5-year clinical follow-up and were propensity-matched to 1,823 patients without DM (mean age 61.8 ± 10.9 years; 54.4% male). Patients with DM did not exhibit a heightened risk of death compared with the propensity-matched nondiabetic subjects in the absence of CAD on coronary CTA (risk-adjusted hazard ratio [HR] of DM: 1.32; 95% confidence interval [CI]: 0.78 to 2.24; p = 0.296). Patients with DM were at increased risk of dying compared with nondiabetic subjects in the setting of nonobstructive CAD (in the propensity-matched cohort: HR, 2.10; 95% CI: 1.43 to 3.09; p < 0.001) with a mortality risk greater than nondiabetic subjects with obstructive disease (p < 0.001). In a risk-adjusted hazard analysis among patients with DM, both per-patient obstructive CAD and nonobstructive CAD conferred an increase in all-cause mortality risk compared with patients without atherosclerosis on coronary CTA (nonobstructive disease-HR: 2.07; 95% CI: 1.33 to 3.24; p = 0.001; obstructive disease-HR: 2.22; 95% CI: 1.47 to 3.36; p < 0.001). CONCLUSIONS Among patients with DM, nonobstructive and obstructive CAD according to coronary CTA were associated with higher rates of all-cause mortality and major adverse cardiovascular events at 5 years, and this risk was significantly higher than in nondiabetic subjects. Importantly, patients with DM without CAD according to coronary CTA were at a risk comparable to that of nondiabetic subjects.
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Affiliation(s)
- Philipp Blanke
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Naoum
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amir Ahmadi
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chaitu Cheruvu
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeanette Soon
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chesnal Arepalli
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Matthew J Budoff
- Department of Medicine, Harbor-UCLA Medical Center, Los Angeles, California
| | | | - Mouaz H Al-Mallah
- Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, Michigan
| | - Filippo Cademartiri
- Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy, and Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hugo Marquez
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | | | - Todd C Villines
- Department of Medicine, Walter Reed Medical Center, Washington, D.C
| | - Martin Hadamitzky
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Erica Maffei
- Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy, and Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Benjamin W Chow
- Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - James Min
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Jonathon Leipsic
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Soon J, Sulaiman N, Park JK, Kueh SHA, Naoum C, Murphy D, Ellis J, Hague CJ, Blanke P, Leipsic J. The effect of a whole heart motion-correction algorithm on CT image quality and measurement reproducibility in Pre-TAVR aortic annulus evaluation. J Cardiovasc Comput Tomogr 2016; 10:386-90. [PMID: 27576115 DOI: 10.1016/j.jcct.2016.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/15/2016] [Accepted: 08/02/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Motion correction (MC) algorithms have been shown to improve image quality, interpretability and diagnostic accuracy in coronary CT angiography. We sought to determine whether MC extended to the whole heart would demonstrate improved image quality and reproducibility of aortic annular measurements in pre-TAVR CT. MATERIALS AND METHODS Twenty-two consecutive contrast enhanced CT data sets acquired for pre TAVR evaluation using retrospective ECG synchronization during a single heart beat were retrospectively identified. Image data sets were obtained from raw data acquired at 35% and 75% of the R-R interval using both standard (STD) and motion corrected (MC) reconstruction algorithms. Four data sets (2 STD, 2 MC) per patient were analyzed by 2 independent, blinded readers for aortic annular area, short and long axis, perimeter and average diameter. Image quality was graded using a 5 point Likert score (1 and 2 non diagnostic, 5 excellent). Statistical analysis was performed using Wilcoxon matched paired tests, Bland-Altman (B-A) plots and Lin's concordance coefficient comparing 35% STD to 35% MC, and 75% STD to 75% MC. RESULTS Eighty-eight datasets were analyzed (44 STD, 44 MC). At 35%, there was a significant improvement in image quality for MC (Likert score 3.3 ± 0.9 STD vs. 3.9 ± 0.7 MC, p < 0.007). While B-A analysis demonstrated narrower interobserver agreement for aortic annular area (bias 0.03 vs 0.02 cm(2), range -0.32 to 0.39 cm(2) vs -0.50 to 0.55 cm(2)), and perimeter (bias 0.3 vs 0.3 mm, range -3.1 to 3.8 mm vs -4.6 to 5.3 mm), this was not statistically significant by concordance correlation coefficient. At 75%, there was no significant difference in image quality (Likert score 3.3 ± 0.9 vs. 3.5 ± 0.76, p = 0.454) or annular measurement agreement intervals. CONCLUSION Motion correction algorithms may yield significant improvements of image quality in systolic CT data sets of the heart. Further validation studies are required to determine the effect on annular measurements and translation into clinical practice.
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Affiliation(s)
- Jeanette Soon
- Dept of Radiology and Centre for Heart Valve Innovation, St Paul's Hospital, Vancouver, Canada
| | - Nada Sulaiman
- Dept of Radiology and Centre for Heart Valve Innovation, St Paul's Hospital, Vancouver, Canada
| | - Jong Kwan Park
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Shaw-Hua Anthony Kueh
- Dept of Radiology and Centre for Heart Valve Innovation, St Paul's Hospital, Vancouver, Canada
| | - Christopher Naoum
- Cardiology Department, Concord Hospital, The University of Sydney, Australia
| | - Darra Murphy
- Dept of Radiology and Centre for Heart Valve Innovation, St Paul's Hospital, Vancouver, Canada
| | - Jennifer Ellis
- Dept of Radiology and Centre for Heart Valve Innovation, St Paul's Hospital, Vancouver, Canada
| | - Cameron J Hague
- Dept of Radiology and Centre for Heart Valve Innovation, St Paul's Hospital, Vancouver, Canada
| | - Philipp Blanke
- Dept of Radiology and Centre for Heart Valve Innovation, St Paul's Hospital, Vancouver, Canada
| | - Jonathon Leipsic
- Dept of Radiology and Centre for Heart Valve Innovation, St Paul's Hospital, Vancouver, Canada.
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Grunau B, Leipsic J, Purssell E, Kasteel N, Nguyen K, Kazem M, Naoum C, Raju R, Blanke P, Heilbron B, Taylor C, Scheuermeyer FX. Comparison of Rates of Coronary Angiography and Combined Testing Procedures in Patients Seen in the Emergency Room With Chest Pain (But No Objective Acute Coronary Syndrome Findings) Having Coronary Computed Tomography Versus Exercise Stress Testing. Am J Cardiol 2016; 118:155-61. [PMID: 27236251 DOI: 10.1016/j.amjcard.2016.04.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/15/2016] [Accepted: 04/26/2016] [Indexed: 02/01/2023]
Abstract
Coronary computed tomography angiography (CCTA) appears comparable to standard care, including exercise stress testing (EST), in diagnosing acute coronary syndrome in emergency department (ED) patients with chest pain but may increase downstream testing. The objective of this study was to investigate rates of post-CCTA versus post-EST testing for (1) invasive angiography and (2) all combined cardiac testing. This was a retrospective cohort study performed at 2 urban Canadian EDs involving patients aged up to 65 years with chest pain but no objective ACS findings that were evaluated with CCTA or EST at the physician's discretion. The primary outcome was the proportion of patients who had 30-day invasive angiography in each group; secondary outcomes included all subsequent 30-day cardiac testing, including nuclear medicine scanning. From July 1, 2012, to June 30, 2014, we collected 1,700 patients: 521 CCTA and 1,179 EST. Demographics and risk factors were similar in both cohorts. In the following 30 days, 30 CCTA (5.8%) and 297 EST (25.2%) patients underwent any type of additional cardiac testing (difference 19.4%, 95% CI 16.0 to 22.6), whereas 12 CCTA (2.3%) and 20 EST patients (1.7%) underwent angiography (difference 0.6%, 95% CI -0.8% to 2.6%). No patients in either group died or had a myocardial infarction within 30 days. For ED patients with chest pain who underwent brief observation, CCTA and EST had similar 30-day angiography rates, but CCTA patients underwent significantly less overall cardiac investigations.
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Leipsic J, Naoum C, Blanke P. Diagnostic Algorithms for Stable Chest Pain. J Am Coll Cardiol 2016; 67:2617-9. [DOI: 10.1016/j.jacc.2016.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 11/27/2022]
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Naoum C, Blanke P, Dvir D, Pibarot P, Humphries K, Webb J, Leipsic J. Clinical Outcomes and Imaging Findings in Women Undergoing TAVR. JACC Cardiovasc Imaging 2016; 9:483-93. [DOI: 10.1016/j.jcmg.2016.02.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/12/2016] [Accepted: 02/18/2016] [Indexed: 01/09/2023]
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Naoum C, Leipsic J, Cheung A, Ye J, Bilbey N, Mak G, Berger A, Dvir D, Arepalli C, Grewal J, Muller D, Murphy D, Hague C, Piazza N, Webb J, Blanke P. Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse. JACC Cardiovasc Imaging 2016; 9:269-80. [DOI: 10.1016/j.jcmg.2015.08.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 02/03/2023]
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Raju R, Cury RC, Precious B, Blanke P, Naoum C, Arepalli C, Batlle JC, Murphy D, Hague C, Leipsic JA. Comparison of image quality, and diagnostic interpretability of a new volumetric high temporal resolution scanner versus 64-slice MDCT. Clin Imaging 2016; 40:205-11. [DOI: 10.1016/j.clinimag.2015.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/10/2015] [Accepted: 10/20/2015] [Indexed: 01/22/2023]
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Cheruvu C, Naoum C, Blanke P, Norgaard B, Leipsic J. Beyond Stenosis With Fractional Flow Reserve Via Computed Tomography and Advanced Plaque Analyses for the Diagnosis of Lesion-Specific Ischemia. Can J Cardiol 2016; 32:1315.e1-1315.e9. [PMID: 27032888 DOI: 10.1016/j.cjca.2016.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/14/2015] [Accepted: 01/04/2016] [Indexed: 12/24/2022] Open
Abstract
In the treatment of stable coronary artery disease (CAD), the determination of stenosis severity by invasive coronary angiography (ICA) is a critical procedure, and for borderline lesions, the detection of ischemia through invasive fractional flow reserve (FFR) is the gold standard. With advances in computational fluid dynamics, FFR can now be calculated noninvasively using anatomic data from coronary computed tomographic angiography (CCTA). This technique is known as FFRCT. The purpose of this review is to summarize the science of FFRCT, describe its diagnostic accuracy, discuss its clinical and economic impact, and elucidate factors beyond stenosis severity that may mechanistically relate to lesion-specific ischemia. These factors include adverse atherosclerotic plaque characteristics such as positive remodelling, low-attenuation plaque, and spotty calcification, as well as aggregate plaque volume. These factors can be appreciated noninvasively by CCTA but not by ICA. The diagnostic accuracy of FFRCT, compared with the gold standard of FFR, has been validated in 3 prospective multicentre blinded core laboratory-controlled trials, and as a result FFRCT has been approved by the US Food and Drug Administration for clinical use. FFRCT has also been shown in a clinical utility trial to better identify patients without obstructive CAD when compared with standard noninvasive assessment of stable CAD, thereby avoiding unnecessary angiograms. In addition, the use of FFRCT has been shown to allow for a significant cost savings compared with traditional care. It is therefore important for cardiologists to appreciate the value of this important new methodology.
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Affiliation(s)
- Chaitu Cheruvu
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Naoum
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bjarne Norgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Cheruvu C, Precious B, Naoum C, Blanke P, Ahmadi A, Soon J, Arepalli C, Gransar H, Achenbach S, Berman DS, Budoff MJ, Callister TQ, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Rubinshtein R, Marquez H, DeLago A, Villines TC, Hadamitzky M, Hausleiter J, Shaw LJ, Kaufmann PA, Cury RC, Feuchtner G, Kim YJ, Maffei E, Raff G, Pontone G, Andreini D, Chang HJ, Min JK, Leipsic J. Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: Results from the 5 year follow-up of the CONFIRM International Multicenter Registry. J Cardiovasc Comput Tomogr 2015; 10:22-7. [PMID: 26719237 DOI: 10.1016/j.jcct.2015.12.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/04/2015] [Accepted: 12/11/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Coronary computed tomography angiography (coronary CTA) can prognosticate outcomes in patients without modifiable risk factors over medium term follow-up. This ability was driven by major adverse cardiovascular events (MACE). OBJECTIVE Determine if coronary CTA could discriminate risk of mortality with longer term follow-up. In addition we sought to determine the long-term relationship to MACE. METHODS From 12 centers, 1884 patients undergoing coronary CTA without prior coronary artery disease (CAD) or any modifiable CAD risk factors were identified. The presence of CAD was classified as none (0% stenosis), mild (1% to 49% stenosis) and obstructive (≥50% stenosis severity). The primary endpoint was all-cause mortality and the secondary endpoint was MACE. MACE was defined as the combination of death, nonfatal myocardial infarction, unstable angina, and late target vessel revascularization (>90 days). RESULTS Mean age was 55.6 ± 14.5 years. At mean 5.6 ± 1.3 years follow-up, 145(7.7%) deaths occurred. All-cause mortality demonstrated a dose-response relationship to the severity and number of coronary vessels exhibiting CAD. Increased mortality was observed for >1 segment non-obstructive CAD (hazard ratio [HR]:1.73; 95% confidence interval [CI]: 1.07-2.79; p = 0.025), obstructive 1&2 vessel CAD (HR: 1.70; 95% CI: 1.08-2.71; p = 0.023) and 3-vessel or left main CAD (HR: 2.87; 95% CI: 1.57-5.23; p = 0.001). Both obstructive CAD (HR: 6.63; 95% CI: 3.91-11.26; p < 0.001) and non-obstructive CAD (HR: 2.20; 95% CI: 1.31-3.67; p = 0.003) predicted MACE with increased hazard associated with increasing CAD severity; 5.60% in no CAD, 13.24% in non-obstructive and 36.28% in obstructive CAD, p < 0.001 for trend. CONCLUSIONS In individuals being assessed for CAD with no modifiable risk factors, all-cause mortality in the long term (>5 years) was predicted by the presence of more than 1 segment of non-obstructive plaque, obstructive 1- or 2-vessel CAD and 3 vessel/left main CAD. Any CAD, whether non-obstructive or obstructive, predicted MACE over the same time period.
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Affiliation(s)
- Chaitu Cheruvu
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Bruce Precious
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Naoum
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Philipp Blanke
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Amir Ahmadi
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeanette Soon
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Chesnaldey Arepalli
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Heidi Gransar
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Daniel S Berman
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA
| | | | - Mouaz H Al-Mallah
- Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA
| | - Filippo Cademartiri
- Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy
| | | | | | - Hugo Marquez
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Todd C Villines
- Department of Medicine, Walter Reed Medical Center, Washington, DC, USA
| | - Martin Hadamitzky
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Erica Maffei
- Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy
| | | | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.
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Scheuermeyer FX, Grunau B, Raju R, Choy S, Naoum C, Blanke P, Hague C, Heilbron B, Taylor C, Kalla D, Christenson J, Innes G, Hanakova M, Leipsic J. Safety and efficiency of outpatient versus emergency department-based coronary CT angiography for evaluation of patients with potential ischemic chest pain. J Cardiovasc Comput Tomogr 2015; 9:534-7. [PMID: 26310589 DOI: 10.1016/j.jcct.2015.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/06/2015] [Accepted: 08/06/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND While coronary CT angiography (coronary CTA) may be comparable to standard care in diagnosing acute coronary syndrome (ACS) in emergency department (ED) chest pain patients, it has traditionally been obtained prior to ED discharge and a strategy of delayed outpatient coronary CTA following an ED visit has not been evaluated. OBJECTIVE To investigate the safety of discharging stable ED patients and obtaining outpatient CCTA. METHODS At two urban Canadian EDs, patients up to 65 years with chest pain but no findings indicating presence of ACS were further evaluated depending upon time of presentation: (1) ED-based coronary CTA during normal working hours, (2) or outpatient coronary CTA within 72 hours at other times. All data were collected prospectively. The primary outcome was the proportion of patients who had an outpatient coronary CTA ordered and had a predefined major adverse cardiac event (MACE) between ED discharge and outpatient CT; secondary outcome was the ED length of stay in both groups. RESULTS From July 1, 2012 to June 30, 2014, we enrolled 521 consecutive patients: 350 with outpatient CT and 171 with ED-based CT. Demographics and risk factors were similar in both cohorts. No outpatient CT patients had a MACE prior to coronary CTA. (0.0%, 95% CI 0 to 0.9%) The median length of stay for ED-based evaluation was 6.6 hours (interquartile range 5.4 to 8.3 hours) while the outpatient group had a median length of stay of 7.0 hours (IQR 6.0 to 9.8 hours, n.s.). CONCLUSIONS In ED chest pain patients with a low risk of ACS, performing coronary CTA as an outpatient may be a safe strategy.
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Affiliation(s)
- Frank X Scheuermeyer
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada; Department of Emergency Medicine, Mount St Joseph's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Brian Grunau
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Rekha Raju
- Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Stephen Choy
- Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Christopher Naoum
- Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Philipp Blanke
- Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Cameron Hague
- Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Brett Heilbron
- Division of Cardiology, Department of Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Carolyn Taylor
- Division of Cardiology, Department of Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Daniel Kalla
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Jim Christenson
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Grant Innes
- Department of Emergency Medicine, Foothills Hospital and the University of Calgary, Calgary, AB, Canada
| | - Michaela Hanakova
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Jonathon Leipsic
- Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
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Murphy DT, Blanke P, Alaamri S, Naoum C, Rubinshtein R, Pache G, Precious B, Berger A, Raju R, Dvir D, Wood DA, Webb J, Leipsic JA. Dynamism of the aortic annulus: Effect of diastolic versus systolic CT annular measurements on device selection in transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr 2015; 10:37-43. [PMID: 26239964 DOI: 10.1016/j.jcct.2015.07.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/28/2015] [Accepted: 07/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Annular dimensions, including cross-sectional area, perimeter and subsequently derived diameters, are subject to dynamic changes throughout the cardiac cycle. There is ongoing controversy as to whether perimeter measurement changes between systole and diastole are too small to impact on valve sizing. OBJECTIVES To assess both the variability of aortic annular dimensions throughout the cardiac cycle across a range of sub-annular calcification using computed tomography (CT) and the impact of this variability on device size selection for balloon-expandable valves in a large, all-comer multi-center cohort. METHODS ECG-gated CT data of 507 patients (mean 81 ± 7.5 years, 60.1% male) were analyzed in this retrospective, multicenter analysis. Aortic annulus dimensions were assessed on pre-specified systolic and diastolic phases by planimetry, yielding both area and perimeter. Contour smoothing was employed to avoid artificial increase in perimeter values by uneven contours. The extent of subannular calcification was graded semi-quantitatively and assessed in relation to the degree of annular dynamism. Hypothetical device sizing was undertaken to assess the impact of using systolic and diastolic measurements on valve selection. RESULTS Mean annular dimensions were larger during systole than diastole (area: 474.4 ± 87.4 mm(2) vs. 438.3 ± 84.3 mm(2) or 8.23%, p < 0.001; perimeter: 78.5 ± 7.2 mm vs. 75.9 ± 7.2 mm or 3.36%, p < 0.001). The magnitude of annular area and perimeter change (systolic minus diastolic measurement) was greater among patients without calcification compared to patients with grade 3 calcification. Using diastolic rather than systolic data for device sizing resulted in a change of the recommended valve size in nearly half of patients for both annular area and perimeter. CONCLUSIONS The systematic differences between systolic and diastolic annular measurements for cross-sectional area and perimeter have implications for device sizing with potential for valve under-sizing if diastolic annular dimensions are employed.
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Affiliation(s)
- Darra T Murphy
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - Philipp Blanke
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - Shalan Alaamri
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - Christopher Naoum
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - Ronen Rubinshtein
- Cardiology Department, Lady Davis Carmel Medical Centre, Haifa, Israel.
| | - Gregor Pache
- Division of Cardiovascular Radiology, University Hospital Freiburg, Freiburg, Germany.
| | - Bruce Precious
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - Adam Berger
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - Rekha Raju
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - Danny Dvir
- Department of Cardiology, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - David A Wood
- Department of Cardiology, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - John Webb
- Department of Cardiology, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - Jonathon A Leipsic
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
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