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Kuronuma K, Miller RJH, Wei CC, Singh A, Lemley MH, Van Kriekinge SD, Kavanagh PB, Gransar H, Han D, Hayes SW, Thomson L, Dey D, Friedman JD, Berman DS, Slomka PJ. Downward myocardial creep during stress PET imaging is inversely associated with mortality. Eur J Nucl Med Mol Imaging 2024; 51:1622-1631. [PMID: 38253908 PMCID: PMC11042981 DOI: 10.1007/s00259-024-06611-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE The myocardial creep is a phenomenon in which the heart moves from its original position during stress-dynamic PET myocardial perfusion imaging (MPI) that can confound myocardial blood flow measurements. Therefore, myocardial motion correction is important to obtain reliable myocardial flow quantification. However, the clinical importance of the magnitude of myocardial creep has not been explored. We aimed to explore the prognostic value of myocardial creep quantified by an automated motion correction algorithm beyond traditional PET-MPI imaging variables. METHODS Consecutive patients undergoing regadenoson rest-stress [82Rb]Cl PET-MPI were included. A newly developed 3D motion correction algorithm quantified myocardial creep, the maximum motion at stress during the first pass (60 s), in each direction. All-cause mortality (ACM) served as the primary endpoint. RESULTS A total of 4,276 patients (median age 71 years; 60% male) were analyzed, and 1,007 ACM events were documented during a 5-year median follow-up. Processing time for automatic motion correction was < 12 s per patient. Myocardial creep in the superior to inferior (downward) direction was greater than the other directions (median, 4.2 mm vs. 1.3-1.7 mm). Annual mortality rates adjusted for age and sex were reduced with a larger downward creep, with a 4.2-fold ratio between the first (0 mm motion) and 10th decile (11 mm motion) (mortality, 7.9% vs. 1.9%/year). Downward creep was associated with lower ACM after full adjustment for clinical and imaging parameters (adjusted hazard ratio, 0.93; 95%CI, 0.91-0.95; p < 0.001). Adding downward creep to the standard PET-MPI imaging model significantly improved ACM prediction (area under the receiver operating characteristics curve, 0.790 vs. 0.775; p < 0.001), but other directions did not (p > 0.5). CONCLUSIONS Downward myocardial creep during regadenoson stress carries additional information for the prediction of ACM beyond conventional flow and perfusion PET-MPI. This novel imaging biomarker is quantified automatically and rapidly from stress dynamic PET-MPI.
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Affiliation(s)
- Keiichiro Kuronuma
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- Department of Cardiology, Nihon University, Tokyo, Japan
| | - Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Chih-Chun Wei
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Ananya Singh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Mark H Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Paul B Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Sean W Hayes
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Louise Thomson
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - John D Friedman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
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Han D, Hyun MC, Miller RJH, Gransar H, Slomka PJ, Dey D, Hayes SW, Friedman JD, Thomson LEJ, Berman DS, Rozanski A. 10-year experience of utilizing a stress-first SPECT myocardial perfusion imaging. Int J Cardiol 2024; 401:131863. [PMID: 38365012 DOI: 10.1016/j.ijcard.2024.131863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Despite its potential benefits, the utilization of stress-only protocol in clinical practice has been limited. We report utilizing stress-first single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). METHODS We assessed 12,472 patients who were referred for SPECT-MPI between 2013 and 2020. The temporal changes in frequency of stress-only imaging were assessed according to risk factors, mode of stress, prior coronary artery disease (CAD) history, left ventricular function, and symptom status. The clinical endpoint was all-cause mortality. RESULTS In our lab, stress/rest SPECT-MPI in place of rest/stress SPECT-MPI was first introduced in November 2011 and was performed more commonly than rest/stress imaging after 2013. Stress-only SPECT-MPI scanning has been performed in 30-34% of our SPECT-MPI studies since 2013 (i.e.. 31.7% in 2013 and 33.6% in 2020). During the study period, we routinely used two-position imaging (additional prone or upright imaging) to reduce attenuation and motion artifact and introduced SPECT/CT scanner in 2018. The rate of stress-only study remained consistent before and after implementing the SPECT/CT scanner. The frequency of stress-only imaging was 43% among patients without a history of prior CAD and 19% among those with a prior CAD history. Among patients undergoing treadmill exercise, the frequency of stress-only imaging was 48%, while 32% among patients undergoing pharmacologic stress test. In multivariate Cox analysis, there was no significant difference in mortality risk between stress-only and stress/rest protocols in patients with normal SPECT-MPI results (p = 0.271). CONCLUSION Implementation of a stress-first imaging protocol has consistently resulted in safe cancellation of 30% of rest SPECT-MPI studies.
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Affiliation(s)
- Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Mark C Hyun
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Piotr J Slomka
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Damini Dey
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Sean W Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - John D Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Louise E J Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Alan Rozanski
- The Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Natanzon SS, Han D, Kuronuma K, Gransar H, Miller RJH, Slomka PJ, Dey D, Hayes SW, Friedman JD, Thomson LEJ, Berman DS, Rozanski A. Self-reported exercise activity influences the relationship between coronary computed tomography angiographic finding and mortality. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00070-4. [PMID: 38589269 DOI: 10.1016/j.jcct.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
AIM Recent studies suggest that the application of exercise activity questionnaires, including the use of a single-item exercise question, can be additive to the prognostic efficacy of imaging findings. This study aims to evaluate the prognostic efficacy of exercise activity in patients undergoing coronary computed tomography angiography (CCTA). METHODS AND RESULTS We assessed 9772 patients who underwent CCTA at a single center between 2007 and 2020. Patients were divided into 4 groups of physical activity as no exercise (n = 1643, 17%), mild exercise (n = 3156, 32%), moderate exercise (n = 3542, 36%), and high exercise (n = 1431,15%), based on a single-item self-reported questionnaire. Coronary stenosis was categorized as no (0%), non-obstructive (1-49%), borderline (50-69%), and obstructive (≥70%). During a median follow-up of 4.64 (IQR 1.53-7.89) years, 490 (7.6%) died. There was a stepwise inverse relationship between exercise activity and mortality (p < 0.001). Compared with the high activity group, the no activity group had a 3-fold higher mortality risk (HR: 3.3, 95%CI (1.94-5.63), p < 0.001) after adjustment for age, clinical risk factors, symptoms, and statin use. For any level of CCTA stenosis, mortality rates were inversely associated with the degree of patients' exercise activity. The risk of all-cause mortality was similar among the patients with obstructive stenosis with high exercise versus those with no coronary stenosis but no exercise activity (p = 0.912). CONCLUSION Physical activity as assessed by a single-item self-reported questionnaire is a strong stepwise inverse predictor of mortality risk among patients undergoing CCTA.
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Affiliation(s)
- Sharon Shalom Natanzon
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keiichiro Kuronuma
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J H Miller
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean W Hayes
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise E J Thomson
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Rozanski
- Division of Cardiac Sciences, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Torosyan N, Schwartz B, Chen B, Ebinger JE, Gransar H, Park R, Rozanski A, Bairey Merz CN, Berman DS. Changes in Preventive Therapies Following Coronary Computed Tomography Angiography vs Invasive Angiography in Nonobstructive CAD. JACC Cardiovasc Imaging 2024; 17:339-341. [PMID: 37921720 DOI: 10.1016/j.jcmg.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023]
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Williams MC, Shanbhag AD, Zhou J, Michalowska AM, Lemley M, Miller RJ, Killekar A, Waechter P, Gransar H, Van Kriekinge SD, Builoff V, Feher A, Miller EJ, Bateman T, Dey D, Berman D, Slomka PJ. Automated vessel specific coronary artery calcification quantification with deep learning in a large multi-center registry. Eur Heart J Cardiovasc Imaging 2024:jeae045. [PMID: 38376471 DOI: 10.1093/ehjci/jeae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
AIMS Vessel specific coronary artery calcification (CAC) is additive to global CAC for prognostic assessment. We assessed accuracy and prognostic implications of vessel-specific automated deep learning (DL) CAC analysis on electrocardiogram gated and attenuation correction computed tomography (CT) in a large multicenter registry. METHODS AND RESULTS Vessel-specific CAC was assessed in the left main/left anterior descending (LM/LAD), left circumflex (LCX) and right coronary artery (RCA) using a DL model trained on 3000 gated CT and tested on 2094 gated CT and 5969 non-gated attenuation correction CT. Vessel-specific agreement was assessed with linear weighted Cohen's Kappa for CAC zero, 1-100, 101-400 and >400 Agatston units (AU). Risk of major adverse cardiovascular events (MACE) was assessed during 2.4±1.4 years follow-up, with hazard ratios (HR) and 95% confidence intervals (CI). There was strong to excellent agreement between DL and expert ground truth for CAC in LM/LAD, LCX and RCA on gated CT [0.90 (95% CI 0.89 to 0.92); 0.70 (0.68 to 0.73); 0.79 (0.77 to 0.81)] and attenuation correction CT [(0.78 (0.77 to 0.80); 0.60 (0.58 to 0.62); 0.70 (0.68 to 0.71)]. MACE occurred in 242 (12%) undergoing gated CT and 841(14%) of undergoing attenuation correction CT. LM/LAD CAC >400 AU was associated with the highest risk of MACE on gated (HR 12.0, 95% CI 7.96, 18.0, p<0.001) and attenuation correction CT (HR 4.21, 95% CI 3.48, 5.08, p<0.001). CONCLUSION Vessel-specific CAC assessment with DL can be performed accurately and rapidly on gated CT and attenuation correction CT and provides important prognostic information.
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Affiliation(s)
- Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aakash D Shanbhag
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Jianhang Zhou
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anna M Michalowska
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert Jh Miller
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Aditya Killekar
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Parker Waechter
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Valerie Builoff
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Timothy Bateman
- Cardiovascular Imaging Technologies LLC, Kansas City, MO, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Berman
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Rozanski A, Miller RJH, Han D, Gransar H, Hayes SW, Friedman JD, Thomson LEJ, Berman DS. Comparative predictors of mortality among patients referred for stress single-photon emission computed tomography versus positron emission tomography myocardial perfusion imaging. J Nucl Cardiol 2024; 32:101811. [PMID: 38244976 DOI: 10.1016/j.nuclcard.2024.101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
BACKGROUND There is currently little information regarding the usage and comparative predictors of mortality among patients referred for single-photon emission computed tomography (SPECT) versus positron emission tomography (PET) myocardial perfusion imaging (MPI) within multimodality imaging laboratories. METHODS We compared the clinical characteristics and mortality outcomes among 15,718 patients referred for SPECT-MPI and 6202 patients referred for PET-MPI between 2008 and 2017. RESULTS Approximately two-thirds of MPI studies were performed using SPECT-MPI. The PET-MPI group was substantially older and included more patients with known coronary artery disease (CAD), hypertension, diabetes, and myocardial ischemia. The annualized mortality rate was also higher in the PET-MPI group, and this difference persisted after propensity matching 3615 SPECT-MPI and 3615 PET-MPI patients to have similar clinical profiles. Among the SPECT-MPI patients, the most potent predictor of mortality was exercise ability and performance, including consideration of patients' mode of stress testing and exercise duration. Among the PET-MPI patients, myocardial flow reserve (MFR) was the most potent predictor of mortality. CONCLUSIONS In our real-world setting, PET-MPI was more commonly employed among older patients with more cardiac risk factors than SPECT-MPI patients. The most potent predictors of mortality in our SPECT and PET-MPI groups were variables exclusive to each test: exercise ability/capacity for SPECT-MPI patients and MFR for PET-MPI patients.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Robert J H Miller
- Division of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Canada
| | - Donghee Han
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean W Hayes
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise E J Thomson
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- The Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Rozanski A, Han D, Miller RJH, Gransar H, Hayes SW, Friedman JD, Thomson L, Berman DS. Is typical angina still prognostically important? The influence of "treatment bias" upon prognostic assessments. J Nucl Cardiol 2024; 31:101778. [PMID: 38237364 DOI: 10.1016/j.nuclcard.2023.101778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
BACKGROUND Since typical angina has become less frequent, it is unclear if this symptom still has prognostic significance. METHODS We evaluated 38,383 patients undergoing stress/rest SPECT myocardial perfusion imaging followed for a median of 10.9 years. After dividing patients by clinical symptoms, we evaluated the magnitude of myocardial ischemia and subsequent mortality among medically treated versus revascularized subgroups following testing. RESULTS Patients with typical angina had more frequent and greater ischemia than other symptom groups, but not higher mortality. Among typical angina patients, those who underwent early revascularization had substantially greater ischemia than the medically treated subgroup, including a far higher proportion with severe ischemia (44.9% vs 4.3%, P < 0.001) and transient ischemic dilation of the LV (31.3% vs 4.7%, P < 0.001). Nevertheless, the revascularized typical angina subgroup had a lower adjusted mortality risk than the medically treated subgroup (HR = 0.72, 95% CI: 0.57-0.92, P = 0.009) CONCLUSIONS: Typical angina is associated with substantially more ischemia than other clinical symptoms. However, the high referral of patients with typical angina patients with ischemia to early revascularization resulted in this group having a lower rather than higher mortality risk versus other symptom groups. These findings illustrate the need to account for "treatment bias" among prognostic studies.
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Affiliation(s)
- Alan Rozanski
- Department of Cardiology, Mount Sinai Morningside Hospital and Mount Sinai Heart, New York, NY, USA.
| | - Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, CA, USA
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Sean W Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - John D Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Louise Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
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Miller RJH, Gransar H, Rozanski A, Dey D, Al‐Mallah M, Chow BJW, Kaufmann PA, Cademartiri F, Maffei E, Han D, Slomka PJ, Berman DS. Simplified Approach to Predicting Obstructive Coronary Disease With Integration of Coronary Calcium: Development and External Validation. J Am Heart Assoc 2023; 12:e031601. [PMID: 38108259 PMCID: PMC10863788 DOI: 10.1161/jaha.123.031601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The Diamond-Forrester model was used extensively to predict obstructive coronary artery disease (CAD) but overestimates probability in current populations. Coronary artery calcium (CAC) is a useful marker of CAD, which is not routinely integrated with other features. We derived simple likelihood tables, integrating CAC with age, sex, and cardiac chest pain to predict obstructive CAD. METHODS AND RESULTS The training population included patients from 3 multinational sites (n=2055), with 2 sites for external testing (n=3321). We determined associations between age, sex, cardiac chest pain, and CAC with the presence of obstructive CAD, defined as any stenosis ≥50% on coronary computed tomography angiography. Prediction performance was assessed using area under the receiver-operating characteristic curves (AUCs) and compared with the CAD Consortium models with and without CAC, which require detailed calculations, and the updated Diamond-Forrester model. In external testing, the proposed likelihood tables had higher AUC (0.875 [95% CI, 0.862-0.889]) than the CAD Consortium clinical+CAC score (AUC, 0.868 [95% CI, 0.855-0.881]; P=0.030) and the updated Diamond-Forrester model (AUC, 0.679 [95% CI, 0.658-0.699]; P<0.001). The calibration for the likelihood tables was better than the CAD Consortium model (Brier score, 0.116 versus 0.121; P=0.005). CONCLUSIONS We have developed and externally validated simple likelihood tables to integrate CAC with age, sex, and cardiac chest pain, demonstrating improved prediction performance compared with other risk models. Our tool affords physicians with the opportunity to rapidly and easily integrate a small number of important features to estimate a patient's likelihood of obstructive CAD as an aid to clinical management.
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Affiliation(s)
- Robert J. H. Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryAlbertaCanada
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Alan Rozanski
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
- Division of Cardiology and Department of MedicineMount Sinai Morningside HospitalMount Sinai Heart and the Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Mouaz Al‐Mallah
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | - Benjamin J. W. Chow
- Departments of Medicine (Cardiology and Nuclear Medicine) and RadiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Philipp A. Kaufmann
- Department of Nuclear MedicineUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | | | - Erica Maffei
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) SYNLAB SDNNaplesItaly
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Piotr J. Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Daniel S. Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
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9
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Rozanski A, Gransar H, Sakul S, Miller RJH, Han D, Hayes SW, Friedman JD, Thomson LEJ, Berman DS. Increasing frequency of dyspnea among patients referred for cardiac stress testing. J Nucl Cardiol 2023; 30:2303-2313. [PMID: 37861920 DOI: 10.1007/s12350-023-03375-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/09/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To assess the frequency, change in prevalence, and prognostic significance of dyspnea among contemporary patients referred for cardiac stress testing. PATIENTS AND METHODS We evaluated the prevalence of dyspnea and its relationship to all-cause mortality among 33,564 patients undergoing stress/rest SPECT-MPI between January 1, 2002 and December 31, 2017. Dyspnea was assessed as a single-item question. Patients were divided into three temporal groups. RESULTS The overall prevalence of dyspnea in our cohort was 30.2%. However, there was a stepwise increase in the temporal prevalence of dyspnea, which was present in 25.6% of patients studied between 2002 and 2006, 30.5% of patients studied between 2007 and 2011, and 38.7% of patients studied between 2012 and 2017. There was a temporal increase in the prevalence of dyspnea in each age, symptom, and risk factor subgroup. The adjusted hazard ratio for mortality was higher among patients with dyspnea vs those without dyspnea both among all patients, and within each chest pain subgroup. CONCLUSIONS Dyspnea has become increasingly prevalent among patients referred for cardiac stress testing and is now present among nearly two-fifths of contemporary cohorts referred for stress-rest SPECT-MPI. Prospective study is needed to standardize the assessment of dyspnea and evaluate the reasons for its increasing prevalence.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sakul Sakul
- Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean W Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise E J Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Rozanski A, Han D, Miller RJH, Gransar H, Slomka P, Hayes SW, Friedman JD, Thomson LEJ, Berman DS. Comparison of coronary artery calcium scores among patients referred for cardiac imaging tests. Prog Cardiovasc Dis 2023; 81:24-32. [PMID: 37858662 DOI: 10.1016/j.pcad.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND While coronary artery calcium (CAC) can now be evaluated by multiple imaging modalities, there is presently scant study regarding how CAC scores may vary among populations of varying clinical risk. METHODS We evaluated the distribution of CAC scores among three patient groups: 18,941 referred for CAC scanning, 5101 referred for diagnostic coronary CT angiography (CCTA), and 3307 referred for diagnostic positron emission tomography (PET) myocardial perfusion imaging (MPI). We assessed the relationship between CAC score and myocardial ischemia, obstructive coronary artery disease (CAD), and all-cause mortality across imaging modalities. RESULTS Within each age group, the frequency of CAC abnormalities were relatively similar across testing modalities, despite an annualized mortality rate which varied from 0.5%/year among CAC patients to 3.8%/year among PET-MPI patients (p < 0.001). Among CCTA and PET-MPI patients, a zero CAC score was common, occurring in ~70% of patients <50 years, ~40% of patients 50-59 years, and ~ 25% of patients 60-69 years. Among CCTA patients, zero CAC was associated with a normal coronary angiogram with high frequency, ranging from 92.2% among patients <50 years to 87.9% among patients ≥70 years. Among PET-MPI patients, zero CAC was associated with a very low frequency of inducible ischemia across all age groups, ranging from 1.5% among patients <50 years to 0.9% among patients ≥70 years. CONCLUSIONS In our study, relatively similar CAC scores were noted among patients varying markedly in mortality risk. Clinically, zero CAC scores predicted both a low likelihood of obstructive CAD and inducible myocardial ischemia in all age groups and were observed with high frequency across diagnostic testing modalities.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Robert J H Miller
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Piotr Slomka
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Sean W Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - John D Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Louise E J Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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11
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Kuronuma K, Miller RJH, Van Kriekinge SD, Han D, Singh A, Gransar H, Dey D, Berman DS, Slomka PJ. Incremental prognostic value of stress phase entropy over standard PET myocardial perfusion imaging variables. Eur J Nucl Med Mol Imaging 2023; 50:3619-3629. [PMID: 37428217 PMCID: PMC10547643 DOI: 10.1007/s00259-023-06323-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Phase analysis can assess left ventricular dyssynchrony. The independent prognostic value of phase variables over positron emission tomography myocardial perfusion imaging (PET-MPI) variables including myocardial flow reserve (MFR) has not been studied. The aim of this study was to explore the prognostic value of phase variables for predicting mortality over standard PET-MPI variables. METHODS Consecutive patients who underwent pharmacological stress-rest 82Rb PET study were enrolled. All PET-MPI variables including phase variables (phase entropy, phase bandwidth, and phase standard deviation) were automatically obtained by QPET software (Cedars-Sinai, Los Angeles, CA). Cox proportional hazard analyses were used to assess associations with all-cause mortality (ACM). RESULTS In a total of 3963 patients (median age 71 years; 57% male), 923 patients (23%) died during a median follow-up of 5 years. Annualized mortality rates increased with stress phase entropy, with a 4.6-fold difference between the lowest and highest decile groups of entropy (2.6 vs. 12.0%/year). Abnormal stress phase entropy (optimal cutoff value, 43.8%) stratified ACM risk in patients with normal and impaired MFR (both p < 0.001). Among three phase variables, only stress phase entropy was significantly associated with ACM after the adjustment of standard clinical and PET-MPI variables including MFR and stress-rest change of phase variables, whether modeled as binary variables (adjusted hazard ratio, 1.44 for abnormal entropy [> 43.8%]; 95%CI, 1.18-1.75; p < 0.001) or continuous variables (adjusted hazard ratio, 1.05 per 5% increase; 95%CI, 1.01-1.10; p = 0.030). The addition of stress phase entropy to the standard PET-MPI variables significantly improved the discriminatory power for ACM prediction (p < 0.001), but the other phase variables did not (p > 0.1). CONCLUSION Stress phase entropy is independently and incrementally associated with ACM beyond standard PET-MPI variables including MFR. Phase entropy can be obtained automatically and included in clinical reporting of PET-MPI studies to improve patient risk prediction.
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Affiliation(s)
- Keiichiro Kuronuma
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
- Department of Cardiology, Nihon University, Tokyo, Japan
| | - Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Ananya Singh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA.
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12
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Han D, Lin A, Kuronuma K, Gransar H, Dey D, Friedman JD, Berman DS, Tamarappoo BK. Cardiac Computed Tomography for Quantification of Myocardial Extracellular Volume Fraction: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023; 16:1306-1317. [PMID: 37269267 DOI: 10.1016/j.jcmg.2023.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Extracellular volume (ECV) is a quantitative measure of extracellular compartment expansion, and an increase in ECV is a marker of myocardial fibrosis. Although cardiac magnetic resonance (CMR) is considered the standard imaging tool for ECV quantification, cardiac computed tomography (CT) has also been used for ECV assessment. OBJECTIVES The aim of this meta-analysis was to evaluate the correlation and agreement in the quantification of myocardial ECV by CT and CMR. METHODS PubMed and Web of Science were searched for relevant publications reporting on the use of CT for ECV quantification compared with CMR as the reference standard. The authors employed a meta-analysis using the restricted maximum-likelihood estimator with a random-effects method to estimate summary correlation and mean difference. A subgroup analysis was performed to compare the correlation and mean differences between single-energy CT (SECT) and dual-energy CT (DECT) techniques for the ECV quantification. RESULTS Of 435 papers, 13 studies comprising 383 patients were identified. The mean age range was 57.3 to 82 years, and 65% of patients were male. Overall, there was an excellent correlation between CT-derived ECV and CMR-derived ECV (mean: 0.90 [95% CI: 0.86-0.95]). The pooled mean difference between CT and CMR was 0.96% (95% CI: 0.14%-1.78%). Seven studies reported correlation values using SECT, and 4 studies reported those using DECT. The pooled correlation from studies utilizing DECT for ECV quantification was significantly higher compared with those with SECT (mean: 0.94 [95% CI: 0.91-0.98] vs 0.87 [95% CI: 0.80-0.94], respectively; P = 0.01). There was no significant difference in pooled mean differences between SECT vs DECT (P = 0.85). CONCLUSIONS CT-derived ECV showed an excellent correlation and mean difference of <1% with CMR-derived ECV. However, the overall quality of the included studies was low, and larger, prospective studies are needed to examine the accuracy and diagnostic and prognostic utility of CT-derived ECV.
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Affiliation(s)
- Donghee Han
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Keiichiro Kuronuma
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Heidi Gransar
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John D Friedman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| | - Balaji K Tamarappoo
- Cardiovascular Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Budoff MJ, Kinninger A, Gransar H, Achenbach S, Al-Mallah M, Bax JJ, Berman DS, Cademartiri F, Callister TQ, Chang HJ, Chow BJW, Cury RC, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Leipsic J, Lin FY, Kim YJ, Marques H, Pontone G, Rubinshtein R, Shaw LJ, Villines TC, Min JK. When Does a Calcium Score Equate to Secondary Prevention?: Insights From the Multinational CONFIRM Registry. JACC Cardiovasc Imaging 2023; 16:1181-1189. [PMID: 37227328 DOI: 10.1016/j.jcmg.2023.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/30/2023] [Accepted: 03/14/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Elevated coronary artery calcium (CAC) scores in subjects without prior atherosclerotic cardiovascular disease (ASCVD) have been shown to be associated with increased cardiovascular risk. OBJECTIVES The authors sought to determine at what level individuals with elevated CAC scores who have not had an ASCVD event should be treated as aggressively for cardiovascular risk factors as patients who have already survived an ASCVD event. METHODS The authors performed a cohort study comparing event rates of patients with established ASVCD to event rates in persons with no history of ASCVD and known calcium scores to ascertain at what level elevated CAC scores equate to risk associated with existing ASCVD. In the multinational CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry, the authors compared ASCVD event rates in persons without a history of myocardial infarction (MI) or revascularization (as categorized on CAC scores) to event rates in those with established ASCVD. They identified 4,511 individuals without known coronary artery disease (CAC) who were compared to 438 individuals with established ASCVD. CAC was categorized as 0, 1 to 100, 101 to 300, and >300. Cumulative major adverse cardiovascular events (MACE), MACE plus late revascularization, MI, and all-cause mortality incidence was assessed using the Kaplan-Meier method for persons with no ASCVD history by CAC level and persons with established ASCVD. Cox proportional hazards regression analysis was used to calculate HRs with 95% CIs, which were adjusted for traditional cardiovascular risk factors. RESULTS The mean age was 57.6 ± 12.4 years (56% male). In total, 442 of 4,949 (9%) patients experienced MACEs over a median follow-up of 4 years (IQR: 1.7-5.7 years). Incident MACEs increased with higher CAC scores, with the highest rates observed with CAC score >300 and in those with prior ASCVD. All-cause mortality, MACEs, MACE + late revascularization, and MI event rates were not statistically significantly different in those with CAC >300 compared with established ASCVD (all P > 0.05). Persons with a CAC score <300 had substantially lower event rates. CONCLUSIONS Patients with CAC scores >300 are at an equivalent risk of MACE and its components as those treated for established ASCVD. This observation, that those with CAC >300 have event rates comparable to those with established ASCVD, supplies important background for further study related to secondary prevention treatment targets in subjects without prior ASCVD with elevated CAC. Understanding the CAC scores that are associated with ASCVD risk equivalent to stable secondary prevention populations may be important for guiding the intensity of preventive approaches more broadly.
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Affiliation(s)
- Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-University of California, Los Angeles, Torrance, California, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
| | - April Kinninger
- Department of Medicine, Lundquist Institute at Harbor-University of California, Los Angeles, Torrance, California, USA
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephan Achenbach
- Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mouaz Al-Mallah
- Department of Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Jeroen J Bax
- CardioVascular Imaging Unit, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniel S Berman
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Filippo Cademartiri
- CardioVascular Imaging Unit, Leiden University Medical Center, Leiden, the Netherlands
| | - Tracy Q Callister
- Tennessee Heart and Vascular Institute, Hendersonville, Tennessee, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Korea
| | - Benjamin J W Chow
- Department of Radiology, University of Ottawa Heart Institute and University of Ottawa, Ontario, Canada
| | - Ricardo C Cury
- Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | - Joerg Hausleiter
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fay Y Lin
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Hugo Marques
- Department of Radiology, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | | | - Leslee J Shaw
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Todd C Villines
- Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA
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Rozanski A, Han D, Miller RJH, Gransar H, Slomka PJ, Hayes SW, Friedman JD, Thomson LEJ, Berman DS. Decline in typical angina among patients referred for cardiac stress testing. J Nucl Cardiol 2023; 30:1309-1320. [PMID: 37415006 DOI: 10.1007/s12350-023-03305-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/12/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To evaluate temporal trends in the prevalence of typical angina and its clinical correlates among patients referred for stress/rest SPECT myocardial perfusion imaging (MPI). PATIENTS AND METHODS We evaluated the prevalence of chest pain symptoms and their relationship to inducible myocardial ischemia among 61,717 patients undergoing stress/rest SPECT-MPI between January 2, 1991 and December 31, 2017. We also assessed the relationship between chest pain symptom and angiographic findings among 6,579 patients undergoing coronary CT angiography between 2011 and 2017. RESULTS The prevalence of typical angina among SPECT-MPI patients declined from 16.2% between 1991 and 1997 to 3.1% between 2011 and 2017, while the prevalence of dyspnea without any chest pain increased from 5.9 to 14.5% over the same period. The frequency of inducible myocardial ischemia declined over time within all symptom groups, but its frequency among current patients (2011-2017) with typical angina was approximately three-fold higher versus other symptom groups (28.4% versus 8.6%, p < 0.001). Overall, patients with typical angina had a higher prevalence of obstructive CAD on CCTA than those with other clinical symptoms, but 33.3% of typical angina patients had no coronary stenoses, 31.1% had 1-49% stenoses, and 35.4% had ≥ 50% stenoses. CONCLUSIONS The prevalence of typical angina has declined to a very low level among contemporary patients referred for noninvasive cardiac tests. The angiographic findings among current typical angina patients are now quite heterogeneous, with one-third of such patients having normal coronary angiograms. However, typical angina remains associated with a substantially higher frequency of inducible myocardial ischemia compared to patients with other cardiac symptoms.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue, New York, NY, 10025, USA.
| | - Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean W Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise E J Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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15
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Miller RJH, Mamas MA, Tamarappoo B, Rozanski A, Han D, Gransar H, Slomka PJ, Dey D, Berman DS. Extensive coronary artery calcification is associated with all-cause mortality patients with a history of cancer. J Cardiovasc Comput Tomogr 2023; 17:284-285. [PMID: 37059633 DOI: 10.1016/j.jcct.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/16/2023] [Accepted: 04/01/2023] [Indexed: 04/16/2023]
Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Libin Cardiovascular Institute of Alberta and University of Calgary, Calgary, AB, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Balaji Tamarappoo
- Department of Cardiology, Indiana University, Indianapolis, IN, United States
| | - Alan Rozanski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, Division of Cardiac Sciences, New York, NY, United States
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
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Shanbhag AD, Zhou J, miller R, Pieszko K, Lemley M, Killekar A, Van Kriekinge SD, Gransar H, Kavanagh P, miller EJ, Bateman TM, Dey D, Berman DS, Slomka P. DEEP LEARNING ACCURATELY QUANTIFIES PER VESSEL CORONARY CALCIUM SCORES IN A LARGE MULTICENTER INTERNATIONAL REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Pontone G, Mushtaq S, Al'Aref SJ, Andreini D, Baggiano A, Canan A, Cavalcante JL, Chelliah A, Chen M, Choi A, Damini D, De Cecco CN, Farooqi KM, Ferencik M, Feuchtner G, Hecht H, Gransar H, Kolossváry M, Leipsic J, Lu MT, Marwan M, Ng MY, Maurovich-Horvat P, Nagpal P, Nicol E, Weir-McCall J, Whelton SP, Williams MC, Reid A, Fairbairn TA, Villines T, Vliegenthart R, Arbab-Zadeh A. The journal of cardiovascular computed tomography: A year in review: 2022. J Cardiovasc Comput Tomogr 2023; 17:86-95. [PMID: 36934047 DOI: 10.1016/j.jcct.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/20/2023]
Abstract
This review aims to summarize key articles published in the Journal of Cardiovascular Computed Tomography (JCCT) in 2022, focusing on those that had the most scientific and educational impact. The JCCT continues to expand; the number of submissions, published manuscripts, cited articles, article downloads, social media presence, and impact factor continues to grow. The articles selected by the Editorial Board of the JCCT in this review highlight the role of cardiovascular computed tomography (CCT) to detect subclinical atherosclerosis, assess the functional relevance of stenoses, and plan invasive coronary and valve procedures. A section is dedicated to CCT in infants and other patients with congenital heart disease, in women, and to the importance of training in CT. In addition, we highlight key consensus documents and guidelines published in JCCT last year. The Journal values the tremendous work by authors, reviewers, and editors to accomplish these contributions.
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Affiliation(s)
- Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Subhi J Al'Aref
- Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Arzu Canan
- Department of Radiology, Division of Cardiothoracic Imaging, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joao L Cavalcante
- Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Anjali Chelliah
- Department of Pediatrics, Division of Pediatric Cardiology, Goryeb Children's Hospital/Atlantic Medical Center, Morristown, NJ, USA; Columbia University Irving Medical Center, New York, NY, USA
| | - Marcus Chen
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew Choi
- Cardiology and Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Dey Damini
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Kanwal M Farooqi
- Division of Pediatric Cardiology, NewYork-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - Maros Ferencik
- MCR, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harvey Hecht
- Ican School of Medicine at Mount Sinai, Mount Sinai Morningside Medical Center, NYC, USA
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary; Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Jonathon Leipsic
- Department of Radiology and Medicine (Cardiology) UBC, Vancouver, Canada
| | - Michael T Lu
- Cardiovascular Imaging Research Center (CIRC), MGH Department of Radiology Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Mohamed Marwan
- Cardiology Department, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Prashant Nagpal
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Ed Nicol
- Royal Brompton Hospital, Sydney Street, London and School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | | | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, 21287, USA
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Anna Reid
- Manchester Heart Institute, Manchester University NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK
| | - Timothy A Fairbairn
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Rosemarie Vliegenthart
- Department of Radiology, University of Groningen/University Medical Center Groningen, Groningen, the Netherlands
| | - Armin Arbab-Zadeh
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
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Kuronuma K, Miller RJH, Wei CC, Singh A, Lemley M, Van Kriekinge SD, Kavanagh P, Gransar H, Han D, Hayes SW, Thomson L, Dey D, Friedman JD, Berman DS, Slomka P. DOWNWARD MYOCARDIAL CREEP AUTOMATICALLY QUANTIFIED DURING STRESS POSITRON EMISSION TOMOGRAPHY MYOCARDIAL PERFUSION IMAGING IS INVERSELY ASSOCIATED WITH MORTALITY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Lin B, Han D, Gransar H, Rozanski A, Miller R, Dey D, Hayes SW, Friedman JD, Thomson L, Berman DS. CORONARY ARTERY CALCIUM SCORE IS MORE PREDICTIVE FOR RISK OF MORTALITY THAN SEGMENT INVOLVEMENT SCORE BY CORONARY ARTERY DISEASE REPORTING AND DATA SYSTEM 2.0 CLASSIFICATION CATEGORIES FOR PLAQUE BURDEN. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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20
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Malhotra P, Han D, Singh A, Miller RJH, Gransar H, Hayes SW, Friedman JD, Thomson L, Rozanski A, Slomka P, Berman DS. DIFFERENCES IN MYOCARDIAL FLOW RESERVE AND PROGNOSIS BETWEEN PATIENTS WITH AND WITHOUT DIABETES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01944-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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21
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Miller RJH, Rozanski A, Slomka PJ, Han D, Gransar H, Hayes SW, Friedman JD, Thomson LEJ, Berman DS. Development and validation of ischemia risk scores. J Nucl Cardiol 2023; 30:324-334. [PMID: 35484468 DOI: 10.1007/s12350-022-02976-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The likelihood of ischemia on myocardial perfusion imaging is central to physician decisions regarding test selection, but dedicated risk scores are lacking. We derived and validated two novel ischemia risk scores to support physician decision making. METHODS Risk scores were derived using 15,186 patients and validated with 2,995 patients from a different center. Logistic regression was used to assess associations with ischemia to derive point-based and calculated ischemia scores. Predictive performance for ischemia was assessed using area under the receiver operating characteristic curve (AUC) and compared with the CAD consortium basic and clinical models. RESULTS During derivation, the calculated ischemia risk score (0.801) had higher AUC compared to the point-based score (0.786, p < 0.001). During validation, the calculated ischemia score (0.716, 95% CI 0.684- 0.748) had higher AUC compared to the point-based ischemia score (0.699, 95% CI 0.666- 0.732, p = 0.016) and the clinical CAD model (AUC 0.667, 95% CI 0.633- 0.701, p = 0.002). Calibration for both ischemia scores was good in both populations (Brier score < 0.100). CONCLUSIONS We developed two novel risk scores for predicting probability of ischemia on MPI which demonstrated high accuracy during model derivation and in external testing. These scores could support physician decisions regarding diagnostic testing strategies.
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Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Alan Rozanski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Cardiac Sciences, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean W Hayes
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise E J Thomson
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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22
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Lee J, Shaikh K, Nakanishi R, Gransar H, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Rubinshtein R, Villines TC, Lu Y, Peña JM, Lin FY, Min JK, Shaw LJ, Budoff MJ. Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Patients With and Without Diabetes: Long-Term Outcomes From the CONFIRM Registry. Heart Lung Circ 2023; 32:175-183. [PMID: 36336615 DOI: 10.1016/j.hlc.2022.09.014] [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: 05/14/2022] [Revised: 08/21/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prognostic significance of non-obstructive left main (LM) disease was recently reported. However, the influence of diabetes mellitus (DM) on event rates in patients with and without non-obstructive LM disease is not well-known. METHODS We evaluated 27,252 patients undergoing coronary computed tomographic angiography from the COroNary CT Angiography Evaluation For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) Registry. Cumulative long-term incidence of all-cause mortality (ACM) was assessed between DM and non-DM patients by normal or non-obstructive LM disease (1-49% stenosis). RESULTS The mean age of the study population was 57.6±12.6 years. Of the 27,252 patients, 4,434 (16%) patients had DM. A total of 899 (3%) deaths occurred during the follow-up of 3.6±1.9. years. Compared to patients with normal LM, those with non-obstructive LM had more pronounced overall coronary atherosclerosis and more cardiovascular risk factors. After clinical risk factors, segment involvement score, and stenosis severity adjustment, compared to patients without DM and normal LM, patients with DM were associated with increased ACM regardless of normal (HR 1.48, 95% CI 1.22-1.78, p<0.001) or non-obstructive LM (HR 1.46, 95% CI 1.04-2.04, p=0.029), while nonobstructive LM disease was not associated with increased ACM in patients without DM (HR 0.85, 95% CI 0.67-1.07, p=0.165) and there was no significant interaction between DM and LM status (HR 1.03, 95% CI 0.69-1.54, p=0.879). CONCLUSION From the CONFIRM registry, we demonstrated that DM was associated with increased ACM. However, the presence of non-obstructive LM was not an independent risk marker of ACM, and there was no significant interaction between DM and non-obstructive LM disease for ACM.
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Affiliation(s)
- Juhwan Lee
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; Department of Medicine, CHA University GUMI CHA Hospital, Gyeongsangbuk-do, South Korea
| | - Kashif Shaikh
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; Department of Medicine, University of Tennessee, Knoxville, Tennessee, USA
| | - Rine Nakanishi
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Heidi Gransar
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremburg, Erlangen, Germany
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | - 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
| | | | | | - 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, 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-Universität München, Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital, Zurich, Zurich, Switzerland
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa/Massa, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | | | - 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
| | - Todd C Villines
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Jessica M Peña
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | | | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
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23
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Miller RJH, Singh A, Otaki Y, Tamarappoo BK, Kavanagh P, Parekh T, Hu LH, Gransar H, Sharir T, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli MF, Liang JX, Dey D, Berman DS, Slomka PJ. Mitigating bias in deep learning for diagnosis of coronary artery disease from myocardial perfusion SPECT images. Eur J Nucl Med Mol Imaging 2023; 50:387-397. [PMID: 36194270 PMCID: PMC10042590 DOI: 10.1007/s00259-022-05972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/15/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Artificial intelligence (AI) has high diagnostic accuracy for coronary artery disease (CAD) from myocardial perfusion imaging (MPI). However, when trained using high-risk populations (such as patients with correlating invasive testing), the disease probability can be overestimated due to selection bias. We evaluated different strategies for training AI models to improve the calibration (accurate estimate of disease probability), using external testing. METHODS Deep learning was trained using 828 patients from 3 sites, with MPI and invasive angiography within 6 months. Perfusion was assessed using upright (U-TPD) and supine total perfusion deficit (S-TPD). AI training without data augmentation (model 1) was compared to training with augmentation (increased sampling) of patients without obstructive CAD (model 2), and patients without CAD and TPD < 2% (model 3). All models were tested in an external population of patients with invasive angiography within 6 months (n = 332) or low likelihood of CAD (n = 179). RESULTS Model 3 achieved the best calibration (Brier score 0.104 vs 0.121, p < 0.01). Improvement in calibration was particularly evident in women (Brier score 0.084 vs 0.124, p < 0.01). In external testing (n = 511), the area under the receiver operating characteristic curve (AUC) was higher for model 3 (0.930), compared to U-TPD (AUC 0.897) and S-TPD (AUC 0.900, p < 0.01 for both). CONCLUSION Training AI models with augmentation of low-risk patients can improve calibration of AI models developed to identify patients with CAD, allowing more accurate assignment of disease probability. This is particularly important in lower-risk populations and in women, where overestimation of disease probability could significantly influence down-stream patient management.
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Affiliation(s)
- Robert J H Miller
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Ananya Singh
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Yuka Otaki
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Balaji K Tamarappoo
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Paul Kavanagh
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Tejas Parekh
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Lien-Hsin Hu
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Heidi Gransar
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel and Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Andrew J Einstein
- Department of Medicine, and Department of Radiology, Division of Cardiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Sharmila Dorbala
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo F Di Carli
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - Joanna X Liang
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Damini Dey
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Piotr J Slomka
- Departments of Medicine, Division of Artificial Intelligence, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA.
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Kuronuma K, Han D, Miller RJH, Rozanski A, Gransar H, Dey D, Hayes SW, Friedman JD, Thomson L, Slomka PJ, Berman DS. Long-term Survival Benefit From Revascularization Compared With Medical Therapy in Patients With or Without Diabetes Undergoing Myocardial Perfusion Single Photon Emission Computed Tomography. Diabetes Care 2022; 45:3016-3023. [PMID: 36001757 DOI: 10.2337/dc22-0454] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/04/2022] [Accepted: 07/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To explore the long-term association of survival benefit from early revascularization with the magnitude of ischemia in patients with diabetes compared with those without diabetes using a large observational cohort of patients undergoing single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). RESEARCH DESIGN AND METHODS Of 41,982 patients who underwent stress and rest SPECT-MPI from 1998 to 2017, 8,328 (19.8%) had diabetes. A propensity score was used to match 8,046 patients with diabetes to 8,046 patients without diabetes. Early revascularization was defined as occurring within 90 days after SPECT-MPI. The percentage of myocardial ischemia was assessed from the magnitude of reversible myocardial perfusion defect on SPECT-MPI. RESULTS Over a median 10.3-year follow-up, the annualized mortality rate was higher for the patients with diabetes compared with those without diabetes (4.7 vs. 3.6%; P < 0.001). There were significant interactions between early revascularization and percent myocardial ischemia in patients with and without diabetes (all interaction P values <0.05). After adjusting for confounding variables, survival benefit from early revascularization was observed in patients with diabetes above a threshold of >8.6% ischemia and in patients without diabetes above a threshold of >12.1%. Patients with diabetes receiving insulin had a higher mortality rate (6.2 vs. 4.1%; P < 0.001), but there was no interaction between revascularization and insulin use (interaction P value = 0.405). CONCLUSIONS Patients with diabetes, especially those on insulin treatment, had higher mortality rate compared with patients without diabetes. Early revascularization was associated with a mortality benefit at a lower ischemic threshold in patients with diabetes compared with those without diabetes.
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Affiliation(s)
- Keiichiro Kuronuma
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Cardiology, Nihon University, Tokyo, Japan
| | - Donghee Han
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alan Rozanski
- Department of Cardiology, Mount Sinai Morningside Hospital and Mount Sinai Heart, New York, NY
| | - Heidi Gransar
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sean W Hayes
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John D Friedman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Louise Thomson
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
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Rozanski A, Miller RJH, Han D, Gransar H, Slomka P, Dey D, Hayes SB, Friedman J, Thomson LB, Berman DS. The prevalence and predictors of inducible myocardial ischemia among patients referred for radionuclide stress testing. J Nucl Cardiol 2022; 29:2839-2849. [PMID: 34608604 DOI: 10.1007/s12350-021-02797-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/30/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND The frequency of inducible myocardial ischemia has declined in contemporary stress test cohorts, suggesting a need to re-evaluate its optimal use. To-date, however, a comprehensive analysis of the most potent predictors of myocardial ischemia among cardiac stress test patients has not been conducted. METHODS We assessed 27,615 patients referred for stress-rest SPECT myocardial perfusion imaging between January 1, 2004 and December 31, 2017. Chi-square analysis was used to ascertain the most potent predictors of ischemia. RESULTS Among our cohort, CAD status (presence/absence of known CAD), rest left ventricular ejection fraction (LVEF), and typical angina were the most potent predictors of ischemia. The frequency of ischemia was only 6.6% among patients with an LVEF > 55% but 38.1% for patients with LVEF < 45% (P < 0.001). The frequency of myocardial ischemia was fourfold higher among patients with known CAD vs no known CAD (28.0% vs 6.5%, P < 0.001) and approximately threefold higher among patients with typical angina vs patients with atypical symptoms (P < 0.001). CONCLUSIONS The frequency of myocardial ischemia varies markedly according to the common clinical parameters and is particularly high among patients with known CAD, low LVEF, and typical angina. These observations may be used to develop more cost-effective strategies for referring patients for cardiac stress testing.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue, New York, NY, 10025, USA.
| | - Robert J H Miller
- Division of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr Slomka
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean B Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise B Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Han D, Rozanski A, Gransar H, Tzolos E, Miller RJH, Sharir T, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Liang JX, Hu LH, Dey D, Berman DS, Slomka PJ. Comparison of diabetes to other prognostic predictors among patients referred for cardiac stress testing: A contemporary analysis from the REFINE SPECT Registry. J Nucl Cardiol 2022; 29:3003-3014. [PMID: 34757571 PMCID: PMC9085969 DOI: 10.1007/s12350-021-02810-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/12/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is increasingly prevalent among contemporary populations referred for cardiac stress testing, but its potency as a predictor for major adverse cardiovascular events (MACE) vs other clinical variables is not well delineated. METHODS AND RESULTS From 19,658 patients who underwent SPECT-MPI, we identified 3122 patients with DM without known coronary artery disease (CAD) (DM+/CAD-) and 3564 without DM with known CAD (DM-/CAD+). Propensity score matching was used to control for the differences in characteristics between DM+/CAD- and DM-/CAD+ groups. There was comparable MACE in the matched DM+/CAD- and DM-/CAD+ groups (HR 1.15, 95% CI 0.97-1.37). By Chi-square analysis, type of stress (exercise or pharmacologic), total perfusion deficit (TPD), and left ventricular function were the most potent predictors of MACE, followed by CAD and DM status. The combined consideration of mode of stress, TPD, and DM provided synergistic stratification, an 8.87-fold (HR 8.87, 95% CI 7.27-10.82) increase in MACE among pharmacologically stressed patients with DM and TPD > 10% (vs non-ischemic, exercised stressed patients without DM). CONCLUSIONS Propensity-matched patients with DM and no known CAD have similar MACE risk compared to patients with known CAD and no DM. DM is synergistic with mode of stress testing and TPD in predicting the risk of cardiac stress test patients.
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Affiliation(s)
- Donghee Han
- Departments of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai, Los Angeles, CA, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai St. Luke's Hospital, New York, NY, USA
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai, Los Angeles, CA, USA
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel
- Ben Gurion University of the Negev, Beersheba, Israel
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai, Los Angeles, CA, USA
| | - Lien-Hsin Hu
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai, Los Angeles, CA, USA.
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Chen X, Park R, Hurtado C, Gransar H, Tep B, Miranda-Peats R, Soohoo SL, Rozanski A, Berman DS. Evaluation of California Non-Comprehensive Death File Against National Death Index. Dialogues in Health 2022; 1. [PMID: 37007866 PMCID: PMC10065452 DOI: 10.1016/j.dialog.2022.100015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The National Death Index (NDI) by the Centers for Disease Control and Prevention and Death Master File (DMF) by Social Security Administration are the two most broadly utilized data files for mortality outcomes in clinical research. NDI's high costs and the elimination of protected death records from California in DMF calls for alternative death files. The recently emerged California Non-Comprehensive Death File (CNDF) serves as an alternative source for vital statistics. This study aims to evaluate the sensitivity and specificity of CNDF compared to NDI. Of 40,724 consented subjects in the Cedars-Sinai Cardiac Imaging Research Registry, 25,836 eligible subjects were queried through the NDI and the CDNF. After exclusion of death records to establish the same temporal and geographic availability of data, NDI identified 5,707 exact matches, while CNDF identified 6,051 death records. CNDF had a sensitivity of 94.3% and specificity of 96.4% compared to NDI exact matches. NDI also produced 581 close matches: all were verified as deaths by CNDF through matching death date and patient identifiers. Combining all NDI death records, CNDF had a sensitivity of 94.8% and specificity of 99.5%. CNDF is a reliable source for obtaining mortality outcomes and providing additional mortality validation. The use of CNDF can aid and replace the use of NDI in the state of California.
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Tummala R, Han D, Friedman J, Hayes S, Thomson L, Gransar H, Slomka P, Rozanski A, Dey D, Berman D. Association between plaque localization in proximal coronary segments and MACE outcomes in patients with mild CAC: Results from the EISNER study. Am J Prev Cardiol 2022; 12:100423. [PMID: 36199447 PMCID: PMC9529495 DOI: 10.1016/j.ajpc.2022.100423] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Coronary artery calcium score (CAC) is a validated tool to predict and reclassify cardiovascular risk. Additional metrics such as regional distribution and extent of CAC over Agatston CAC score may allow further risk stratification. In this study, we evaluate the prognostic significance of proximal CAC involvement in asymptomatic population from the prospective EISNER (Early-Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) registry, focusing on patients with mild CAC (score 1-99). Methods This study included a total of 2,047 adult asymptomatic subject who underwent baseline CAC scan and 14-year follow-up for MACE, defined as myocardial infarction, late revascularization, or cardiac death. Proximal involvement was defined as presence of CAC in the LM, proximal LAD, LCX or RCA. CAC was categorized as 0, 1-99, and ≥100. Results 1,090 (53.2%) subjects had no CAC, 576 (28.1%) had CAC 1-99, and 381 (18.7%) had CAC ≥100. Proximal involvement was seen in 67.2% of subjects with CAC 1-99 and 97.3% of subjects with CAC ≥100. In the CAC 1-99 category, the presence of proximal CAC was associated with increased MACE risk after adjustment for CAC score, CAC extent and conventional risk factors compared to those without proximal CAC (HR: 2.84 95% CI: 1.29-6.25, p=0.009). Conclusion In asymptomatic subjects with CAC scores of 1-99, the presence and extent of proximal CAC plaques provides strong independent prognostic information in predicting MACE
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Affiliation(s)
- Ramyashree Tummala
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John Friedman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean Hayes
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise Thomson
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr Slomka
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, New York, New York
| | - Damini Dey
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Berman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Corresponding author at: 8700 Beverly Blvd, Los Angeles, California, 90048, United States
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Shaikh K, Ahmed A, Gransar H, Lee J, Leipsic J, Nakanishi R, Alla V, Bax JJ, Chow BJW, Berman DS, Maffei E, Lin FY, Ahmad A, DeLago A, Pontone G, Feuchtner G, Marques H, Min JK, Hausleiter J, Hadamitzky M, Kaufmann PA, de Araújo Gonçalves P, Cury RC, Kim YJ, Chang HJ, Rubinshtein R, Villines TC, Lu Y, Shaw LJ, Acenbach S, Al Mallah MH, Andreini D, Cademartiri F, Callister TQ, Budoff MJ. Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry. J Diabetes Complications 2022; 36:108309. [PMID: 36444796 DOI: 10.1016/j.jdiacomp.2022.108309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Absence of subclinical atherosclerosis is considered safe to defer statin therapy in general population. However, impact of statins on atherosclerotic cardiovascular disease in patients with diabetes stratified by coronary artery calcium (CAC) scores and extent of non-obstructive CAD on coronary computed tomography angiography (CCTA) has not been evaluated. METHODS CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multi-center Registry) study enrolled consecutive adults 18 years of age between 2005 and 2009 who underwent 364-detector row CCTA for suspected CAD. The long-term registry includes data on 12,086 subjects who underwent CCTA at 17 centers in 9 countries. In this sub-study of CONFIRM registry, patients with diabetes mellitus (DM) and without diabetes mellitus with normal CCTA or non-obstructive plaque (<50 % diameter stenosis) for whom data on baseline statin use was available were included. CAC score was calculated using Agatston score. The magnitude of non-obstructive coronary artery disease on CCTA was quantified using segment involvement score (SIS). Primary outcome was major cardiovascular events (MACE) which included all-cause mortality, myocardial infarction, and target vessel re-vascularization. RESULTS A total of 7247 patients (Mean age 56.8 years) with a median follow up of 5 years were included. For DM patients, baseline statin therapy significantly reduced MACE for patients with CAC ≥100 (HR: 0.24; 95 % CI 0.07-0.87; p = 0.03) and SIS≥3 (HR: 0.23; 95 % CI 0.06-0.83; p = 0.024) compared to those not on statin therapy. Among Diabetics with lower CAC (<100) and SIS (≤3) scores, MACE was similar in statin and non-statin groups. In contrast, among non-DM patients, MACE was similar in statin and no statin groups irrespective of baseline CAC (1-99 or ≥100) and SIS. CONCLUSION In this large multicenter cohort of patients, the presence and extent of subclinical atherosclerosis as assessed by CAC and SIS identified patients most likely to derive benefit from statin therapy.
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Affiliation(s)
- Kashif Shaikh
- Lundquist Institute of Biomedical Sciences at Harbor-UCLA Medical Center, USA; University of Tennessee, Department of Medicine, Division of Cardiology, Knoxville, USA.
| | - Arslan Ahmed
- Creighton University Department of Medicine, Division of Cardiology, USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - JuHwan Lee
- CHA University Gumi CHA Hospital, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Rine Nakanishi
- Lundquist Institute of Biomedical Sciences at Harbor-UCLA Medical Center, USA
| | - Venkata Alla
- Creighton University Department of Medicine, Division of Cardiology, USA
| | - Jeroen J Bax
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, ON, Canada
| | - Daniel S Berman
- Creighton University Department of Medicine, Division of Cardiology, USA
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa/Massa, Italy.
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Aiza Ahmad
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-UniversitätMünchen, Munich, Germany
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland; University of Zurich, Switzerland
| | | | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyuk-Jae Chang
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, 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
| | - Todd C Villines
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Stephen Acenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremburg, Germany
| | - Mouaz H Al Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | | | | | - Matthew J Budoff
- Lundquist Institute of Biomedical Sciences at Harbor-UCLA Medical Center, USA
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Pieszko K, Shanbhag A, Killekar A, Miller RJ, Lemley M, Otaki Y, Singh A, Kwiecinski J, Gransar H, Van Kriekinge SD, Kavanagh PB, Miller EJ, Bateman T, Liang JX, Berman DS, Dey D, Slomka PJ. Deep Learning of Coronary Calcium Scores From PET/CT Attenuation Maps Accurately Predicts Adverse Cardiovascular Events. JACC Cardiovasc Imaging 2022; 16:675-687. [PMID: 36284402 DOI: 10.1016/j.jcmg.2022.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Assessment of coronary artery calcium (CAC) by computed tomographic (CT) imaging provides an accurate measure of atherosclerotic burden. CAC is also visible in computed tomographic attenuation correction (CTAC) scans, always acquired with cardiac positron emission tomographic (PET) imaging. OBJECTIVES The aim of this study was to develop a deep-learning (DL) model capable of fully automated CAC definition from PET CTAC scans. METHODS The novel DL model, originally developed for video applications, was adapted to rapidly quantify CAC. The model was trained using 9,543 expert-annotated CT scans and was tested in 4,331 patients from an external cohort undergoing PET/CT imaging with major adverse cardiac events (MACEs) (follow-up 4.3 years), including same-day paired electrocardiographically gated CAC scans available in 2,737 patients. MACE risk stratification in 4 CAC score categories (0, 1-100, 101-400, and >400) was analyzed and CAC scores derived from electrocardiographically gated CT scans (standard scores) by expert observers were compared with automatic DL scores from CTAC scans. RESULTS Automatic DL scoring required <6 seconds per scan. DL CTAC scores provided stepwise increase in the risk for MACE across the CAC score categories (HR up to 3.2; P < 0.001). Net reclassification improvement of standard CAC scores over DL CTAC scores was nonsignificant (-0.02; 95% CI: -0.11 to 0.07). The negative predictive values for MACE of zero CAC with standard (85%) and DL CTAC (83%) CAC scores were similar (P = 0.19). CONCLUSIONS DL CTAC scores predict cardiovascular risk similarly to standard CAC scores quantified manually by experienced operators from dedicated electrocardiographically gated CAC scans and can be obtained almost instantly, with no changes to PET/CT scanning protocol.
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31
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Singh A, Kwiecinski J, Miller RJH, Otaki Y, Kavanagh PB, Van Kriekinge SD, Parekh T, Gransar H, Pieszko K, Killekar A, Tummala R, Liang JX, Di Carli M, Berman DS, Dey D, Slomka PJ. Deep Learning for Explainable Estimation of Mortality Risk From Myocardial Positron Emission Tomography Images. Circ Cardiovasc Imaging 2022; 15:e014526. [PMID: 36126124 PMCID: PMC10035936 DOI: 10.1161/circimaging.122.014526] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND We aim to develop an explainable deep learning (DL) network for the prediction of all-cause mortality directly from positron emission tomography myocardial perfusion imaging flow and perfusion polar map data and evaluate it using prospective testing. METHODS A total of 4735 consecutive patients referred for stress and rest 82Rb positron emission tomography between 2010 and 2018 were followed up for all-cause mortality for 4.15 (2.24-6.3) years. DL network utilized polar maps of stress and rest perfusion, myocardial blood flow, myocardial flow reserve, and spill-over fraction combined with cardiac volumes, singular indices, and sex. Patients scanned from 2010 to 2016 were used for training and validation. The network was tested in a set of 1135 patients scanned from 2017 to 2018 to simulate prospective clinical implementation. RESULTS In prospective testing, the area under the receiver operating characteristic curve for all-cause mortality prediction by DL (0.82 [95% CI, 0.77-0.86]) was higher than ischemia (0.60 [95% CI, 0.54-0.66]; P <0.001), myocardial flow reserve (0.70 [95% CI, 0.64-0.76], P <0.001) or a comprehensive logistic regression model (0.75 [95% CI, 0.69-0.80], P <0.05). The highest quartile of patients by DL had an annual all-cause mortality rate of 11.87% and had a 16.8 ([95% CI, 6.12%-46.3%]; P <0.001)-fold increase in the risk of death compared with the lowest quartile patients. DL showed a 21.6% overall reclassification improvement as compared with established measures of ischemia. CONCLUSIONS The DL model trained directly on polar maps allows improved patient risk stratification in comparison with established methods for positron emission tomography flow or perfusion assessments.
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Affiliation(s)
- Ananya Singh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jacek Kwiecinski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Robert JH Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Yuka Otaki
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul B. Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Serge D. Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tejas Parekh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Interventional Cardiology and Cardiac Surgery, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
| | - Aditya Killekar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ramyashree Tummala
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joanna X. Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marcelo Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Daniel S. Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J. Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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van den Hoogen IJ, Stuijfzand WJ, Gianni U, van Rosendael AR, Bax AM, Lu Y, Tantawy SW, Hollenberg EJ, Andreini D, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Chow BJW, Conte E, Cury RC, Feuchtner G, Gonçalves PDA, Hadamitzky M, Kim YJ, Leipsic J, Maffei E, Marques H, Plank F, Pontone G, Villines TC, Lee SE, Al'Aref SJ, Baskaran L, Danad I, Gransar H, Budoff MJ, Samady H, Virmani R, Berman DS, Chang HJ, Narula J, Min JK, Bax JJ, Lin FY, Shaw LJ. Early versus late acute coronary syndrome risk patterns of coronary atherosclerotic plaque. Eur Heart J Cardiovasc Imaging 2022; 23:1314-1323. [PMID: 35904766 DOI: 10.1093/ehjci/jeac114] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/02/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The temporal instability of coronary atherosclerotic plaque preceding an incident acute coronary syndrome (ACS) is not well defined. We sought to examine differences in the volume and composition of coronary atherosclerosis between patients experiencing an early (≤90 days) versus late ACS (>90 days) after baseline coronary computed tomography angiography (CCTA). METHODS AND RESULTS From a multicenter study, we enrolled patients who underwent a clinically indicated baseline CCTA and experienced ACS during follow-up. Separate core laboratories performed blinded adjudication of ACS events and quantification of CCTA including compositional plaque volumes by Hounsfield units (HU): calcified plaque >350 HU, fibrous plaque 131-350 HU, fibrofatty plaque 31-130 HU and necrotic core <30 HU. In 234 patients (mean age 62 ± 12 years, 36% women), early and late ACS occurred in 129 and 105 patients after a mean of 395 ± 622 days, respectively. Patients with early ACS had a greater maximal diameter stenosis and maximal cross-sectional plaque burden as compared to patients with late ACS (P < 0.05). Larger total, fibrous, fibrofatty, and necrotic core volumes were observed in the early ACS group (P < 0.05). Findings for total, fibrous, fibrofatty, and necrotic core volumes were reproduced in an external validation cohort (P < 0.05). CONCLUSIONS Volumetric differences in composition of coronary atherosclerosis exist between ACS patients according to their timing antecedent to the acute event. These data support that a large burden of non-calcified plaque on CCTA is strongly associated with near-term plaque instability and ACS risk.
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Affiliation(s)
- Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wijnand J Stuijfzand
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Umberto Gianni
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - A Maxim Bax
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Sara W Tantawy
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Faculty of Medicine, Department of Radiology, Ain Shams University, Cairo, Egypt
| | - Emma J Hollenberg
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | | | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - 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
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
| | - Fabian Plank
- Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Todd C Villines
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Subhi J Al'Aref
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Lohendran Baskaran
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiovascular Medicine, National Heart Centre, Singapore
| | - Ibrahim Danad
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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Han D, Rozanski A, Miller R, Gransar H, Hayes S, Friedman J, Thomson L, Berman D. 604 Temporal Changes In Prognostic Outcomes Among Patients Undergoing Coronary Artery Calcium Scanning: 1998 To 2013. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tamarappoo BK, Otaki Y, Sharir T, Hu LH, Gransar H, Einstein AJ, Fish MB, Ruddy TD, Kaufmann P, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Eisenberg E, Liang JX, Dey D, Berman DS, Slomka PJ. Differences in Prognostic Value of Myocardial Perfusion Single-Photon Emission Computed Tomography Using High-Efficiency Solid-State Detector Between Men and Women in a Large International Multicenter Study. Circ Cardiovasc Imaging 2022; 15:e012741. [PMID: 35727872 PMCID: PMC9307118 DOI: 10.1161/circimaging.121.012741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Semiquantitative assessment of stress myocardial perfusion defect has been shown to have greater prognostic value for prediction of major adverse cardiac events (MACE) in women compared with men in single-center studies with conventional single-photon emission computed tomography (SPECT) cameras. We evaluated sex-specific difference in the prognostic value of automated quantification of ischemic total perfusion defect (ITPD) and the interaction between sex and ITPD using high-efficiency SPECT cameras with solid-state detectors in an international multicenter imaging registry (REFINE SPECT [Registry of Fast Myocardial Perfusion Imaging With Next-Generation SPECT]). METHODS Rest and exercise or pharmacological stress SPECT myocardial perfusion imaging were performed in 17 833 patients from 5 centers. MACE was defined as the first occurrence of death or myocardial infarction. Total perfusion defect (TPD) at rest, stress, and ejection fraction were quantified automatically by software. ITPD was given by stressTPD-restTPD. Cox proportional hazards model was used to evaluate the association between ITPD versus MACE-free survival and expressed as a hazard ratio. RESULTS In 10614 men and 7219 women, with a median follow-up of 4.75 years (interquartile range, 3.7-6.1), there were 1709 MACE. In a multivariable Cox model, after adjusting for revascularization and other confounding variables, ITPD was associated with MACE (hazard ratio, 1.08 [95% CI, 1.05-1.1]; P<0.001). There was an interaction between ITPD and sex (P<0.001); predicted survival for ITPD<5% was worse among men compared to women, whereas survival among women was worse than men for ITPD≥5%, P<0.001. CONCLUSIONS In the international, multicenter REFINE SPECT registry, moderate and severe ischemia as quantified by ITPD from high-efficiency SPECT is associated with a worse prognosis in women compared with men.
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Affiliation(s)
- Balaji K Tamarappoo
- Department of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles (B.K.T., Y.O., L.-H.H., H.G., E.E., J.X.L., D.D., D.S.B., P.J.S.)
| | - Yuka Otaki
- Department of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles (B.K.T., Y.O., L.-H.H., H.G., E.E., J.X.L., D.D., D.S.B., P.J.S.)
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel (T.S.)
- Ben Gurion University of the Negev, Beer Sheba, Israel (T.S.)
| | - Lien-Hsin Hu
- Department of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles (B.K.T., Y.O., L.-H.H., H.G., E.E., J.X.L., D.D., D.S.B., P.J.S.)
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taiwan (L.-H.H.)
| | - Heidi Gransar
- Department of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles (B.K.T., Y.O., L.-H.H., H.G., E.E., J.X.L., D.D., D.S.B., P.J.S.)
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital (A.J.E.)
| | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR (M.B.F.)
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, ON, Canada (T.D.R.)
| | - Philipp Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland (P.K.)
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A.J.S., E.J.M.)
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A.J.S., E.J.M.)
| | | | - Sharmila Dorbala
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Boston, MA (S.D., M.D.C.)
| | - Marcelo Di Carli
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Boston, MA (S.D., M.D.C.)
| | - Evann Eisenberg
- Department of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles (B.K.T., Y.O., L.-H.H., H.G., E.E., J.X.L., D.D., D.S.B., P.J.S.)
| | - Joanna X Liang
- Department of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles (B.K.T., Y.O., L.-H.H., H.G., E.E., J.X.L., D.D., D.S.B., P.J.S.)
| | - Damini Dey
- Department of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles (B.K.T., Y.O., L.-H.H., H.G., E.E., J.X.L., D.D., D.S.B., P.J.S.)
| | - Daniel S Berman
- Department of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles (B.K.T., Y.O., L.-H.H., H.G., E.E., J.X.L., D.D., D.S.B., P.J.S.)
| | - Piotr J Slomka
- Department of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles (B.K.T., Y.O., L.-H.H., H.G., E.E., J.X.L., D.D., D.S.B., P.J.S.)
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Kolossváry M, Reid AB, Baggiano A, Nagpal P, Canan A, Al'Aref SJ, Andreini D, Cavalcante JL, de Cecco CN, Chelliah A, Chen MY, Choi AD, Dey D, Fairbairn T, Ferencik M, Gransar H, Hecht H, Leipsic J, Lu MT, Marwan M, Maurovich-Horvat P, Ng MY, Nicol ED, Pontone G, Vliegenthart R, Whelton SP, Williams MC, Arbab-Zadeh A, Farooqi KM, Weir-McCall J, Feuchtner G, Villines TC. The Journal of cardiovascular computed tomography: A year in review 2021. J Cardiovasc Comput Tomogr 2022; 16:266-276. [PMID: 35370125 DOI: 10.1016/j.jcct.2022.03.004] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This review aims to summarize original articles published in the Journal of Cardiovascular Computed Tomography (JCCT) for the year 2021, focusing on those that had the most scientific and educational impact. The JCCT continues to expand; the number of submissions, published manuscripts, cited articles, article downloads, social media presence, and impact factor continues to increase. The articles selected by the Editorial Board of the JCCT in this review focus on coronary artery disease, coronary physiology, structural heart disease, and technical advances in cardiovascular CT. In addition, we highlight key consensus documents and guidelines published in the Journal in 2021. The Journal recognizes the tremendous work done by each author and reviewer this year - thank you.
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Affiliation(s)
- Márton Kolossváry
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna B Reid
- University of Manchester NHS Foundation Trust, Manchester, UK
| | | | - Prashant Nagpal
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Arzu Canan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Subhi J Al'Aref
- Department of Medicine, Division of Cardiology. University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - João L Cavalcante
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Carlo N de Cecco
- Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging, Emory University, Atlanta, GA, USA
| | - Anjali Chelliah
- Department of Pediatrics, Division of Cardiology, Goryeb Children's Hospital/Atlantic Health System, Morristown, NJ, USA; Department of Pediatrics, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Timothy Fairbairn
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Heidi Gransar
- Department of Imaging, Cardiac Imaging Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Harvey Hecht
- Ican School of Medicine at Mount Sinai, Mount Sinai Morningside Medical Center, NYC, USA
| | - Jonathan Leipsic
- Department of Radiology and Medicine (Cardiology), University of British Columbia, Canada
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Hungary; Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong SAR, China
| | - Edward D Nicol
- Departments of Cardiology and Radiology, Royal Brompton Hospital, London UK; School of Bioengineering and Imaging Sciences, Kings College, London, UK
| | | | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen/University Medical Center Groningen, Groningen, the Netherlands
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | | | - Armin Arbab-Zadeh
- Department of Medicine/Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Kanwal M Farooqi
- Department of Pediatrics, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Gudrun Feuchtner
- Innsbruck Medical University, Dept. Radiology, Innsbruck, Austria
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA.
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van Rosendael AR, van den Hoogen IJ, Lin FY, Gianni U, Lu Y, Andreini D, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Chow BJ, Conte E, Cury RC, Feuchtner G, de Araújo Gonçalves P, Hadamitzky M, Kim YJ, Leipsic JA, Maffei E, Marques H, Plank F, Pontone G, Raff GL, Villines TC, Lee SE, Al’Aref SJ, Baskaran L, Cho I, Danad I, Gransar H, Budoff MJ, Samady H, Virmani R, Min JK, Narula J, Berman DS, Chang HJ, Shaw LJ, Bax JJ. Age related compositional plaque burden by CT in patients with future ACS. J Cardiovasc Comput Tomogr 2022; 16:491-497. [DOI: 10.1016/j.jcct.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
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Klein E, Miller RJH, Sharir T, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Otaki Y, Gransar H, Liang JX, Dey D, Berman DS, Slomka PJ. Automated quantitative analysis of CZT SPECT stratifies cardiovascular risk in the obese population: Analysis of the REFINE SPECT registry. J Nucl Cardiol 2022; 29:727-736. [PMID: 32929639 PMCID: PMC8497048 DOI: 10.1007/s12350-020-02334-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obese patients constitute a substantial proportion of patients referred for SPECT myocardial perfusion imaging (MPI), presenting a challenge of increased soft tissue attenuation. We investigated whether automated quantitative perfusion analysis can stratify risk among different obesity categories and whether two-view acquisition adds to prognostic assessment. METHODS Participants were categorized according to body mass index (BMI). SPECT MPI was assessed visually and quantified automatically; combined total perfusion deficit (TPD) was evaluated. Kaplan-Meier and Cox proportional hazard analyses were used to assess major adverse cardiac event (MACE) risk. Prognostic accuracy for MACE was also compared. RESULTS Patients were classified according to BMI: BMI < 30, 30 ≤ BMI < 35, BMI ≥ 35. In adjusted analysis, each category of increasing stress TPD was associated with increased MACE risk, except for 1% ≤ TPD < 5% and 5% ≤ TPD < 10% in patients with BMI ≥ 35. Compared to visual analysis, single-position stress TPD had higher prognostic accuracy in patients with BMI < 30 (AUC .652 vs .631, P < .001) and 30 ≤ BMI < 35 (AUC .660 vs .636, P = .027). Combined TPD had better discrimination than visual analysis in patients with BMI ≥ 35 (AUC .662 vs .615, P = .003). CONCLUSIONS Automated quantitative methods for SPECT MPI interpretation provide robust risk stratification in the obese population. Combined stress TPD provides additional prognostic accuracy in patients with more significant obesity.
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Affiliation(s)
- Eyal Klein
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Robert J H Miller
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Center, Tel Aviv, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Mathews B Fish
- Department of Nuclear Medicine, Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Albert J Sinusas
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | - Edward J Miller
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | | | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Yuka Otaki
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Heidi Gransar
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Joanna X Liang
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA.
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Rozanski A, Gransar H, Hayes SW, Friedman JD, Thomson L, Berman DS. Mortality risk among patients undergoing exercise versus pharmacologic myocardial perfusion imaging: A propensity-based comparison. J Nucl Cardiol 2022; 29:840-852. [PMID: 33047282 DOI: 10.1007/s12350-020-02294-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/22/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The increased risk associated with pharmacologic versus exercise testing is obscured by the higher prevalence of clinical risk factors among pharmacologic patients. Thus, we assessed comparative mortality in a large risk factor-matched group of exercise versus pharmacologic patients undergoing stress/rest SPECT myocardial perfusion imaging (MPI). METHODS 39,179 patients undergoing stress/rest SPECT-MPI were followed for 13.3 ± 5.0 years for all-cause mortality (ACM). We applied propensity-matching to create pharmacologic and exercise groups with similar risk profiles. RESULTS In comparison to exercise patients, pharmacologic patients had an increased risk-adjusted hazard ratio for ACM for each level of ischemia: increased by 3.8-fold (95%CI 3.5-4.1) among nonischemic patients, 2.5-fold (95%CI 2.0-3.2) among mildly ischemic patients, and 2.6-fold (95%CI 2.1-3.3) among moderate/severe ischemic patients. Similar findings were observed among a propensity-matched cohort of 10,113 exercise and 10,113 pharmacologic patients as well as in an additional cohort that also excluded patients with noncardiac co-morbidities. CONCLUSIONS Patients requiring pharmacologic stress testing manifest substantially heightened clinical risk at each level of myocardial ischemia and even when myocardial ischemia is absent. These findings suggest the need to study the pathophysiological drivers of increased risk in association with pharmacologic testing and to convey this risk in clinical reports.
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Affiliation(s)
- Alan Rozanski
- The Department of Cardiology, Mount Sinai Morningside Hospital and Mount Sinai Heart, 1111 Amsterdam Avenue, New York, 10025, USA.
- Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Heidi Gransar
- Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Sean W Hayes
- Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - John D Friedman
- Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Louise Thomson
- Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Daniel S Berman
- Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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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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Lin A, Manral N, McElhinney P, Killekar A, Matsumoto H, Kwiecinski J, Pieszko K, Razipour A, Grodecki K, Park C, Otaki Y, Doris M, Kwan AC, Han D, Kuronuma K, Flores Tomasino G, Tzolos E, Shanbhag A, Goeller M, Marwan M, Gransar H, Tamarappoo BK, Cadet S, Achenbach S, Nicholls SJ, Wong DT, Berman DS, Dweck M, Newby DE, Williams MC, Slomka PJ, Dey D. Deep learning-enabled coronary CT angiography for plaque and stenosis quantification and cardiac risk prediction: an international multicentre study. Lancet Digit Health 2022; 4:e256-e265. [PMID: 35337643 PMCID: PMC9047317 DOI: 10.1016/s2589-7500(22)00022-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/01/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Atherosclerotic plaque quantification from coronary CT angiography (CCTA) enables accurate assessment of coronary artery disease burden and prognosis. We sought to develop and validate a deep learning system for CCTA-derived measures of plaque volume and stenosis severity. METHODS This international, multicentre study included nine cohorts of patients undergoing CCTA at 11 sites, who were assigned into training and test sets. Data were retrospectively collected on patients with a wide range of clinical presentations of coronary artery disease who underwent CCTA between Nov 18, 2010, and Jan 25, 2019. A novel deep learning convolutional neural network was trained to segment coronary plaque in 921 patients (5045 lesions). The deep learning network was then applied to an independent test set, which included an external validation cohort of 175 patients (1081 lesions) and 50 patients (84 lesions) assessed by intravascular ultrasound within 1 month of CCTA. We evaluated the prognostic value of deep learning-based plaque measurements for fatal or non-fatal myocardial infarction (our primary outcome) in 1611 patients from the prospective SCOT-HEART trial, assessed as dichotomous variables using multivariable Cox regression analysis, with adjustment for the ASSIGN clinical risk score. FINDINGS In the overall test set, there was excellent or good agreement, respectively, between deep learning and expert reader measurements of total plaque volume (intraclass correlation coefficient [ICC] 0·964) and percent diameter stenosis (ICC 0·879; both p<0·0001). When compared with intravascular ultrasound, there was excellent agreement for deep learning total plaque volume (ICC 0·949) and minimal luminal area (ICC 0·904). The mean per-patient deep learning plaque analysis time was 5·65 s (SD 1·87) versus 25·66 min (6·79) taken by experts. Over a median follow-up of 4·7 years (IQR 4·0-5·7), myocardial infarction occurred in 41 (2·5%) of 1611 patients from the SCOT-HEART trial. A deep learning-based total plaque volume of 238·5 mm3 or higher was associated with an increased risk of myocardial infarction (hazard ratio [HR] 5·36, 95% CI 1·70-16·86; p=0·0042) after adjustment for the presence of deep learning-based obstructive stenosis (HR 2·49, 1·07-5·50; p=0·0089) and the ASSIGN clinical risk score (HR 1·01, 0·99-1·04; p=0·35). INTERPRETATION Our novel, externally validated deep learning system provides rapid measurements of plaque volume and stenosis severity from CCTA that agree closely with expert readers and intravascular ultrasound, and could have prognostic value for future myocardial infarction. FUNDING National Heart, Lung, and Blood Institute and the Miriam & Sheldon G Adelson Medical Research Foundation.
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Affiliation(s)
- Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia; MonashHeart, Monash Health, Melbourne, VIC, Australia
| | - Nipun Manral
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aditya Killekar
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Jacek Kwiecinski
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Konrad Pieszko
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Interventional Cardiology, Collegium Medicum, University of Zielona Góra, Poland
| | - Aryabod Razipour
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Caroline Park
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yuka Otaki
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mhairi Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Alan C Kwan
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keiichiro Kuronuma
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Guadalupe Flores Tomasino
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Aakash Shanbhag
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Markus Goeller
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Balaji K Tamarappoo
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia; MonashHeart, Monash Health, Melbourne, VIC, Australia
| | - Dennis T Wong
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia; MonashHeart, Monash Health, Melbourne, VIC, Australia
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marc Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Piotr J Slomka
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Asif A, Berman DS, Gransar H, Friedman JD, Hayes SW, Thomas LE, Merz CNB, Tamarappoo B. SEX DIFFERENCES IN PROGNOSTIC SIGNIFICANCE OF PLAQUE BURDEN AND DISTRIBUTION MEASURED BY CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY (CCTA) IN YOUNGER PATIENTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pieszko K, Shanbhag A, Killekar A, Miller RJH, Lemley M, Hyun MC, Singh A, Otaki Y, Van Kriekinge SD, Kavanagh P, Gransar H, Miller EJ, Bateman T, Dey D, Berman DS, Slomka P. DEEP LEARNING FROM UNGATED LOW-DOSE CT ATTENUATION CORRECTION MAPS PREDICTS MAJOR ADVERSE CARDIAC EVENTS SIMILAR TO STANDARD CORONARY CALCIUM SCORES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Han D, Lin A, Kuronuma K, Tzolos E, Kwan AC, Klein E, Andreini D, Bax JJ, Cademartiri F, Chinnaiyan K, Chow BJW, Conte E, Cury RC, Feuchtner G, Hadamitzky M, Kim YJ, Leipsic JA, Maffei E, Marques H, Plank F, Pontone G, Villines TC, Al-Mallah MH, de Araújo Gonçalves P, Danad I, Gransar H, Lu Y, Lee JH, Lee SE, Baskaran L, Al’Aref SJ, Yoon YE, Van Rosendael A, Budoff MJ, Samady H, Stone PH, Virmani R, Achenbach S, Narula J, Chang HJ, Min JK, Lin FY, Shaw LJ, Slomka PJ, Dey D, Berman DS. Association of Plaque Location and Vessel Geometry Determined by Coronary Computed Tomographic Angiography With Future Acute Coronary Syndrome-Causing Culprit Lesions. JAMA Cardiol 2022; 7:309-319. [PMID: 35080587 PMCID: PMC8792800 DOI: 10.1001/jamacardio.2021.5705] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 01/28/2023]
Abstract
IMPORTANCE Distinct plaque locations and vessel geometric features predispose to altered coronary flow hemodynamics. The association between these lesion-level characteristics assessed by coronary computed tomographic angiography (CCTA) and risk of future acute coronary syndrome (ACS) is unknown. OBJECTIVE To examine whether CCTA-derived adverse geometric characteristics (AGCs) of coronary lesions describing location and vessel geometry add to plaque morphology and burden for identifying culprit lesion precursors associated with future ACS. DESIGN, SETTING, AND PARTICIPANTS This substudy of ICONIC (Incident Coronary Syndromes Identified by Computed Tomography), a multicenter nested case-control cohort study, included patients with ACS and a culprit lesion precursor identified on baseline CCTA (n = 116) and propensity score-matched non-ACS controls (n = 116). Data were collected from July 20, 2012, to April 30, 2017, and analyzed from October 1, 2020, to October 31, 2021. EXPOSURES Coronary lesions were evaluated for the following 3 AGCs: (1) distance from the coronary ostium to lesion; (2) location at vessel bifurcations; and (3) vessel tortuosity, defined as the presence of 1 bend of greater than 90° or 3 curves of 45° to 90° using a 3-point angle within the lesion. MAIN OUTCOMES AND MEASURES Association between lesion-level AGCs and risk of future ACS-causing culprit lesions. RESULTS Of 548 lesions, 116 culprit lesion precursors were identified in 116 patients (80 [69.0%] men; mean [SD], age 62.7 [11.5] years). Compared with nonculprit lesions, culprit lesion precursors had a shorter distance from the ostium (median, 35.1 [IQR, 23.6-48.4] mm vs 44.5 [IQR, 28.2-70.8] mm), more frequently localized to bifurcations (85 [73.3%] vs 168 [38.9%]), and had more tortuous vessel segments (5 [4.3%] vs 6 [1.4%]; all P < .05). In multivariable Cox regression analysis, an increasing number of AGCs was associated with a greater risk of future culprit lesions (hazard ratio [HR] for 1 AGC, 2.90 [95% CI, 1.38-6.08]; P = .005; HR for ≥2 AGCs, 6.84 [95% CI, 3.33-14.04]; P < .001). Adverse geometric characteristics provided incremental discriminatory value for culprit lesion precursors when added to a model containing stenosis severity, adverse morphological plaque characteristics, and quantitative plaque characteristics (area under the curve, 0.766 [95% CI, 0.718-0.814] vs 0.733 [95% CI, 0.685-0.782]). In per-patient comparison, patients with ACS had a higher frequency of lesions with adverse plaque characteristics, AGCs, or both compared with control patients (≥2 adverse plaque characteristics, 70 [60.3%] vs 50 [43.1%]; ≥2 AGCs, 92 [79.3%] vs 60 [51.7%]; ≥2 of both, 37 [31.9%] vs 20 [17.2%]; all P < .05). CONCLUSIONS AND RELEVANCE These findings support the concept that CCTA-derived AGCs capturing lesion location and vessel geometry are associated with risk of future ACS-causing culprit lesions. Adverse geometric characteristics may provide additive prognostic information beyond plaque assessment in CCTA.
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Affiliation(s)
- Donghee Han
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Lin
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Keiichiro Kuronuma
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alan C. Kwan
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eyal Klein
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Jeroen J. Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan
| | - Benjamin J. W. Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Edoardo Conte
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center, Munich, Germany
| | - Yong-Jin Kim
- Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon A. Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Fabian Plank
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Todd C. Villines
- Cardiology Service, Walter Reed National Military Center, Bethesda, Maryland
| | - Mouaz H. Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | | | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Heidi Gransar
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yao Lu
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York
| | - Ji-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Sang-Eun Lee
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | | | - Subhi J. Al’Aref
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Yeonyee E. Yoon
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York
| | - Alexander Van Rosendael
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA (University of California, Los Angeles), Torrance, California
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Peter H. Stone
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland
| | | | - Jagat Narula
- Department of Cardiology, Icahn School of Medicine at Mt Sinai Hospital, New York, New York
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Fay Y. Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York
| | - Leslee J. Shaw
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York
| | - Piotr J. Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel S. Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
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Chen B, Han D, Gransar H, Friedman J, Tamarappoo B, Makkar R, Berman DS. PREDICTIVE VALUE OF CTA-DERIVED SEPTAL EXTRACELLULAR VOLUME FRACTION FOR PACEMAKER IMPLANTATION POST TAVR IN PATIENTS WITH LOW-FLOW, LOW GRADIENT AORTIC STENOSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02226-4] [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: 11/29/2022]
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Chen B, Brown JN, Han D, Gransar H, Hayes S, Friedman J, Dey D, Makkar R, Tamarappoo B, Berman DS. ASSESSMENT OF AORTIC VALVE TISSUE COMPOSITION BY SEMI-AUTOMATED ANALYSIS OF CTA FOR PREDICTING THE NEED FOR PACEMAKER IMPLANTATION IN TAVR PATIENTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lin A, Manral N, McElhinney P, Killekar A, Matsumoto H, Kwiecinski J, Pieszko K, Grodecki K, Otaki Y, Han D, Tzolos E, Shanbhag A, Goeller M, Marwan M, Gransar H, Cadet S, Achenbach S, Nicholls SJ, Wong DTL, Berman DS, Dweck M, Newby DE, Williams MC, Slomka P, Dey D. DEEP LEARNING FROM CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY FOR ATHEROSCLEROTIC PLAQUE AND STENOSIS QUANTIFICATION AND CARDIAC RISK PREDICTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Han D, Malhotra P, Miller RJH, Otaki Y, Gransar H, Hayes SW, Thomson L, Friedman JD, Rozanski A, Slomka P, Berman DS. RELATIONSHIP BETWEEN CORONARY ARTERY CALCIUM AND STRESS-INDUCED PERFUSION ABNORMALITY IN PATIENTS UNDERGOING RB-82 PET MPI. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02306-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Miller RJH, Han D, Rozanski A, Gransar H, Friedman JD, Hayes S, Thomson L, Tamarappoo B, Slomka PJ, Berman DS. CZT camera systems may provide better risk stratification for low-risk patients. J Nucl Cardiol 2021; 28:2927-2936. [PMID: 32500175 DOI: 10.1007/s12350-020-02128-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/10/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The photon sensitivity and spatial resolution of single-photon emission-computed tomography (SPECT) has been significantly improved by solid-state camera systems using cadmium zinc telluride (CZT) detectors. While the diagnostic accuracy of these systems is well established, there is little evidence directly comparing the prognostic utility to conventional NaI cameras. METHODS AND RESULTS Retrospective analysis of patients undergoing SPECT between 2008 and 2012. Visual SPECT assessment was performed utilizing the 17-segment model to determine summed stress scores (SSS). We identified 12,830 consecutive patients, mean age 63.2 ± 13.7 and 56.1% male, 5072 of whom underwent CZT and 7758 NaI imaging. During a median follow-up duration of 7.0 years (IQR 5.5-8.2), a total of 2788 (21.7%) patients died. Compared to SSS 0, minimal perfusion abnormality (SSS 1-3) was associated with increased all-cause mortality with CZT camera (adjusted HR 1.32, P = .017) and NaI camera (adjusted HR 1.29, P = .001, interaction P = .803). Increasing stress abnormality was associated with a similar increase in risk with CZT or NaI imaging (interaction P > .500). In a propensity matched analysis, patients with normal perfusion stress perfusion assessed with a CZT was associated with decreased mortality compared to normal perfusion assessed by a NaI camera system (hazard ratio .88, 95% CI .78-.99, P = .040). CONCLUSIONS Increasing stress perfusion abnormality was associated with similar increase in all-cause mortality with CZT or NaI cameras. CZT and NaI camera systems provide similar risk stratification, however, normal myocardial perfusion may be associated with a more benign prognosis when assessed with a CZT camera system.
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Affiliation(s)
- Robert J H Miller
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Donghee Han
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heidi Gransar
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John D Friedman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean Hayes
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise Thomson
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Balaji Tamarappoo
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- , Room 1258, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
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Rozanski A, Gransar H, Hayes SW, Friedman JD, Thomson LEJ, Lavie CJ, Berman DS. Synergistic Assessment of Mortality Risk According to Body Mass Index and Exercise Ability and Capacity in Patients Referred for Radionuclide Stress Testing. Mayo Clin Proc 2021; 96:3001-3011. [PMID: 34311969 DOI: 10.1016/j.mayocp.2021.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/11/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the interrelationship between body mass index (BMI), mode of stress testing (exercise or pharmacological), exercise capacity, and all-cause mortality in patients referred for stress-rest single photon emission computed tomography myocardial perfusion imaging. PATIENTS AND METHODS We evaluated all-cause mortality in 21,638 patients undergoing stress-rest single photon emission computed tomography myocardial perfusion imaging between January 2, 1991, and December 31, 2012. Patients were divided into exercise and pharmacologically tested groups and 9 BMI categories. The median follow-up was 12.8 years (range, 5.0-26.8 years). RESULTS In exercise patients, mortality was increased with both low and high BMI vs patients with a normal referent BMI of 22.5 to 24.9 kg/m2. In pharmacologically tested patients, only low BMI, but not high BMI, was associated with increased mortality vs normal BMI. When exercise and pharmacologically tested groups were compared directly, pharmacologically tested patients manifested a marked increase in mortality risk vs exercise patients within each BMI category, ranging from an approximately 4-fold increase in mortality in those with normal or high BMI to a 12.3-fold increase in those with low BMI values. Similar findings were observed in a cohort of 4804 exercise and 4804 pharmacologically tested patients matched to have similar age and coronary artery disease risk factor profiles. In exercise patients, further risk stratification was achieved when considering both BMI and metabolic equivalent tasks of achieved exercise. CONCLUSION The combined assessment of BMI and exercise ability and capacity provides synergistic and marked risk stratification of future mortality risk in patients referred for radionuclide stress testing, providing considerable insights into the "obesity paradox" that is observed in populations referred for stress testing.
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Affiliation(s)
- Alan Rozanski
- Department of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Heidi Gransar
- Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sean W Hayes
- Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John D Friedman
- Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Louise E J Thomson
- Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA
| | - Daniel S Berman
- Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Han D, Chen B, Gransar H, Achenbach S, Al-Mallah MH, Budoff MJ, Cademartiri F, Maffei E, Callister TQ, Chinnaiyan K, Chow BJW, DeLago A, Hadamitzky M, Hausleiter J, Kaufmann PA, Villines TC, Kim YJ, Leipsic J, Feuchtner G, Cury RC, Pontone G, Andreini D, Marques H, Rubinshtein R, Chang HJ, Lin FY, Shaw LJ, Min JK, Berman DS. Prognostic significance of plaque location in non-obstructive coronary artery disease: from the CONFIRM registry. Eur Heart J Cardiovasc Imaging 2021; 23:1240-1247. [PMID: 34791117 DOI: 10.1093/ehjci/jeab223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/09/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023] Open
Abstract
AIM Obstructive coronary artery disease (CAD) in proximal coronary segments is associated with a poor prognosis. However, the relative importance of plaque location regarding the risk for major adverse cardiovascular events (MACE) in patients with non-obstructive CAD has not been well defined. METHODS AND RESULTS From the Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter (CONFIRM) registry, 4644 patients without obstructive CAD were included in this study. The degree of stenosis was classified as 0 (no) and 1-49% (non-obstructive). Proximal involvement was defined as any plaque present in the left main or the proximal segment of the left anterior descending artery, left circumflex artery, and right coronary artery. Extensive CAD was defined as segment involvement score of >4. During a median follow-up of 5.2 years (interquartile range 4.1-6.0), 340 (7.3%) MACE occurred. Within the non-obstructive CAD group (n = 2065), proximal involvement was observed in 1767 (85.6%) cases. When compared to non-obstructive CAD patients without proximal involvement, those with proximal involvement had an increased MACE risk (log-rank P = 0.033). Multivariate Cox analysis showed when compared to patients with no CAD, proximal non-obstructive CAD was associated with increased MACE risk [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.47-2.45, P < 0.001] after adjusting for extensive CAD and conventional cardiovascular risk factors; however, non-proximal non-obstructive CAD did not increase MACE risk (HR 1.26, 95% CI 0.79-2.01, P = 0.339). CONCLUSIONS Independent of plaque extent, proximal coronary involvement was associated with increased MACE risk in patients with non-obstructive CAD. The plaque location information by coronary computed tomography angiography may provide additional risk prediction over CAD extent in patients with non-obstructive CAD.
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Affiliation(s)
- Donghee Han
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| | - Billy Chen
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| | - Stephan Achenbach
- Department of Medicine, University of Erlangen, Schloßplatz 4, 91054 Erlangen, Germany
| | - Mouaz H Al-Mallah
- Department of Medicine, Wayne State University, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202 USA
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, 1000 W Carson St, Torrance, CA 90502, USA
| | - Filippo Cademartiri
- Department of Radiology/Centre de Recherche, Montreal Heart Institute/Unniversitè de Montreal, Montreal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Erica Maffei
- Department of Radiology/Centre de Recherche, Montreal Heart Institute/Unniversitè de Montreal, Montreal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Tracy Q Callister
- Department of Cardiology, Tennessee Heart and Vascular Institute, 353 New Shackle Island Rd Hendersonville, TN 37075 USA
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, 3535 W 13 Mile Rd #742, Royal Oak, MI 48073, USA
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada
| | - Augustin DeLago
- Capitol Cardiology Associate, 7 Southwoods Blvd, Albany, NY 12211 USA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Lazarettstraße 36, 80636 München, Germany
| | - Joerg Hausleiter
- Department of Radiology, Medizinische Klinik I der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, 80336 München, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Todd C Villines
- Department of Medicine, Walter Reed Medical Center, 4494 Palmer Rd N, Bethesda, MD 20814, USA
| | - Yong-Jin Kim
- Department of Medicine, Seoul National University Hospital, Jongno-gu, Seoul 03080, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, 1081 Burrard Street Vancouver, BC V6Z 1Y6, Canada
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52 A, Fritz-Pregl-Straße 3, 6020 Innsbruck, Austria
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, 8900 N Kendall Dr, Miami, FL 33176, USA
| | - Gianluca Pontone
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea, 4, 20138 Milano, MI, Italy
| | - Daniele Andreini
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea, 4, 20138 Milano, MI, Italy
| | - Hugo Marques
- Department of Surgery, Curry Cabral Hospital, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, 3200003, Israel
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medicine, 428 East, 72nd Street, New York, NY 10021
| | - Leslee J Shaw
- Department of Population Health Science, Blavatnik Women's Health Research Institute, Mount Sinai School of Medicine, NY, USA
| | - James K Min
- Cleerly, Inc., 101 Greenwich St, New York, NY 10006, USA
| | - Daniel S Berman
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
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