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Coronary Artery Disease: HELP
Articles by Suhny Abbara
Based on 47 articles published since 2008
||||

Between 2008 and 2019, S. Abbara wrote the following 47 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. 2018

Truong, Quynh A / Rinehart, Sarah / Abbara, Suhny / Achenbach, Stephan / Berman, Daniel S / Bullock-Palmer, Renee / Carrascosa, Patricia / Chinnaiyan, Kavitha M / Dey, Damini / Ferencik, Maros / Fuechtner, Gudrun / Hecht, Harvey / Jacobs, Jill E / Lee, Sang-Eun / Leipsic, Jonathan / Lin, Fay / Meave, Aloha / Pugliese, Francesca / Sierra-Galán, Lilia M / Williams, Michelle C / Villines, Todd C / Shaw, Leslee J / Anonymous3891033. ·Weill Cornell Medicine, USA. Electronic address: qat9001@med.cornell.edu. · Piedmont Healthcare, USA. · UT Southwestern Medical Center, USA. · University of Erlangan, Germany. · Cedars-Sinai Medical Center, USA. · Deborah Heart and Lung Center, USA. · Maipu Diagnosis, Argentina. · William Beaumont Hospital, USA. · Oregon Health & Science University, USA. · Medical University of Innsbruck, Austria. · Mount Sinai Health System, USA. · NYU Langone Medical Center, USA. · Severance Hospital, South Korea. · Providence Healthcare, Canada. · Weill Cornell Medicine, USA. · Ignacio Chavez National Institute for Cardiology, Mexico. · William Harvey Research Institute, UK. · American British Cowdray Medical Center, Mexico. · British Heart Foundation, UK. · Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, USA. ·J Cardiovasc Comput Tomogr · Pubmed #30392926.

ABSTRACT: This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. In addition to accurate detection of obstructive coronary artery disease (CAD), CT angiography (CTA) identifies nonobstructive atherosclerotic plaque extent and composition which is otherwise not detected by alternative stress testing modalities. Moreover, CTA has superior risk stratification when compared to stress testing in symptomatic women with stable chest pain (or equivalent) symptoms. For the evaluation of symptomatic women both in the emergency department and the outpatient setting, there is abundant evidence from large observational registries and multi-center randomized trials, that CT imaging is an effective procedure. Although radiation doses are far less for CT when compared to nuclear imaging, radiation dose reduction strategies should be applied in all women undergoing CT imaging. Effective and appropriate use of CT imaging can provide the means for improved detection of at-risk women and thereby focus preventive management resulting in long-term risk reduction and improved clinical outcomes.

2 Guideline ACR Appropriateness Criteria 2018

Anonymous2701124 / Shah, Amar B / Kirsch, Jacobo / Bolen, Michael A / Batlle, Juan C / Brown, Richard K J / Eberhardt, Robert T / Hurwitz, Lynne M / Inacio, Joao R / Jin, Jill O / Krishnamurthy, Rajesh / Leipsic, Jonathon A / Rajiah, Prabhakar / Singh, Satinder P / White, Richard D / Zimmerman, Stefan L / Abbara, Suhny. ·Westchester Medical Center, Valhalla, New York. Electronic address: ashah27@northwell.edu. · Panel Chair, Cleveland Clinic Florida, Weston, Florida. · Panel Vice-Chair, Cleveland Clinic, Cleveland, Ohio. · Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida. · University of Michigan Health System, Ann Arbor, Michigan. · Boston University School of Medicine, Boston, Massachusetts; American College of Cardiology. · Duke University Medical Center, Durham, North Carolina. · The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. · Northwestern University Feinberg School of Medicine, Chicago, Illinois; American College of Physicians. · Nationwide Children's Hospital, Columbus, Ohio. · St. Paul's Hospital, Vancouver, British Columbia, Canada. · UT Southwestern Medical Center, Dallas, Texas. · University of Alabama at Birmingham, Birmingham, Alabama. · The Ohio State University Wexner Medical Center, Columbus, Ohio. · Johns Hopkins Medical Institute, Baltimore, Maryland. · Specialty Chair, UT Southwestern Medical Center, Dallas, Texas. ·J Am Coll Radiol · Pubmed #30392597.

ABSTRACT: Chronic chest pain (CCP) of a cardiac etiology is a common clinical problem. The diagnosis and classification of the case of chest pain has rapidly evolved providing the clinician with multiple cardiac imaging strategies. Though scintigraphy and rest echocardiography remain as appropriate imaging tools in the diagnostic evaluation, new technology is available. Current evidence supports the use of alternative imaging tests such as coronary computed tomography angiography (CCTA), cardiac MRI (CMRI), or Rb-82 PET/CT. Since multiple imaging modalities are available to the clinician, the most appropriate noninvasive imaging strategy will be based upon the patient's clinical presentation and clinical status. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

3 Guideline 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. 2017

Hecht, Harvey S / Cronin, Paul / Blaha, Michael J / Budoff, Matthew J / Kazerooni, Ella A / Narula, Jagat / Yankelevitz, David / Abbara, Suhny. ·aLenox Hill Heart & Vascular Institute, New York, NY, United States bUniversity of Michigan Health System, Ann Arbor, MI, United States cJohns Hopkins Medicine, Baltimore, MD, United States dHarbor-UCLA Medical Center, Los Angeles, CA, United States eIcahn School of Medicine at Mt. Sinai, New York, NY, United States fThe Mount Sinai Medical Center, New York, NY, United States gUTSouthwestern Medical Center, Radiology, 5323 Harry Hines Blv, Dallas, TX 75390-9316, United States. ·J Thorac Imaging · Pubmed #28832417.

ABSTRACT: The Society of Cardiovascular Computed Tomography (SCCT) and the Society of Thoracic Radiology (STR) have jointly produced this document. Experts in this subject have been selected from both organizations to examine subject-specific data and write this guideline in partnership. A formal literature review, weighing the strength of evidence has been performed. When available, information from studies on cost was considered. Computed tomography (CT) acquisition, CAC scoring methodologies and clinical outcomes are the primary basis for the recommendations in this guideline. This guideline is intended to assist healthcare providers in clinical decision making. The recommendations reflect a consensus after a thorough review of the best available current scientific evidence and practice patterns of experts in the field and are intended to improve patient care while acknowledging that situations arise where additional information may be needed to better inform patient care.

4 Guideline ACR Appropriateness Criteria 2017

Anonymous3940905 / Akers, Scott R / Panchal, Vandan / Ho, Vincent B / Beache, Garth M / Brown, Richard K J / Ghoshhajra, Brian B / Greenberg, S Bruce / Hsu, Joe Y / Kicska, Gregory A / Min, James K / Stillman, Arthur E / Stojanovska, Jadranka / Abbara, Suhny / Jacobs, Jill E. ·Principal Author, VA Medical Center, Philadelphia, Pennsylvania. Electronic address: akerssco@me.com. · Research Author, Internal Medicine Resident, Henry Ford Allegiance Health, Jackson, Michigan. · Panel Vice-Chair, Uniformed Services University of the Health Sciences, Bethesda, Maryland. · University of Louisville School of Medicine, Louisville, Kentucky. · University Hospital, Ann Arbor, Michigan. · Massachusetts General Hospital, Boston, Massachusetts. · Arkansas Children's Hospital, Little Rock, Arkansas. · Kaiser Permanente, Los Angeles, California. · University of Washington, Seattle, Washington. · Cedars Sinai Medical Center, Los Angeles, California; American College of Cardiology. · Emory University Hospital, Atlanta, Georgia. · University of Michigan Health System, Ann Arbor, Michigan. · Specialty Chair, UT Southwestern Medical Center, Dallas, Texas. · Panel Chair, New York University Medical Center, New York, New York. ·J Am Coll Radiol · Pubmed #28473096.

ABSTRACT: In patients with chronic chest pain in the setting of high probability of coronary artery disease (CAD), imaging has major and diverse roles. First, imaging is valuable in determining and documenting the presence, extent, and severity of myocardial ischemia, hibernation, scarring, and/or the presence, site, and severity of obstructive coronary lesions. Second, imaging findings are important in determining the course of management of patients with suspected chronic myocardial ischemia and better defining those patients best suited for medical therapy, angioplasty/stenting, or surgery. Third, imaging is also necessary to determine the long-term prognosis and likely benefit from various therapeutic options by evaluating ventricular function, diastolic relaxation, and end-systolic volume. Imaging studies are also required to demonstrate other abnormalities, such as congenital/acquired coronary anomalies and severe left ventricular hypertrophy, that can produce angina in the absence of symptomatic coronary obstructive disease due to atherosclerosis. Clinical risk assessment is necessary to determine the pretest probability of CAD. Multiple methods are available to categorize patients as low, medium, or high risk for developing CAD. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

5 Guideline 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. 2017

Hecht, Harvey S / Cronin, Paul / Blaha, Michael J / Budoff, Matthew J / Kazerooni, Ella A / Narula, Jagat / Yankelevitz, David / Abbara, Suhny. ·Lenox Hill Heart & Vascular Institute, New York, NY, United States. · University of Michigan Health System, Ann Arbor, MI, United States. · Johns Hopkins Medicine, Baltimore, MD, United States. · Harbor-UCLA Medical Center, Los Angeles, CA, United States. · Icahn School of Medicine at Mt. Sinai, New York, NY, United States. · The Mount Sinai Medical Center, New York, NY, United States. · UTSouthwestern Medical Center, Radiology, 5323 Harry Hines Blv, Dallas, TX 75390-9316, United States. Electronic address: suhny.abbara@utsouthwestern.edu. ·J Cardiovasc Comput Tomogr · Pubmed #27916431.

ABSTRACT: The Society of Cardiovascular Computed Tomography (SCCT) and the Society of Thoracic Radiology (STR) have jointly produced this document. Experts in this subject have been selected from both organizations to examine subject-specific data and write this guideline in partnership. A formal literature review, weighing the strength of evidence has been performed. When available, information from studies on cost was considered. Computed tomography (CT) acquisition, CAC scoring methodologies and clinical outcomes are the primary basis for the recommendations in this guideline. This guideline is intended to assist healthcare providers in clinical decision making. The recommendations reflect a consensus after a thorough review of the best available current scientific evidence and practice patterns of experts in the field and are intended to improve patient care while acknowledging that situations arise where additional information may be needed to better inform patient care.

6 Guideline SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). 2016

Abbara, Suhny / Blanke, Philipp / Maroules, Christopher D / Cheezum, Michael / Choi, Andrew D / Han, B Kelly / Marwan, Mohamed / Naoum, Chris / Norgaard, Bjarne L / Rubinshtein, Ronen / Schoenhagen, Paul / Villines, Todd / Leipsic, Jonathon. ·University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: Suhny.Abbara@UTSouthwestern.edu. · Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. · University of Texas Southwestern Medical Center, Dallas, TX, United States. · Cardiology Service Ft. Belvoir Community Hospital, Ft. Belvoir, VA, United States. · Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington DC, United States. · Minneapolis Heart Institute and Children's Heart Clinic, Minneapolis, MN, United States. · Cardiology Department, University Hospital, Erlangen, Germany. · Concord Hospital, The University of Sydney, Sydney, Australia. · Department of Cardiology B, Aarhus University Hospital-Skejby, Aarhus N, Denmark. · Lady Davis Carmel Medical Center & Rappaport School of Medicine- Technion- IIT, Haifa, Israel. · Cardiovascular Imaging, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States. · Walter Reed National Military Medical Center, Bethesda, MD, United States. ·J Cardiovasc Comput Tomogr · Pubmed #27780758.

ABSTRACT: In response to recent technological advancements in acquisition techniques as well as a growing body of evidence regarding the optimal performance of coronary computed tomography angiography (coronary CTA), the Society of Cardiovascular Computed Tomography Guidelines Committee has produced this update to its previously established 2009 "Guidelines for the Performance of Coronary CTA" (1). The purpose of this document is to provide standards meant to ensure reliable practice methods and quality outcomes based on the best available data in order to improve the diagnostic care of patients. Society of Cardiovascular Computed Tomography Guidelines for the Interpretation is published separately (2). The Society of Cardiovascular Computed Tomography Guidelines Committee ensures compliance with all existing standards for the declaration of conflict of interest by all authors and reviewers for the purpose ofclarity and transparency.

7 Guideline Coronary Artery Disease - Reporting and Data System (CAD-RADS): An Expert Consensus Document of SCCT, ACR and NASCI: Endorsed by the ACC. 2016

Cury, Ricardo C / Abbara, Suhny / Achenbach, Stephan / Agatston, Arthur / Berman, Daniel S / Budoff, Matthew J / Dill, Karin E / Jacobs, Jill E / Maroules, Christopher D / Rubin, Geoffrey D / Rybicki, Frank J / Schoepf, U Joseph / Shaw, Leslee J / Stillman, Arthur E / White, Charles S / Woodard, Pamela K / Leipsic, Jonathon A. · ·JACC Cardiovasc Imaging · Pubmed #27609151.

ABSTRACT: The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.

8 Guideline CAD-RADS(TM) Coronary Artery Disease - Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. 2016

Cury, Ricardo C / Abbara, Suhny / Achenbach, Stephan / Agatston, Arthur / Berman, Daniel S / Budoff, Matthew J / Dill, Karin E / Jacobs, Jill E / Maroules, Christopher D / Rubin, Geoffrey D / Rybicki, Frank J / Schoepf, U Joseph / Shaw, Leslee J / Stillman, Arthur E / White, Charles S / Woodard, Pamela K / Leipsic, Jonathon A. ·Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 N Kendall Drive, Miami, FL, 33176, United States. Electronic address: rcury@baptisthealth.net. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: Suhny.Abbara@UTSouthwestern.edu. · Friedrich-Alexander-Universität, Erlangen-Nürnberg, Department of Cardiology, Ulmenweg 18, 90154, Erlangen, Germany. Electronic address: Stephan.Achenbach@uk-erlangen.de. · Baptist Health Medical Grp, 1691 Michigan Avenue, Miami, FL, 33139, United States. Electronic address: ArthurSAg@baptisthealth.net. · Cedars-Sinai Med Center, 8700 Beverly Boulevard, Taper Building, Rm 1258, Los Angeles, CA, 90048, United States. Electronic address: bermand@cshs.org. · 1124 W. Carson Street, Torrance, CA, 90502, United States. Electronic address: mbudoff@labiomed.org. · 5841 South Maryland Ave, MC2026, Chicago, IL, 60637, United States. Electronic address: kdill@radiology.bsd.uchicago.edu. · 550 First Avenue, New York, NY, 10016, United States. Electronic address: jill.jacobs@nyumc.org. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: christopher.maroules@gmail.com. · 2400 Pratt Street, Room 8020, DCRI Box 17969, Durham, NC, 27715, United States. Electronic address: grubin@duke.edu. · The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, CA K1H 8L6, Canada. Electronic address: frybicki@toh.on.ca. · 25 Courtenay Dr., Charleston, SC, 29425, United States. Electronic address: schoepf@musc.edu. · 1256 Briarcliff Rd. NE, Rm 529, Atlanta, GA, 30324, United States. Electronic address: lshaw3@emory.edu. · 1364 Clifton Road, NE, Atlanta, GA, 30322, United States. Electronic address: aestill@emory.edu. · University of Maryland, 22 S. Greene St., Baltimore, MD, 21201, United States. Electronic address: cwhite@umm.edu. · Mallinckrodt Instit of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, United States. Electronic address: woodardp@mir.wustl.edu. · Department of Radiology|St. Paul's Hospital, 2nd Floor, Providence Building, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, United States. Electronic address: jleipsic@providencehealth.bc.ca. ·J Cardiovasc Comput Tomogr · Pubmed #27318587.

ABSTRACT: The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.

9 Editorial Coronary Computed Tomographic Angiography - The evidence dominates! 2017

Shaw, Leslee J / Villines, Todd / Blankstein, Ron / Abbara, Suhny / Weigold, Guy / Slim, Ahmad / Leipsic, Jonathon. ·Emory University School of Medicine, Atlanta, Georgia. Electronic address: lshaw3@emory.edu. · Walter Reed Medical Center, Bethesda, MD, United States. · Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. · University of Texas Southwestern Medical Center, Dallas, TX, United States. · MedStar Washington Hospital Center, Washington DC, United States. · Tulane University School of Medicine, New Orleans, LA, United States. · The University of British Columbia, Vancouver, BC, Canada. ·J Cardiovasc Comput Tomogr · Pubmed #28017553.

ABSTRACT: -- No abstract --

10 Editorial Contrast injection protocols: it is time to get creative! 2015

Leiner, Tim / Abbara, Suhny. ·Utrecht University Medical Center, Center for Image Sciences, Department of Radiology, Heidelberglaan 100, 3584CX Utrecht, The Netherlands. · Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9316, USA. Electronic address: Suhny.Abbara@UTSouthwestern.edu. ·J Cardiovasc Comput Tomogr · Pubmed #25677791.

ABSTRACT: -- No abstract --

11 Editorial Dual-energy computed tomography: promised land or empty promise? 2008

Abbara, Suhny / Sahani, Dushyant. · ·J Cardiovasc Comput Tomogr · Pubmed #19083957.

ABSTRACT: -- No abstract --

12 Review Current Evidence in Cardiothoracic Imaging: Growing Evidence for Coronary Computed Tomography Angiography as a First-line Test in Stable Chest Pain. 2019

Maroules, Christopher D / Rajiah, Prabhakar / Bhasin, Mohit / Abbara, Suhny. ·Department of Radiology, Naval Medical Center, Portsmouth. · Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX. · Department of Cardiology, Eastern Virginia Medical School, Norfolk, VA. ·J Thorac Imaging · Pubmed #30157094.

ABSTRACT: Coronary computed tomography angiography (CCTA) is a validated technique for the evaluation of patients with suspected coronary artery disease, showing high accuracy compared with invasive coronary angiography and high negative predictive value. CCTA is also well positioned as a first-line test for the evaluation of stable chest pain. This purpose of this review is to examine the evidence behind CCTA in the setting of stable chest pain, with attention to 5 key strengths of a CCTA-based approach: (1) effective gatekeeping to cardiac catheterization, (2) selective discrimination for revascularization and tailored medical therapy, (3) advanced risk stratification, (4) improvement in outcomes, and (5) support from multisociety guidelines. Given the expansion of CT technologies to include functional strategies for evaluating ischemia both with and without vasodilators, CCTA is poised to become the comprehensive examination for stable chest pain and anginal equivalent cardiopulmonary symptoms.

13 Review CT coronary imaging-a fast evolving world. 2018

Rajiah, P / Abbara, S. ·From the Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA. ·QJM · Pubmed #29025029.

ABSTRACT: Computed tomography (CT) has become an important modality in the evaluation of coronary artery disease (CAD). The tremendous technological advances in CT in the last two decades has made it possible to obtain high quality images of coronary arteries with high spatial and temporal resolutions. Multiple trials have confirmed the accuracy of CT compared to invasive catheter angiography. CT is also able to evaluate beyond the lumen in characterizing and quantifying atherosclerotic plaques, including evaluation of high risk features. Although CTA has low specificity in identification of lesion-specific ischemia, functional techniques are now possible such as CT myocardial perfusion and CT-fractional flow reserve (FFR) which evaluate the hemodynamic significance of stenosis and help with revascularization strategies. Multi-energy CT provides additional information beyond what is possible with a conventional CT and is useful in variety of clinical applications, including myocardial perfusion imaging, lesion characterization and low contrast studies. Large trials have confirmed the ability of CT to predict major adverse cardiovascular events and recent trials have even demonstrated improved clinical outcomes by using CT for the evaluation of CAD. CT is also useful in structural heart disease and 3 D printing is now increasingly used for surgical/interventional planning. Machine learning is evolving rapidly and is likely to impact diagnosis and management.

14 Review ACR Appropriateness Criteria® chronic chest pain--high probability of coronary artery disease. 2011

Earls, James P / White, Richard D / Woodard, Pamela K / Abbara, Suhny / Atalay, Michael K / Carr, J Jeffrey / Haramati, Linda B / Hendel, Robert C / Ho, Vincent B / Hoffman, Udo / Khan, Arfa R / Mammen, Leena / Martin, Edward T / Rozenshtein, Anna / Ryan, Thomas / Schoepf, Joseph / Steiner, Robert M / White, Charles S. ·Fairfax Radiological Consultants, Fairfax, Virginia, USA. jpearls@yahoo.com ·J Am Coll Radiol · Pubmed #21962781.

ABSTRACT: Imaging is valuable in determining the presence, extent, and severity of myocardial ischemia and the severity of obstructive coronary lesions in patients with chronic chest pain in the setting of high probability of coronary artery disease. Imaging is critical for defining patients best suited for medical therapy or intervention, and findings can be used to predict long-term prognosis and the likely benefit from various therapeutic options. Chest radiography, radionuclide single photon-emission CT, radionuclide ventriculography, and conventional coronary angiography are the imaging modalities historically used in evaluating suspected chronic myocardial ischemia. Stress echocardiography, PET, cardiac MRI, and multidetector cardiac CT have all been more recently shown to be valuable in the evaluation of ischemic heart disease. Other imaging techniques may be helpful in those patients who do not present with signs classic for angina pectoris or in those patients who do not respond as expected to standard management. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

15 Review Patient preparation and scanning techniques. 2010

Taylor, Carolyn M / Blum, Andrew / Abbara, Suhny. ·University of British Columbia, St Paul's Hospital, Vancouver, Canada. cmtaylor@providencehealth.bc.ca ·Radiol Clin North Am · Pubmed #20705165.

ABSTRACT: Cardiac computed tomographic angiography (CCTA) is a unique diagnostic modality that can provide a comprehensive assessment of cardiac anatomy. Rapid advances in scanner and software technology have resulted in the ability to noninvasively image the coronary arteries. However, careful patient preparation and scanning technique is required to ensure optimal image quality while minimizing radiation dose delivered. Important components of patient preparation include knowledge of the indications and contraindications for CCTA, patient screening, patient premedication, patient positioning, prescan instruction, and electrocardiograph lead placement. Scanning technique should be determined on a patient by patient basis and tailored according to age and radiation risk, body mass index and chest circumference, heart rate and variability, presence of stents, and coronary calcification.

16 Article Defining coronary artery calcium concordance and repeatability - Implications for development and change: The Dallas Heart Study. 2017

Paixao, Andre R M / Neeland, Ian J / Ayers, Colby R / Xing, Frank / Berry, Jarett D / de Lemos, James A / Abbara, Suhny / Peshock, Ronald M / Khera, Amit. ·Arkansas Heart Hospital, Little Rock, AR, USA; University of Arkansas for Medical Sciences, Little Rock, AR, USA. · University of Texas Southwestern Medical Center, Dallas, TX, USA. · University of Missouri-Kansas City, Kansas City, MO, USA. · University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: amit.khera@utsouthwestern.edu. ·J Cardiovasc Comput Tomogr · Pubmed #28732689.

ABSTRACT: BACKGROUND: Development and change of coronary artery calcium (CAC) are associated with coronary heart disease. Interpretation of serial CAC measurements will require better understanding of changes in CAC beyond the variability in the test itself. METHODS: Dallas Heart Study participants (2888) with duplicate CAC scans obtained minutes apart were analyzed to determine interscan concordance and 95% confidence bounds (ie: repeatability limits) for each discrete CAC value. These data derived cutoffs were then used to define change above measurement variation and determine the frequency of CAC development and change among 1779 subjects with follow up CAC scans performed 6.9 years later. RESULTS: Binary concordance (0 vs. >0) was 91%. The value of CAC denoting true development of CAC by exceeding the 95% confidence bounds for a single score of 0 was 2.7 Agatston units (AU). Among those with scores >0, the 95% confidence bounds for CAC change were determined by the following formulas: for CAC≤100AU: 5.6√CAC + 0.3*CAC - 3.1; for CAC>100AU: 12.4√CAC - 67.7. Using these parameters, CAC development occurred in 15.0% and CAC change occurred in 48.9%. Although 225 individuals (24.9%) had a decrease in CAC over follow up, only 1 (0.1%) crossed the lower confidence bound. Compared with prior reported definition of CAC development (ie: >0), the novel threshold of 2.7AU resulted in better measures of model performance. In contrast, for CAC change, no consistent differences in performance metrics were observed compared with previously reported definitions. CONCLUSION: There is significant interscan variability in CAC measurement, including around scores of 0. Incorporating repeatability estimates may help discern true differences from those due to measurement variability, an approach that may enhance determination of CAC development and change.

17 Article Obesity, metabolic syndrome and cardiovascular prognosis: from the Partners coronary computed tomography angiography registry. 2017

Hulten, Edward A / Bittencourt, Marcio Sommer / Preston, Ryan / Singh, Avinainder / Romagnolli, Carla / Ghoshhajra, Brian / Shah, Ravi / Abbasi, Siddique / Abbara, Suhny / Nasir, Khurram / Blaha, Michael / Hoffmann, Udo / Di Carli, Marcelo F / Blankstein, Ron. ·Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. · Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD, USA. · Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil. · Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD, USA. · Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · Cardiology Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. · Cardiothoracic Imaging Division, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9316, USA. · Center for Wellness and Prevention Research, Baptist Health South Florida, Miami, FL, USA. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. · Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. rblankstein@partners.org. · Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. rblankstein@partners.org. ·Cardiovasc Diabetol · Pubmed #28122619.

ABSTRACT: OBJECTIVE: To investigate the relationship among body mass index (BMI), cardiometabolic risk and coronary artery disease (CAD) among patients undergoing coronary computed tomography angiography (CTA). METHODS: Retrospective cohort study of 1118 patients, who underwent coronary CTA at two centers from September 2004 to October 2011. Coronary CTA were categorized as normal, nonobstructive CAD (<50%), or obstructive CAD (≥50%) in addition to segment involvement (SIS) and stenosis scores. Extensive CAD was defined as SIS > 4. Association of BMI with cardiovascular prognosis was evaluated using multivariable fractional polynomial models. RESULTS: Mean age of the cohort was 57 ± 13 years with median follow-up of 3.2 years. Increasing BMI was associated with MetS (OR 1.28 per 1 kg/m CONCLUSIONS: Compared to normal BMI, there was an increased burden of CAD for BMI > 25 kg/m

18 Article Non-diagnostic coronary artery calcification and stenosis: a correlation of coronary computed tomography angiography and invasive coronary angiography. 2017

Engel, Leif-Christopher / Thai, Wai-Ee / Medina-Zuluaga, Hector / Karolyi, Mihaly / Sidhu, Manavjot S / Maurovich-Horvat, Pal / Margey, Ronan / Pomerantsev, Eugene / Abbara, Suhny / Ghoshhajra, Brian B / Hoffmann, Udo / Liew, Gary Y. ·Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. ·Acta Radiol · Pubmed #27614067.

ABSTRACT: Background Heavy coronary artery calcification (CAC) impairs diagnostic accuracy of coronary computed tomography angiography (cCTA) and is considered to be a major limitation. Purpose To investigate the effect of non-evaluable CAC seen on cCTA on clinical decision-making by determining the degree of subsequent invasive testing and to assess the relationship between non-evaluable segments containing CAC and significant stenosis as seen in invasive coronary angiography (ICA). Material and Methods The study comprised of 356 patients who underwent cCTA and subsequent ICA within 2 months between 2005 and 2009. Clinical reports were reviewed to identify the indications for referral to ICA. In a subset of 68 patients where non-diagnostic CAC on cCTA and significant stenosis on ICA were present in the same segment, we correlated and analyzed the underlying stenosis severity of the lesion on ICA to the cCTA. Lesions with CAC were analyzed in a standardized fashion by application of reading rules. Results Non-diagnostic CAC on cCTA prompted ICA in 5.6% of patients. CAC occurred at the site of maximum stenosis in segments with stenosis <50% (95.9% [47/49]), 50-69% (82.4% [28/34]), 70-99% (64.5% [31/48]), and 100% (33.3% [1/3]). At the point of maximum calcium deposit, non-obstructive disease was present in 61.2%. Application of reading rules resulted in a 44% reduction in non-diagnostic cCTA reads. Conclusion Severe CAC may prompt further investigation with ICA. There is less CAC with increasing lesion severity at the point of maximum stenosis. Additional application of reading rules improved non-diagnostic cCTA reads.

19 Article CAD-RADS™: Coronary Artery Disease - Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. 2016

Cury, Ricardo C / Abbara, Suhny / Achenbach, Stephan / Agatston, Arthur / Berman, Daniel S / Budoff, Matthew J / Dill, Karin E / Jacobs, Jill E / Maroules, Christopher D / Rubin, Geoffrey D / Rybicki, Frank J / Schoepf, U Joseph / Shaw, Leslee J / Stillman, Arthur E / White, Charles S / Woodard, Pamela K / Leipsic, Jonathon A. ·Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 N Kendall Drive, Miami, FL, 33176, United States. Electronic address: rcury@baptisthealth.net. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: Suhny.Abbara@UTSouthwestern.edu. · Friedrich-Alexander-Universität, Erlangen-Nürnberg, Department of Cardiology, Ulmenweg 18, 90154, Erlangen, Germany. Electronic address: Stephan.Achenbach@uk-erlangen.de. · Baptist Health Medical Grp, 1691 Michigan Avenue, Miami, FL, 33139, United States. Electronic address: ArthurSAg@baptisthealth.net. · Cedars-Sinai Med Center, 8700 Beverly Boulevard, Taper Building, Rm 1258, Los Angeles, CA, 90048, United States. Electronic address: bermand@cshs.org. · 1124 W. Carson Street, Torrance, CA, 90502, United States. Electronic address: mbudoff@labiomed.org. · 5841 South Maryland Ave, MC2026, Chicago, IL, 60637, United States. Electronic address: kdill@radiology.bsd.uchicago.edu. · 550 First Avenue, New York, NY, 10016, United States. Electronic address: jill.jacobs@nyumc.org. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: christopher.maroules@gmail.com. · 2400 Pratt Street, Room 8020, DCRI Box 17969, Durham, NC, 27715, United States. Electronic address: grubin@duke.edu. · The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, CA K1H 8L6, Canada. Electronic address: frybicki@toh.on.ca. · 25 Courtenay Dr., Charleston, SC, 29425, United States. Electronic address: schoepf@musc.edu. · 1256 Briarcliff Rd. NE, Rm 529, Atlanta, GA, 30324, United States. Electronic address: lshaw3@emory.edu. · 1364 Clifton Road, NE, Atlanta, GA, 30322, United States. Electronic address: aestill@emory.edu. · University of Maryland, 22 S. Greene St., Baltimore, MD, 21201, United States. Electronic address: cwhite@umm.edu. · Mallinckrodt Instit of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, United States. Electronic address: woodardp@mir.wustl.edu. · Department of Radiology, St. Paul's Hospital, 2nd Floor, Providence Building, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, United States. Electronic address: jleipsic@providencehealth.bc.ca. ·J Am Coll Radiol · Pubmed #27318576.

ABSTRACT: The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.

20 Article Plaque burden in HIV-infected patients is associated with serum intestinal microbiota-generated trimethylamine. 2015

Srinivasa, Suman / Fitch, Kathleen V / Lo, Janet / Kadar, Hanane / Knight, Rachel / Wong, Kimberly / Abbara, Suhny / Gauguier, Dominique / Capeau, Jacqueline / Boccara, Franck / Grinspoon, Steven K. ·aProgram in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA bINSERM UMRS1138, Cordeliers Research Centre, Paris cInstitute of Cardiometabolism and Nutrition, University Pierre & Marie Curie, Hospital Pitié Salpetrière, Paris, France dUniversity of Rochester School of Medicine, Rochester, New York, New York eCardiothoracic Imaging Division, Department of Radiology, UTSW Medical Center, Dallas, Texas, USA fBiochimie et Hormonologie, Hôpital Tenon AP-HP Paris, CDR Saint-Antoine, Inserm UMR_S938, Université Paris 6-UPMC, Institute of Cardiometabolism and Nutrition, Paris gDepartment of Cardiology, Saint Antoine Hospital, Inserm U938, Université Paris 6-UPMC, Faculté de Médecine Pierre et Marie Curie, Paris, France. ·AIDS · Pubmed #25565500.

ABSTRACT: OBJECTIVE: Some intestinal microbiota-generated metabolites of phosphatidylcholine are recognized to be proatherogenic. As the HIV population is vulnerable to cardiovascular disease and can develop intestinal dysbiosis associated with systemic inflammation, we investigated the novel relationship between microbiota-derived metabolites of phosphatidylcholine and coronary atherosclerosis in HIV. DESIGN/METHODS: One hundred and fifty-five HIV-infected and 67 non-HIV-infected individuals without known history of cardiovascular disease were previously recruited to assess coronary plaque by computed tomography angiography. In the current study, we evaluate whether serum choline, trimethylamine (TMA), or trimethylamine-N-oxide (TMAO) levels are associated with plaque features. RESULTS: Young, asymptomatic HIV-infected patients (age 47 ± 7 years) demonstrated significantly higher prevalence of plaque (53 vs. 35%, P = 0.01) and number of total plaque segments (1.8 ± 2.5 vs. 1.2 ± 2.2, P = 0.03) when compared with well matched noninfected individuals with similar comorbidities. TMA was significantly associated with calcium score (r = 0.22, P = 0.006), number of total (r = 0.20, P = 0.02) and calcified (r = 0.18, P = 0.03) plaque segments, and calcium plaque volume (r = 0.19, P = 0.02) and mass (r = 0.22, P = 0.009) in the HIV cohort only. In multivariate modeling among HIV-infected patients, TMA remained significantly associated with calcium score (P = 0.008), number of total (P = 0.005) and calcified (P = 0.02) plaque segments, and calcium plaque volume (P = 0.01) and mass (P = 0.007), independent of Framingham risk score. In contrast, there was no association of TMAO to coronary plaque features in either cohort. CONCLUSION: A link between TMA and atherosclerosis has not previously been established. The current study suggests that TMA may be a nontraditional risk factor related to the number of plaque segments and severity of calcified plaque burden in HIV.

21 Article SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. 2014

Leipsic, Jonathon / Abbara, Suhny / Achenbach, Stephan / Cury, Ricardo / Earls, James P / Mancini, Gb John / Nieman, Koen / Pontone, Gianluca / Raff, Gilbert L. ·University of British Columbia, Vancouver, Canada. Electronic address: JLeipsic@providencehealth.bc.ca. · University of Texas Southwestern Medical Center, Dallas, Texas. · University of Erlangen, Erlangen, Germany. · Baptist Cardiac and Vascular Institute, Miami, Florida. · Fairfax Radiological Consultants, PC, Fairfax, Virginia. · University of British Columbia, Vancouver, Canada. · Erasmus MC, Rotterdam, Netherlands. · Centro Cardiologico Monzino, Milan, Italy. · William Beaumont Hospital, Royal Oak, Michigan. ·J Cardiovasc Comput Tomogr · Pubmed #25301040.

ABSTRACT: -- No abstract --

22 Article Coronary artery disease detected by coronary computed tomographic angiography is associated with intensification of preventive medical therapy and lower low-density lipoprotein cholesterol. 2014

Hulten, Edward / Bittencourt, Marcio Sommer / Singh, Avinainder / O'Leary, Daniel / Christman, Mitalee P / Osmani, Wafa / Abbara, Suhny / Steigner, Michael L / Truong, Quynh A / Nasir, Khurram / Rybicki, Frank F / Klein, Josh / Hainer, Jon / Brady, Thomas J / Hoffmann, Udo / Ghoshhajra, Brian B / Hachamovitch, Rory / Di Carli, Marcelo F / Blankstein, Ron. ·From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.) · Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.) · Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.) · Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston · Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.) · and Cleveland Clinic Foundation, OH (R.H.). ·Circ Cardiovasc Imaging · Pubmed #24906356.

ABSTRACT: BACKGROUND: Coronary computed tomographic angiography (CCTA) is an accurate test for the identification of coronary artery disease (CAD), yet the impact of CCTA results on subsequent medical therapy and risk factors has not been widely reported. METHODS AND RESULTS: We identified consecutive patients aged >18 years without prior CAD who underwent CCTA from 2004 to 2011 and had complete data on medications before and after CCTA. CCTA results were categorized as no CAD, <50% stenosis, and ≥50% stenosis. Based on the number of involved segments, extent of disease was categorized as nonextensive (≤4 segments) or extensive CAD (>4 segments). Electronic medical records and patient interviews were reviewed blinded to CCTA findings to assess initiation of aspirin and intensification of lipid-lowering therapies. Survival analysis was performed to evaluate intensification of lipid therapy as a predictor of cardiovascular death or nonfatal myocardial infarction. Among 2839 patients with mean follow-up of 3.6 years, the odds of physician intensification of lipid-lowering therapy significantly increased for those with nonobstructive CAD (odds ratio, 3.6; 95% confidence interval, 2.9-4.9; P<0.001) and obstructive CAD (odds ratio, 5.6; 95% confidence interval, 4.3-7.3; P<0.001). Low-density lipoprotein cholesterol levels declined significantly in association with intensification of lipid-lowering therapy after CCTA in all patient subgroups. In a hypothesis-generating analysis, among patients with nonobstructive but extensive CAD, statin use after CCTA was associated with a reduction in cardiovascular death or myocardial infarction (hazards ratio, 0.18; 95% confidence interval, 0.05-0.66; P=0.01). CONCLUSIONS: Abnormal CCTA findings are associated with downstream intensification in statin and aspirin therapy. In particular, CCTA may lead to increased use of prognostically beneficial therapies in patients identified as having extensive, nonobstructive CAD.

23 Article Increased arterial inflammation relates to high-risk coronary plaque morphology in HIV-infected patients. 2014

Tawakol, Ahmed / Lo, Janet / Zanni, Markella V / Marmarelis, Eleni / Ihenachor, Ezinne J / MacNabb, Megan / Wai, Bryan / Hoffmann, Udo / Abbara, Suhny / Grinspoon, Steven. ·*Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA; †Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and ‡Cardiovascular Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. ·J Acquir Immune Defic Syndr · Pubmed #24828267.

ABSTRACT: BACKGROUND: Mechanisms predisposing HIV-infected patients to increased cardiovascular disease (CVD) risk remain unclear. OBJECTIVE: To determine the interrelationship between arterial inflammation and high-risk coronary plaque morphology in HIV-infected patients with subclinical coronary atherosclerosis. METHODS: Forty-one HIV-infected patients on stable antiretroviral therapy without known CVD but with atherosclerotic plaque on coronary CT angiography were evaluated with F-FDG-PET. Patients were stratified into 2 groups based on relative degree of arterial inflammation [aortic target-to-background ratio (TBR)]. High-risk coronary atherosclerotic plaque morphology features were compared between groups. RESULTS: HIV-infected patients with higher and lower TBRs were similar with respect to traditional CVD risk parameters. Among HIV-infected patients with higher TBR, an increased percentage of patients demonstrated at least 1 low-attenuation coronary atherosclerotic plaque (40% vs. 10%, P = 0.02) and at least 1 coronary atherosclerotic plaque with both low attenuation and positive remodeling (35% vs. 10%, P = 0.04). Moreover, in the higher TBR group, both the number of low-attenuation plaques per patient (P = 0.02) and the number of vulnerability features in the most vulnerable plaque (P = 0.02) were increased. TBR grouping remained significantly related to the number of low-attenuation plaques/subject (β = 0.35, P = 0.004), controlling for age, gender, low-density lipoprotein, duration of HIV, and CD4. CONCLUSIONS: These data demonstrate a relationship between arterial inflammation on F-FDG-PET and high-risk coronary atherosclerotic plaque features among HIV-infected patients with subclinical coronary atherosclerosis. Further studies are needed to determine whether arterial inflammation and related high-risk coronary morphology increase the risk of clinical CVD events in the HIV population.

24 Article Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. 2014

Bittencourt, Marcio Sommer / Hulten, Edward / Ghoshhajra, Brian / O'Leary, Daniel / Christman, Mitalee P / Montana, Philip / Truong, Quynh A / Steigner, Michael / Murthy, Venkatesh L / Rybicki, Frank J / Nasir, Khurram / Gowdak, Luis Henrique W / Hainer, Jon / Brady, Thomas J / Di Carli, Marcelo F / Hoffmann, Udo / Abbara, Suhny / Blankstein, Ron. ·Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. ·Circ Cardiovasc Imaging · Pubmed #24550435.

ABSTRACT: BACKGROUND: The contribution of plaque extent to predict cardiovascular events among patients with nonobstructive and obstructive coronary artery disease (CAD) is not well defined. Our objective was to evaluate the prognostic value of plaque extent detected by coronary computed tomography angiography. METHODS AND RESULTS: All consecutive patients without prior CAD referred for coronary computed tomography angiography to evaluate for CAD were included. Examination findings were classified as normal, nonobstructive (<50% stenosis), or obstructive (≥50%). Based on the number of segments with disease, extent of CAD was classified as nonextensive (≤4 segments) or extensive (>4 segments). The cohort included 3242 patients followed for the primary outcome of cardiovascular death or myocardial infarction for a median of 3.6 (2.1-5.0) years. In a multivariable analysis, the presence of extensive nonobstructive CAD (hazard ratio, 3.1; 95% confidence interval, 1.5-6.4), nonextensive obstructive (hazard ratio, 3.0; 95% confidence interval, 1.3-6.9), and extensive obstructive CAD (hazard ratio, 3.9; 95% confidence interval, 2.2-7.2) were associated with an increased rate of events, whereas nonextensive, nonobstructive CAD was not. The addition of plaque extent to a model that included clinical probability as well as the presence and severity of CAD improved risk prediction. CONCLUSIONS: Among patients with nonobstructive CAD, those with extensive plaque experienced a higher rate of cardiovascular death or myocardial infarction, comparable with those who have nonextensive disease. Even among patients with obstructive CAD, greater extent of nonobstructive plaque was associated with higher event rate. Our findings suggest that regardless of whether obstructive or nonobstructive disease is present, the extent of plaque detected by coronary computed tomography angiography enhances risk assessment.

25 Article HDL redox activity is increased in HIV-infected men in association with macrophage activation and non-calcified coronary atherosclerotic plaque. 2014

Zanni, Markella V / Kelesidis, Theodoros / Fitzgerald, Michael L / Lo, Janet / Abbara, Suhny / Wai, Bryan / Marmarelis, Eleni / Hernandez, Nicholas J / Yang, Otto O / Currier, Judith S / Grinspoon, Steven K. ·Massachusetts General Hospital, Program in Nutritional Metabolism, Harvard Medical School. · David Geffen School of Medicine, University of California Los Angeles. · Massachusetts General Hospital, Lipid Metabolism Unit, Harvard Medical School. · Massachusetts General Hospital, Department of Radiology, Harvard Medical School. ·Antivir Ther · Pubmed #24535655.

ABSTRACT: BACKGROUND: HIV is associated with atherosclerosis and low high-density lipoprotein (HDL). With inflammation, HDL becomes dysfunctional. We previously showed that proinflammatory HDL has high HDL redox activity (HRA). In this study, we compare HRA in HIV-infected versus non-HIV-infected subjects and relate HRA to indices of macrophage activation and cardiovascular disease risk. METHODS: 102 HIV-infected subjects and 41 matched non-HIV controls without clinical cardiovascular disease underwent coronary CT angiography (CTA) and testing for immune/inflammatory biomarkers. The effect of purified HDL from each study subject on the oxidation rate of dihydrorhodamine-123 (DOR) was normalized to the DOR of pooled HDL from healthy subjects. The normalized ratio DOR subject/DOR pooled was used as a measure of HRA, with higher HRA suggesting dysfunctional HDL. RESULTS: HRA was higher in HIV-infected versus non-HIV subjects (1.4 ±0.01 versus 1.3 ±0.01, P=0.03). In multivariate modelling for HRA among all subjects, HIV status remained positively related to HRA (P=0.02), even after controlling for traditional cardiovascular risk factors, comorbid conditions and immune activation. Among HIV-infected subjects, HRA correlated inversely with HDL (rho=-0.32, P=0.002) and log adiponectin (r=-0.28, P=0.006), and correlated positively with log sCD163 (r=0.24, P=0.02) - a monocyte/macrophage activation marker - and with the percentage of non-calcified coronary atherosclerotic plaque (r=0.29, P=0.03). sCD163 remained significantly associated with HRA in multivariate modelling among HIV-infected subjects (P=0.03). CONCLUSIONS: These data demonstrate increased HRA among HIV-infected subjects versus matched non-HIV subjects with comparable HDL levels. In HIV-infected subjects, HRA relates to macrophage activation and to non-calcified coronary atherosclerotic plaque, which may be rupture-prone. Further studies are needed in HIV-infected patients to elucidate the interplay between immune activation, HDL function and CVD risk. CLINICAL TRIAL REGISTRATION NUMBER: NCT 00455793.

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