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Coronary Artery Disease: HELP
Articles by Courtney R. Foster
Based on 12 articles published since 2010
(Why 12 articles?)
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Between 2010 and 2020, Courtney Foster wrote the following 12 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Article Marked exercise-induced T-wave heterogeneity in symptomatic diabetic patients with nonflow-limiting coronary artery stenosis. 2018

Stocco, Fernando G / Evaristo, Ederson / Shah, Nishant R / Cheezum, Michael K / Hainer, Jon / Foster, Courtney / Nearing, Bruce D / Gervino, Ernest / Verrier, Richard L. ·University of Sao Paulo School of Medicine, Sao Paulo, Brazil. · Beth Israel Deaconess Medical Center, Boston, MA, USA. · Brigham & Women's Hospital, Boston, MA, USA. · Harvard Medical School, Boston, MA, USA. · Brown University Warren Alpert Medical School, Providence, RI, USA. ·Ann Noninvasive Electrocardiol · Pubmed #28949056.

ABSTRACT: BACKGROUND: T-wave heterogeneity (TWH) independently predicted cardiovascular mortality in Health Survey 2000 based on 12-lead ECGs recorded at rest. We investigated whether TWH is elevated during exercise tolerance testing (ETT) in symptomatic diabetic patients with nonflow-limiting coronary artery stenosis compared to control subjects without diabetes. METHODS: Cases were all patients (n = 20) with analyzable ECG recordings during both rest and ETT who were enrolled in the Effects of Ranolazine on Coronary Flow Reserve (CFR) in Symptomatic Patients with Diabetes and Suspected or Known Coronary Artery Disease (RAND-CFR) study (NCT01754259); median CFR was 1.44; 80% of cases had CFR <2. Control subjects (n = 9) were nondiabetic patients who had functional flow reserve (FFR) >0.8, a range not associated with inducible ischemia. TWH was analyzed from precordial leads V RESULTS: During exercise to similar rate-pressure products (p = .31), RAND-CFR patients exhibited a 49% increase in TWH during exercise (rest: 49 ± 5 μV; exercise: 73 ± 8 μV, p = .003). By comparison, in control subjects, TWH was not significantly altered (rest: 52 ± 11 μV; ETT: 38 ± 5 μV, p = .19). ETT-induced ST-segment depression >1 mm (p = .11) and T CONCLUSIONS: TWH is capable of detecting latent repolarization abnormalities, which are present during ETT in diabetic patients with nonflow-limiting stenosis but not in control subjects. The technique developed in this study permits TWH analysis from archived ECGs and thereby enables mining of extensive databases for retrospective studies and hypothesis testing.

2 Article Excess Cardiovascular Risk in Women Relative to Men Referred for Coronary Angiography Is Associated With Severely Impaired Coronary Flow Reserve, Not Obstructive Disease. 2017

Taqueti, Viviany R / Shaw, Leslee J / Cook, Nancy R / Murthy, Venkatesh L / Shah, Nishant R / Foster, Courtney R / Hainer, Jon / Blankstein, Ron / Dorbala, Sharmila / Di Carli, Marcelo F. ·From Noninvasive Cardiovascular Imaging Program, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (V.R.T., N.R.S., C.R.F., J.H., R.B., S.D., M.F.D.C.) · Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (L.J.S.) · Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, MA (N.R.C.) · and Divisions of Nuclear Medicine, Cardiothoracic Imaging, and Cardiovascular Medicine, Departments of Medicine and Radiology, University of Michigan, Ann Arbor (V.L.M.). ·Circulation · Pubmed #27881570.

ABSTRACT: BACKGROUND: Cardiovascular disease (CVD) fatality rates are higher for women than for men, yet obstructive coronary artery disease (CAD) is less prevalent in women. Coronary flow reserve (CFR), an integrated measure of large- and small-vessel CAD and myocardial ischemia, identifies patients at risk for CVD death, but is not routinely measured in clinical practice. We sought to investigate the impact of sex, CFR, and angiographic CAD severity on adverse cardiovascular events. METHODS: Consecutive patients (n=329, 43% women) referred for invasive coronary angiography after stress testing with myocardial perfusion positron emission tomography and with left ventricular ejection fraction >40% were followed (median, 3.0 years) for a composite end point of major adverse cardiovascular events, including cardiovascular death and hospitalization for nonfatal myocardial infarction or heart failure. The extent and severity of angiographic CAD were estimated by using the CAD prognostic index, and CFR was quantified by using positron emission tomography. RESULTS: Although women in comparison with men had lower pretest clinical scores, rates of prior myocardial infarction, and burden of angiographic CAD (P<0.001), they demonstrated greater risk of CVD events, even after adjustment for traditional risk factors, imaging findings, and early revascularization (adjusted hazard ratio, 2.05; 95% confidence interval, 1.05-4.02; P=0.03). Impaired CFR was similarly present among women and men, but in patients with low CFR (<1.6, n=163), women showed a higher frequency of nonobstructive CAD, whereas men showed a higher frequency of severely obstructive CAD (P=0.002). After also adjusting for CFR, the effect of sex on outcomes was no longer significant. When stratified by sex and CFR, only women with severely impaired CFR demonstrated significantly increased adjusted risk of CVD events (P<0.0001, P for interaction=0.04). CONCLUSIONS: Women referred for coronary angiography had a significantly lower burden of obstructive CAD in comparison with men but were not protected from CVD events. Excess cardiovascular risk in women was independently associated with impaired CFR, representing a hidden biological risk, and a phenotype less amenable to revascularization. Impaired CFR, particularly absent severely obstructive CAD, may represent a novel target for CVD risk reduction.

3 Article Interaction of impaired coronary flow reserve and cardiomyocyte injury on adverse cardiovascular outcomes in patients without overt coronary artery disease. 2015

Taqueti, Viviany R / Everett, Brendan M / Murthy, Venkatesh L / Gaber, Mariya / Foster, Courtney R / Hainer, Jon / Blankstein, Ron / Dorbala, Sharmila / Di Carli, Marcelo F. ·From the Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (V.R.T., M.G., C.R.F., J.H., R.B., S.D., M.F.D.C.) · Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (B.M.E.) · and Divisions of Nuclear Medicine, Cardiothoracic Imaging, and Cardiovascular Medicine, Departments of Medicine and Radiology, University of Michigan, Ann Arbor (V.L.M.). ·Circulation · Pubmed #25480813.

ABSTRACT: BACKGROUND: Minimally elevated serum cardiac troponin reflects myocardial injury and is associated with increased mortality, even absent coronary artery disease (CAD). We sought to investigate the relationship between low-level troponin elevation and impaired coronary flow reserve (CFR), an integrated measure of coronary vasomotor function, and to assess their contributions to adverse outcomes in patients without overt CAD. METHODS AND RESULTS: Consecutive patients (n=761) undergoing evaluation for suspected CAD with troponin before stress myocardial perfusion positron emission tomography were followed up (median, 2.8 years) for major adverse cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, or late revascularization. Patients with flow-limiting CAD, left ventricular ejection fraction <40%, or revascularization within 60 days of imaging were excluded. CFR was quantified from stress/rest myocardial blood flow with the use of positron emission tomography. Compared with patients with negative troponin, those with at least 1 positive troponin (n=97) had higher pretest clinical scores, more renal dysfunction, and lower left ventricular ejection fraction and CFR. In adjusted analysis, impaired CFR remained independently associated with positive troponin (odds ratio, 2.18; 95% confidence interval, 1.37-3.47; P=0.001), and both impaired CFR and positive troponin were independently associated with major adverse cardiovascular events (hazard ratio, 2.25; 95% confidence interval, 1.31-3.86; P=0.003; and hazard ratio, 2.42; 95% confidence interval, 1.34-4.40; P=0.004, respectively). Impaired CFR and positive troponin identified patients at highest risk of major adverse cardiovascular events (log-rank P<0.0001), with a significant interaction (P<0.007) seen between CFR and troponin. CONCLUSIONS: In patients without overt CAD, impaired CFR was independently associated with minimally elevated troponin and major adverse cardiovascular events. Impaired CFR, here reflecting microvascular dysfunction, modified the effect of a positive troponin on adverse outcomes.

4 Article Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization. 2015

Taqueti, Viviany R / Hachamovitch, Rory / Murthy, Venkatesh L / Naya, Masanao / Foster, Courtney R / Hainer, Jon / Dorbala, Sharmila / Blankstein, Ron / Di Carli, Marcelo F. ·From the Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (V.R.T., M.N., C.R.F., J.H., S.D., R.B., M.F.D.C.) · Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (R.H.) · and Divisions of Nuclear Medicine, Cardiothoracic Imaging, and Cardiovascular Medicine, Departments of Medicine and Radiology, University of Michigan, Ann Arbor (V.L.M.). ·Circulation · Pubmed #25400060.

ABSTRACT: BACKGROUND: Coronary flow reserve (CFR), an integrated measure of focal, diffuse, and small-vessel coronary artery disease (CAD), identifies patients at risk for cardiac death. We sought to determine the association between CFR, angiographic CAD, and cardiovascular outcomes. METHODS AND RESULTS: Consecutive patients (n=329) referred for invasive coronary angiography after stress testing with myocardial perfusion positron emission tomography were followed (median 3.1 years) for cardiovascular death and heart failure admission. The extent and severity of angiographic disease were estimated with the use of the CAD prognostic index, and CFR was measured noninvasively by positron emission tomography. A modest inverse correlation was seen between CFR and CAD prognostic index (r=-0.26; P<0.0001). After adjustment for clinical risk score, ejection fraction, global ischemia, and early revascularization, CFR and CAD prognostic index were independently associated with events (hazard ratio for unit decrease in CFR, 2.02; 95% confidence interval, 1.20-3.40; P=0.008; hazard ratio for 10-U increase in CAD prognostic index, 1.17; 95% confidence interval, 1.01-1.34; P=0.032). Subjects with low CFR experienced rates of events similar to those of subjects with high angiographic scores, and those with low CFR or high CAD prognostic index showed the highest risk of events (P=0.001). There was a significant interaction (P=0.039) between CFR and early revascularization by coronary artery bypass grafting, such that patients with low CFR who underwent coronary artery bypass grafting, but not percutaneous coronary intervention, experienced event rates comparable to those with preserved CFR, independently of revascularization. CONCLUSIONS: CFR was associated with outcomes independently of angiographic CAD and modified the effect of early revascularization. Diffuse atherosclerosis and associated microvascular dysfunction may contribute to the pathophysiology of cardiovascular death and heart failure, and impact the outcomes of revascularization.

5 Article Effects of sex on coronary microvascular dysfunction and cardiac outcomes. 2014

Murthy, Venkatesh L / Naya, Masanao / Taqueti, Viviany R / Foster, Courtney R / Gaber, Mariya / Hainer, Jon / Dorbala, Sharmila / Blankstein, Ron / Rimoldi, Ornella / Camici, Paolo G / Di Carli, Marcelo F. ·From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.) · Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA · Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy · Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.). ·Circulation · Pubmed #24787469.

ABSTRACT: BACKGROUND: Coronary microvascular dysfunction (CMD) is a prevalent and prognostically important finding in patients with symptoms suggestive of coronary artery disease. The relative extent to which CMD affects both sexes is largely unknown. METHODS AND RESULTS: We investigated 405 men and 813 women who were referred for evaluation of suspected coronary artery disease with no previous history of coronary artery disease and no visual evidence of coronary artery disease on rest/stress positron emission tomography myocardial perfusion imaging. Coronary flow reserve was quantified, and coronary flow reserve <2.0 was used to define the presence of CMD. Major adverse cardiac events, including cardiac death, nonfatal myocardial infarction, late revascularization, and hospitalization for heart failure, were assessed in a blinded fashion over a median follow-up of 1.3 years (interquartile range, 0.5-2.3 years). CMD was highly prevalent both in men and women (51% and 54%, respectively; Fisher exact test =0.39; equivalence P=0.0002). Regardless of sex, coronary flow reserve was a powerful incremental predictor of major adverse cardiac events (hazard ratio, 0.80 [95% confidence interval, 0.75-086] per 10% increase in coronary flow reserve; P<0.0001) and resulted in favorable net reclassification improvement (0.280 [95% confidence interval, 0.049-0.512]), after adjustment for clinical risk and ventricular function. In a subgroup (n=404; 307 women/97 men) without evidence of coronary artery calcification on gated computed tomography imaging, CMD was common in both sexes, despite normal stress perfusion imaging and no coronary artery calcification (44% of men versus 48% of women; Fisher exact test P=0.56; equivalence P=0.041). CONCLUSIONS: CMD is highly prevalent among at-risk individuals and is associated with adverse outcomes regardless of sex. The high prevalence of CMD in both sexes suggests that it may be a useful target for future therapeutic interventions.

6 Article Preserved coronary flow reserve effectively excludes high-risk coronary artery disease on angiography. 2014

Naya, Masanao / Murthy, Venkatesh L / Taqueti, Viviany R / Foster, Courtney R / Klein, Josh / Garber, Mariya / Dorbala, Sharmila / Hainer, Jon / Blankstein, Ron / Resnic, Frederick / Di Carli, Marcelo F. ·NonInvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts. ·J Nucl Med · Pubmed #24408896.

ABSTRACT: METHODS: We studied 290 consecutive patients undergoing (82)Rb PET within 180 d of invasive coronary angiography. High-risk CAD on angiography was defined as 2-vessel disease (≥ 70% stenosis), including the proximal left anterior descending artery; 3-vessel disease; or left main CAD (≥ 50% stenosis). Patients with prior Q wave myocardial infarction, elevated troponin levels between studies, prior coronary artery bypass grafting, a left ventricular ejection fraction of less than 40%, or severe valvular heart disease were excluded. RESULTS: Fifty-five patients (19%) had high-risk CAD on angiography. As expected, the trade-off between the sensitivity and the specificity of the CFR for identifying high-risk CAD varied substantially depending on the cutoff selected. In multivariable analysis, a binary CFR of less than or equal to 1.93 provided incremental diagnostic information for the identification of high-risk CAD beyond the model with the Duke clinical risk score (>25%), percentage of left ventricular ischemia (>10%), transient ischemic dilation index (>1.07), and change in the left ventricular ejection fraction during stress (<2) (P = 0.0009). In patients with normal or slightly to moderately abnormal results on perfusion scans (<10% of left ventricular mass) during stress (n = 136), a preserved CFR (>1.93) excluded high-risk CAD with a high sensitivity (86%) and a high negative predictive value (97%). CONCLUSION: A normal CFR has a high negative predictive value for excluding high-risk CAD on angiography. Although an abnormal CFR increases the probability of significant obstructive CAD, it cannot reliably distinguish significant epicardial stenosis from nonobstructive, diffuse atherosclerosis or microvascular dysfunction.

7 Article Prognostic interplay of coronary artery calcification and underlying vascular dysfunction in patients with suspected coronary artery disease. 2013

Naya, Masanao / Murthy, Venkatesh L / Foster, Courtney R / Gaber, Mariya / Klein, Josh / Hainer, Jon / Dorbala, Sharmila / Blankstein, Ron / Di Carli, Marcelo F. ·Division of Cardiovascular Medicine, Department of Medicine, Non-Invasive Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. ·J Am Coll Cardiol · Pubmed #23524053.

ABSTRACT: OBJECTIVES: This study sought to evaluate the interrelation of atherosclerotic burden, as assessed by coronary artery calcium (CAC) score and coronary vascular function, as assessed by quantitative estimates of coronary flow reserve (CFR), with respect to prediction of clinical outcomes. BACKGROUND: The contribution of coronary vascular dysfunction, atherosclerotic burden, and the 2 combined to cardiac events is unknown. METHOD: A total of 901 consecutive patients underwent (82)Rubidium myocardial perfusion imaging (MPI) positron emission tomography (PET) and CAC scan. All patients had normal MPI. The primary endpoint was a composite of major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, late revascularization, and admission for heart failure. RESULTS: At baseline, CFR decreased (2.15 ± 0.72, 2.02 ± 0.65, and 1.88 ± 0.64, p < 0.0001) with increasing levels of CAC (0, 1 to 399, and ≥400). Over a median of 1.53 years (interquartile range: 0.77 to 2.44), there were 57 MACE. Annual risk-adjusted MACE rates were higher for patients with CFR <2.0 compared with ≥2.0 (1.9 vs. 5.5%/year, p = 0.0007) but were only borderline associated with CAC (3.1%, 3.4%, and 6.2%/year for CAC of 0, 1 to 399, and ≥400, respectively; p = 0.09). Annualized adjusted MACE was increased in the presence of impaired CFR even among patients with CAC = 0 (1.4% vs. 5.2%, p = 0.03). Cox proportional hazards analysis revealed that CFR improved model fit, risk discrimination, and risk reclassification over clinical risk, whereas CAC only modestly improved model fit without improving risk discrimination or reclassification. CONCLUSIONS: In symptomatic patients with normal MPI, global CFR but not CAC provides significant incremental risk stratification over clinical risk score for prediction of major adverse cardiac events.

8 Article Coronary vascular dysfunction and prognosis in patients with chronic kidney disease. 2012

Murthy, Venkatesh L / Naya, Masanao / Foster, Courtney R / Hainer, Jon / Gaber, Mariya / Dorbala, Sharmila / Charytan, David M / Blankstein, Ron / Di Carli, Marcelo F. ·Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA 02115, USA. ·JACC Cardiovasc Imaging · Pubmed #23058070.

ABSTRACT: OBJECTIVES: This study sought to evaluate whether impaired vasodilator function, an early manifestation of coronary artery disease, which precedes angiographic stenosis, accounts for increased risk among patients with moderate to severe renal dysfunction. BACKGROUND: Patients with renal dysfunction are at increased risk of adverse cardiac outcomes, even in the absence of overt myocardial ischemia or infarction. METHODS: We included 866 consecutive patients with moderate to severe renal dysfunction referred for rest and stress myocardial perfusion positron emission tomography and followed them for a median of 1.28 years (interquartile range: 0.64 to 2.34). Regional myocardial perfusion abnormalities were assessed by semiquantitative visual analysis of positron emission tomography images. Rest and stress myocardial blood flow were calculated using factor analysis and a 2-compartment kinetic model; they were also used to compute coronary flow reserve (stress/rest myocardial blood flow). The primary endpoint was cardiac death. RESULTS: Overall, 3-year cardiac mortality was 16.2%. After adjusting for clinical risk, left ventricular ejection fraction, as well as the magnitude of scar and/or ischemia, coronary flow reserve below the median (<1.5) was associated with a 2.1-fold increase in the risk of cardiac death (95% confidence interval [CI]: 1.3 to 3.5, p = 0.004). Incorporation of coronary flow reserve into cardiac death risk assessment models resulted in an increase in the C-index from 0.75 to 0.77 (p = 0.05) and in a net reclassification improvement of 0.142 (95% CI: 0.076 to 0.219). Among patients at intermediate risk based on all data other than coronary flow reserve, the net reclassification improvement was 0.489 (95% CI: 0.192 to 0.836). Corresponding improvements in risk assessment for mortality from any cause were also demonstrated. CONCLUSIONS: The presence of coronary vascular dysfunction in patients with moderate to severe renal dysfunction, as assessed by positron emission tomography, is a powerful, independent predictor of cardiac mortality and provides meaningful incremental risk stratification over conventional markers of clinical risk.

9 Article Association between coronary vascular dysfunction and cardiac mortality in patients with and without diabetes mellitus. 2012

Murthy, Venkatesh L / Naya, Masanao / Foster, Courtney R / Gaber, Mariya / Hainer, Jon / Klein, Josh / Dorbala, Sharmila / Blankstein, Ron / Di Carli, Marcelo F. ·Noninvasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. ·Circulation · Pubmed #22919001.

ABSTRACT: BACKGROUND: Diabetes mellitus increases the risk of adverse cardiac outcomes and is considered a coronary artery disease (CAD) equivalent. We examined whether coronary vascular dysfunction, an early manifestation of CAD, accounts for increased risk among diabetics compared with nondiabetics. METHODS AND RESULTS: A total of 2783 consecutive patients (1172 diabetics and 1611 nondiabetics) underwent quantification of coronary flow reserve (CFR; CFR=stress divided by rest myocardial blood flow) by positron emission tomography and were followed up for a median of 1.4 years (quartile 1-3, 0.7-3.2 years). The primary end point was cardiac death. Impaired CFR (below the median) was associated with an adjusted 3.2- and 4.9-fold increase in the rate of cardiac death for diabetics and nondiabetics, respectively (P=0.0004). Addition of CFR to clinical and imaging risk models improved risk discrimination for both diabetics and nondiabetics (c index, 0.77-0.79, P=0.04; 0.82-0.85, P=0.03, respectively). Diabetic patients without known CAD with impaired CFR experienced a rate of cardiac death comparable to that for nondiabetic patients with known CAD (2.8%/y versus 2.0%/y; P=0.33). Conversely, diabetics without known CAD and preserved CFR had very low annualized cardiac mortality, which was similar to patients without known CAD or diabetes mellitus and normal stress perfusion and systolic function (0.3%/y versus 0.5%/y; P=0.65). CONCLUSIONS: Coronary vasodilator dysfunction is a powerful, independent correlate of cardiac mortality among both diabetics and nondiabetics and provides meaningful incremental risk stratification. Among diabetic patients without CAD, those with impaired CFR have event rates comparable to those of patients with prior CAD, whereas those with preserved CFR have event rates comparable to those of nondiabetics.

10 Article Patient management after noninvasive cardiac imaging results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease). 2012

Hachamovitch, Rory / Nutter, Benjamin / Hlatky, Mark A / Shaw, Leslee J / Ridner, Michael L / Dorbala, Sharmila / Beanlands, Rob S B / Chow, Benjamin J W / Branscomb, Elizabeth / Chareonthaitawee, Panithaya / Weigold, W Guy / Voros, Szilard / Abbara, Suhny / Yasuda, Tsunehiro / Jacobs, Jill E / Lesser, John / Berman, Daniel S / Thomson, Louise E J / Raman, Subha / Heller, Gary V / Schussheim, Adam / Brunken, Richard / Williams, Kim A / Farkas, Susan / Delbeke, Dominique / Schoepf, Uwe J / Reichek, Nathaniel / Rabinowitz, Stuart / Sigman, Steven R / Patterson, Randall / Corn, Carolyn R / White, Richard / Kazerooni, Ella / Corbett, James / Bokhari, Sabahat / Machac, Josef / Guarneri, Erminia / Borges-Neto, Salvador / Millstine, John W / Caldwell, James / Arrighi, James / Hoffmann, Udo / Budoff, Matthew / Lima, Joao / Johnson, James R / Johnson, Barbara / Gaber, Mariya / Williams, Julie A / Foster, Courtney / Hainer, Jon / Di Carli, Marcelo F / Anonymous4230716. ·Cleveland Clinic Foundation, Cleveland, Ohio, USA. ·J Am Coll Cardiol · Pubmed #22281249.

ABSTRACT: OBJECTIVES: This study examined short-term cardiac catheterization rates and medication changes after cardiac imaging. BACKGROUND: Noninvasive cardiac imaging is widely used in coronary artery disease, but its effects on subsequent patient management are unclear. METHODS: We assessed the 90-day post-test rates of catheterization and medication changes in a prospective registry of 1,703 patients without a documented history of coronary artery disease and an intermediate to high likelihood of coronary artery disease undergoing cardiac single-photon emission computed tomography, positron emission tomography, or 64-slice coronary computed tomography angiography. RESULTS: Baseline medication use was relatively infrequent. At 90 days, 9.6% of patients underwent catheterization. The rates of catheterization and medication changes increased in proportion to test abnormality findings. Among patients with the most severe test result findings, 38% to 61% were not referred to catheterization, 20% to 30% were not receiving aspirin, 35% to 44% were not receiving a beta-blocker, and 20% to 25% were not receiving a lipid-lowering agent at 90 days after the index test. Risk-adjusted analyses revealed that compared with stress single-photon emission computed tomography or positron emission tomography, changes in aspirin and lipid-lowering agent use was greater after computed tomography angiography, as was the 90-day catheterization referral rate in the setting of normal/nonobstructive and mildly abnormal test results. CONCLUSIONS: Overall, noninvasive testing had only a modest impact on clinical management of patients referred for clinical testing. Although post-imaging use of cardiac catheterization and medical therapy increased in proportion to the degree of abnormality findings, the frequency of catheterization and medication change suggests possible undertreatment of higher risk patients. Patients were more likely to undergo cardiac catheterization after computed tomography angiography than after single-photon emission computed tomography or positron emission tomography after normal/nonobstructive and mildly abnormal study findings. (Study of Perfusion and Anatomy's Role in Coronary Artery [CAD] [SPARC]; NCT00321399).

11 Article Quantitative relationship between the extent and morphology of coronary atherosclerotic plaque and downstream myocardial perfusion. 2011

Naya, Masanao / Murthy, Venkatesh L / Blankstein, Ron / Sitek, Arkadiusz / Hainer, Jon / Foster, Courtney / Gaber, Mariya / Fantony, Jolene M / Dorbala, Sharmila / Di Carli, Marcelo F. ·Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiology), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. ·J Am Coll Cardiol · Pubmed #21996395.

ABSTRACT: OBJECTIVES: The purpose of this study was to quantify the effects of coronary atherosclerosis morphology and extent on myocardial flow reserve (MFR). BACKGROUND: Although the relationship between coronary stenosis and myocardial perfusion is well established, little is known about the contribution of other anatomic descriptors of atherosclerosis burden to this relationship. METHODS: We evaluated the relationship between atherosclerosis plaque burden, morphology, and composition and regional MFR (MFR(regional)) in 73 consecutive patients undergoing Rubidium-82 positron emission tomography and coronary computed tomography angiography for the evaluation of known or suspected coronary artery disease. RESULTS: Atherosclerosis was seen in 51 of 73 patients and in 107 of 209 assessable coronary arteries. On a per-vessel basis, the percentage diameter stenosis (p = 0.02) or summed stenosis score (p = 0.002), integrating stenoses in series, was the best predictor of MFR(regional). Importantly, MFR(regional) varied widely within each coronary stenosis category, even in vessels with nonobstructive plaques (n = 169), 38% of which had abnormal MFR(regional) (<2.0). Total plaque length, composition, and remodeling index were not associated with lower MFR. On a per-patient basis, the modified Duke CAD (coronary artery disease) index (p = 0.04) and the number of segments with mixed plaque (p = 0.01) were the best predictors of low MFR(global). CONCLUSIONS: Computed tomography angiography descriptors of atherosclerosis had only a modest effect on downstream MFR. On a per-patient basis, the extent and severity of atherosclerosis as assessed by the modified Duke CAD index and the number of coronary segments with mixed plaque were associated with decreased MFR.

12 Minor Response to letter regarding article, "effects of sex on coronary microvascular dysfunction and cardiac outcomes". 2015

Murthy, Venkatesh L / Naya, Masanao / Taqueti, Viviany R / Foster, Courtney R / Gaber, Mariya / Hainer, Jon / Dorbala, Sharmila / Blankstein, Ron / Rimoldi, Ornella / Camici, Paolo G / Di Carli, Marcelo F. ·Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Division of Cardiovascular Medicine, Department of Medicine, Brigham & Women's Hospital, Boston, MA, Department of Internal Medicine, Division of Cardiovascular Medicine, Department of Radiology, Divisions of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor, MI. · Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Division of Cardiovascular Medicine, Department of Medicine, Brigham & Women's Hospital, Boston, MA. · Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham & Women's Hospital, Boston, MA. · IBFM CNR and Scientific Institute San Raffaele, Milan, Italy. · Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy. ·Circulation · Pubmed #25779548.

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