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Coronary Artery Disease: HELP
Articles by Udo Hoffmann
Based on 139 articles published since 2009
(Why 139 articles?)
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Between 2009 and 2019, Udo Hoffmann wrote the following 139 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 Editorial The Promise of a Warranty. 2016

Hoffmann, Udo. ·From the Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston. uhoffmann@mgh.harvard.edu. ·Circ Cardiovasc Imaging · Pubmed #26848063.

ABSTRACT: -- No abstract --

2 Editorial The PROMISE trial: An inside perspective. 2015

Hoffmann, Udo / Douglas, Pamela S. ·Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street Suite 400, Boston, MA 02114, USA. Electronic address: uhoffmann@mgh.harvard.edu. · Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. ·J Cardiovasc Comput Tomogr · Pubmed #26025047.

ABSTRACT: -- No abstract --

3 Editorial Computed tomography coronary plaque imaging as a secondary end point for randomized pharmaceutical trials: more bang for the buck? 2010

Hoffmann, Udo / Truong, Quynh A. · ·Circ Cardiovasc Imaging · Pubmed #20484111.

ABSTRACT: -- No abstract --

4 Review CAD-RADS - a new clinical decision support tool for coronary computed tomography angiography. 2018

Foldyna, Borek / Szilveszter, Bálint / Scholtz, Jan-Erik / Banerji, Dahlia / Maurovich-Horvat, Pál / Hoffmann, Udo. ·Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA. bfoldyna@mgh.harvard.edu. · Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Center, Leipzig, Germany. bfoldyna@mgh.harvard.edu. · MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA. ·Eur Radiol · Pubmed #29116390.

ABSTRACT: Coronary computed tomography angiography (CTA) has been established as an accurate method to non-invasively assess coronary artery disease (CAD). The proposed 'Coronary Artery Disease Reporting and Data System' (CAD-RADS) may enable standardised reporting of the broad spectrum of coronary CTA findings related to the presence, extent and composition of coronary atherosclerosis. The CAD-RADS classification is a comprehensive tool for summarising findings on a per-patient-basis dependent on the highest-grade coronary artery lesion, ranging from CAD-RADS 0 (absence of CAD) to CAD-RADS 5 (total occlusion of a coronary artery). In addition, it provides suggestions for clinical management for each classification, including further testing and therapeutic options. Despite some limitations, CAD-RADS may facilitate improved communication between imagers and patient caregivers. As such, CAD-RADS may enable a more efficient use of coronary CTA leading to more accurate utilisation of invasive coronary angiograms. Furthermore, widespread use of CAD-RADS may facilitate registry-based research of diagnostic and prognostic aspects of CTA. KEY POINTS: • CAD-RADS is a tool for standardising coronary CTA reports. • CAD-RADS includes clinical treatment recommendations based on CTA findings. • CAD-RADS has the potential to reduce variability of CTA reports.

5 Review Nonobstructive Coronary Artery Disease by Coronary CT Angiography Improves Risk Stratification and Allocation of Statin Therapy. 2017

Emami, Hamed / Takx, Richard A P / Mayrhofer, Thomas / Janjua, Sumbal / Park, Jakob / Pursnani, Amit / Tawakol, Ahmed / Lu, Michael T / Ferencik, Maros / Hoffmann, Udo. ·Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine, Yale-New Haven Hospital, Yale Medical School, New Haven, Connecticut. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: uhoffmann@partners.org. ·JACC Cardiovasc Imaging · Pubmed #28330658.

ABSTRACT: OBJECTIVES: This study sought to determine prognostic value of nonobstructive coronary artery disease (CAD) for atherosclerotic cardiovascular disease (ASCVD) events and to determine whether incorporation of this information into the pooled cohort equation reclassifies recommendations for statin therapy as defined by the 2013 guidelines for cholesterol management of the American College of Cardiology and American Heart Association (ACC/AHA). BACKGROUND: Detection of nonobstructive CAD by coronary computed tomography angiography may improve risk stratification and permit individualized and more appropriate allocation of statin therapy. METHODS: This study determined the pooled hazard ratio of nonobstructive CAD for ASCVD events from published studies and incorporated this information into the ACC/AHA pooled cohort equation. The study calculated revised sex- and ethnicity-based 10-year ASCVD risk and determined boundaries corresponding to the original 7.5% risk for ASCVD events. It also assessed reclassification for statin eligibility by incorporating the results from meta-analysis to individual patients from a separate cohort. RESULTS: This study included 2 studies (2,295 subjects; 66% male; prevalence of nonobstructive CAD, 47%; median follow-up, 49 months; 67 ASCVD events). The hazard ratio of nonobstructive CAD for ASCVD events was 3.2 (95% confidence interval: 1.5 to 6.7). Incorporation of this information into the pooled cohort equation resulted in reclassification toward statin eligibility in individuals with nonobstructive CAD, with an original ASCVD score of 3.0% and 5.9% or higher in African-American women and men and a score of 4.4% and 4.6% or higher in Caucasian women and men, respectively. The absence of nonobstructive CAD resulted in reclassification toward statin ineligibility if the original ASCVD score was as 10.0% and 17.9% or lower in African-American women and men and 13.7% and 14.3% or lower in Caucasian women and men, respectively. Reclassification is observed in 14% of patients. CONCLUSIONS: Detection of nonobstructive CAD by coronary computed tomography angiography improves risk stratification and permits individualized and more appropriate allocation of statin therapy across sex and ethnicity groups.

6 Review Is there still a role for cardiac CT in the emergency department in the era of highly-sensitive troponins? 2017

Dedic, Admir / Nieman, Koen / Hoffmann, Udo / Ferencik, Maros. ·Departments of Cardiology and Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands. · Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA. · Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA - ferencik@ohsu.edu. · Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA. ·Minerva Cardioangiol · Pubmed #27886161.

ABSTRACT: Physicians practicing cardiovascular medicine are every day confronted with patients presenting with symptoms suggestive of an acute coronary syndrome (ACS). Over the years, there have been substantial technical advances, such as the introduction of new non-invasive imaging techniques and the introduction of new highly sensitive cardiac biomarkers. Physicians have adopted these new assets and have become more experienced with them thus improving medical care. Nevertheless, the search for an efficient, yet safe diagnostic work-up for patients presenting with symptoms suggestive of ACS is ongoing. A large proportion of patients will require some form of non-invasive testing and the choice for the diagnostic modality as well as its timing are important steps in this process. Cardiac computed tomography (CT), a non-invasive imaging technique that rapidly provides visualization of the coronary artery tree, is an attractive option, with its unparalleled negative predictive value for obstructive coronary artery disease (CAD). With the introduction of highly-sensitive troponins (hsTn), the role of non-invasive testing, including cardiac CT, has changed. This review will provide an oversight on what is known about cardiac CT in acute chest presentations. Furthermore, we will discuss the changing role of cardiac CT in the era of hsTn and the possibility of their combined use in the work-up of suspected ACS patients. hsTn is currently an established tool for the diagnosis and triage of patients with suspected ACS. The role of cardiac CT has shifted now to a secondary, comprehensive rule-out test in patients with inconclusive biomarker status, providing information on stenosis severity, plaque burden, high-risk features and the presence of other serious conditions that can also give rise to hsTn.

7 Review ACR Appropriateness Criteria Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease. 2015

Hoffmann, Udo / Akers, Scott R / Brown, Richard K J / Cummings, Kristopher W / Cury, Ricardo C / Greenberg, S Bruce / Ho, Vincent B / Hsu, Joe Y / Min, James K / Panchal, Kalpesh K / Stillman, Arthur E / Woodard, Pamela K / Jacobs, Jill E. ·Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: uhoffmann@partners.org. · VA Medical Center, Philadelphia, Pennsylvania. · University Hospital, Ann Arbor, Michigan. · Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri. · Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida. · Arkansas Children's Hospital, Little Rock, Arkansas. · Uniformed Services University of the Health Sciences, Bethesda, Maryland. · Diagnostic Imaging, Los Angeles, California. · Cedars Sinai Medical Center, Los Angeles, California, American College of Cardiology. · University of Cincinnati Hospital, Cincinnati, Ohio. · Emory University Hospital, Atlanta, Georgia. · New York University Medical Center, New York, New York. ·J Am Coll Radiol · Pubmed #26653833.

ABSTRACT: Primary imaging options in patients at low risk for coronary artery disease (CAD) who present with undifferentiated chest pain and without signs of ischemia are functional testing with exercise or pharmacologic stress-based electrocardiography, echocardiography, or myocardial perfusion imaging to exclude myocardial ischemia after rule-out of myocardial infarction and early cardiac CT because of its high negative predictive value to exclude CAD. Although possible, is not conclusive whether triple-rule-out CT (CAD, pulmonary embolism, and aortic dissection) might improve the efficiency of patient management. More advanced noninvasive tests such as cardiac MRI and invasive imaging with transesophageal echocardiography or coronary angiography are rarely indicated. With increased likelihood of noncardiac causes, a number of diagnostic tests, among them ultrasound of the abdomen, MR angiography of the aorta with or without contrast, x-ray rib views, x-ray barium swallow, and upper gastrointestinal series, can also be appropriate. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three 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. This recommendation is based on excellent evidence, including several randomized comparative effectiveness trials and blinded observational cohort studies.

8 Review New insights from major prospective cohort studies with cardiac CT. 2015

Janjua, Sumbal A / Hoffmann, Udo. ·Division of Cardiac CT/PET/MR, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA, sjanjua@partners.org. ·Curr Cardiol Rep · Pubmed #25725603.

ABSTRACT: Each year, 11 million patients present in the USA with new symptoms suggestive of obstructive coronary artery disease (CAD). Most undergo stress testing but <10% demonstrate myocardial ischemia. Moreover, up to 60% will have CAD which adversely affects outcomes. Cardiac computed tomography (CCT) is being used increasingly as an alternative to stress testing to rule out obstructive CAD in symptomatic patients, and large cohort studies in asymptomatic patients have identified burden of coronary atherosclerosis as a predictor of major adverse cardiovascular events (MACE). This review article will critically evaluate major clinical studies on the use of CCT in both symptomatic and asymptomatic patients and discuss the lessons for the clinical use of CCT.

9 Review Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. 2015

Takx, Richard A P / Blomberg, Björn A / El Aidi, Hamza / Habets, Jesse / de Jong, Pim A / Nagel, Eike / Hoffmann, Udo / Leiner, Tim. ·From the Departments of Radiology (R.A.P.T., B.A.B., H.E.A., J.H., P.A.d.J., T.L.) and Cardiology (H.E.A.), University Medical Center Utrecht, Utrecht, The Netherlands · Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.P.T., U.H.) · and Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, London, United Kingdom (E.N.). ·Circ Cardiovasc Imaging · Pubmed #25596143.

ABSTRACT: BACKGROUND: Hemodynamically significant coronary artery disease is an important indication for revascularization. Stress myocardial perfusion imaging is a noninvasive alternative to invasive fractional flow reserve for evaluating hemodynamically significant coronary artery disease. The aim was to determine the diagnostic accuracy of myocardial perfusion imaging by single-photon emission computed tomography, echocardiography, MRI, positron emission tomography, and computed tomography compared with invasive coronary angiography with fractional flow reserve for the diagnosis of hemodynamically significant coronary artery disease. METHODS AND RESULTS: The meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. PubMed, EMBASE, and Web of Science were searched until May 2014. Thirty-seven studies, reporting on 4721 vessels and 2048 patients, were included. Meta-analysis yielded pooled sensitivity, pooled specificity, pooled likelihood ratios (LR), pooled diagnostic odds ratio, and summary area under the receiver operating characteristic curve. The negative LR (NLR) was chosen as the primary outcome. At the vessel level, MRI (pooled NLR, 0.16; 95% confidence interval [CI], 0.13-0.21) was performed similar to computed tomography (pooled NLR, 0.22; 95% CI, 0.12-0.39) and positron emission tomography (pooled NLR, 0.15; 95% CI, 0.05-0.44), and better than single-photon emission computed tomography (pooled NLR, 0.47; 95% CI, 0.37-0.59). At the patient level, MRI (pooled NLR, 0.14; 95% CI, 0.10-0.18) performed similar to computed tomography (pooled NLR, 0.12; 95% CI, 0.04-0.33) and positron emission tomography (pooled NLR, 0.14; 95% CI, 0.02-0.87), and better than single-photon emission computed tomography (pooled NLR, 0.39; 95% CI, 0.27-0.55) and echocardiography (pooled NLR, 0.42; 95% CI, 0.30-0.59). CONCLUSIONS: Stress myocardial perfusion imaging with MRI, computed tomography, or positron emission tomography can accurately rule out hemodynamically significant coronary artery disease and can act as a gatekeeper for invasive revascularization. Single-photon emission computed tomography and echocardiography are less suited for this purpose.

10 Review Comprehensive plaque assessment by coronary CT angiography. 2014

Maurovich-Horvat, Pál / Ferencik, Maros / Voros, Szilard / Merkely, Béla / Hoffmann, Udo. ·MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, 68 Varosmajor ut, 1025 Budapest, Hungary. · Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114. USA. · Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794 USA. ·Nat Rev Cardiol · Pubmed #24755916.

ABSTRACT: Most acute coronary syndromes are caused by sudden luminal thrombosis due to atherosclerotic plaque rupture or erosion. Preventing such an event seems to be the only effective strategy to reduce mortality and morbidity of coronary heart disease. Coronary lesions prone to rupture have a distinct morphology compared with stable plaques, and provide a unique opportunity for noninvasive imaging to identify vulnerable plaques before they lead to clinical events. The submillimeter spatial resolution and excellent image quality of modern computed tomography (CT) scanners allow coronary atherosclerotic lesions to be detected, characterized, and quantified. Large plaque volume, low CT attenuation, napkin-ring sign, positive remodelling, and spotty calcification are all associated with a high risk of acute cardiovascular events in patients. Computation fluid dynamics allow the calculation of lesion-specific endothelial shear stress and fractional flow reserve, which add functional information to plaque assessment using CT. The combination of morphologic and functional characteristics of coronary plaques might enable noninvasive detection of vulnerable plaques in the future.

11 Review Computed tomography imaging of cardiac allograft vasculopathy. 2012

Ferencik, Maros / Brady, Thomas J / Hoffmann, Udo. ·Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA. maros_ferencik@hms.harvard.edu ·J Cardiovasc Comput Tomogr · Pubmed #22732195.

ABSTRACT: Cardiac allograft vasculopathy (CAV) is the main cause of morbidity and mortality beyond 1 year after heart transplantation. Ischemic symptoms are usually not present because of the denervated allograft and diffuse nature of the disease. Patients present with heart failure, ventricular arrhythmia, or sudden cardiac death as a result of advanced CAV. Therefore, clinical evaluation includes routine annual invasive coronary angiography (ICA) and transthoracic echocardiography to screen for CAV. Noninvasive imaging methods for the detection of CAV have not been widely adopted. Computed tomography (CT) permits detection of coronary stenoses and plaque in the nontransplant population. The strength of CT is its high negative predictive value. These attributes predispose CT to a role of a gatekeeper for further invasive testing in heart transplant recipients. We reviewed the available literature on CT evaluation of CAV. Technical challenges (eg, high heart rates, need for contrast and radiation, image quality) specific for patients who have received a heart transplant are emphasized, and solutions, including appropriate protocols and advances through the new CT technology, are summarized. We systematically analyze the results of studies that report the diagnostic performance of cardiac CT for the detection of coronary stenoses compared with ICA. Similar analysis is performed for the comparison between CT and intravascular ultrasound scanning for the detection of nonobstructive CAV. Finally, we suggest future directions in cardiac CT imaging research of CAV.

12 Review Complementary value of cardiac FDG PET and CT for the characterization of atherosclerotic disease. 2011

Stolzmann, Paul / Subramanian, Sharath / Abdelbaky, Amr / Maurovich-Horvat, Pál / Scheffel, Hans / Tawakol, Ahmed / Hoffmann, Udo. ·Massachusetts General Hospital, Boston, MA 02114, USA. paul.stolzmann@usz.ch ·Radiographics · Pubmed #21918043.

ABSTRACT: For decades, the identification of significant luminal narrowing has been the hallmark to characterize the presence and extent of coronary artery disease. However, it is now known that characterizations of systemic atherosclerosis burden and inflammation, as well as the local quality of plaque composition and morphology, allow better characterization of coronary artery disease and thus may allow improved prediction of adverse cardiovascular events. Plaque characterized histologically as a thin-cap fibroatheroma (ie, an atheroma with a thin fibrous cap, an underlying lipid-rich necrotic core, and inflammatory activity) has been recognized as representing vulnerable or high-risk plaque. Positron emission tomography (PET) and cardiac computed tomography (CT) are noninvasive modalities that provide metabolic (PET) and morphologic (CT) information about atherosclerotic plaque. PET allows the quantification of the uptake of fluorine 18 fluorodeoxyglucose (FDG) within the arterial wall, which provides a measure of macrophage activity within atheromatous plaque. Coronary CT allows the depiction of plaque morphology and composition. Thus, integrated imaging with PET and CT (PET/CT) permits coregistration of FDG activity with the presence and morphology of plaque and may lead to improved characterization of vulnerable plaque or vulnerable patients, or both. This review details the methods and principles of cardiac FDG PET and coronary CT and provides an overview of the research, with an emphasis on the identification and characterization of vulnerable plaque.

13 Review Meta-analysis and systematic review of the long-term predictive value of assessment of coronary atherosclerosis by contrast-enhanced coronary computed tomography angiography. 2011

Bamberg, Fabian / Sommer, Wieland H / Hoffmann, Verena / Achenbach, Stephan / Nikolaou, Konstantin / Conen, David / Reiser, Maximilian F / Hoffmann, Udo / Becker, Christoph R. ·Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany. fbamberg@post.harvard.edu ·J Am Coll Cardiol · Pubmed #21658564.

ABSTRACT: OBJECTIVES: We conducted a systematic review and meta-analysis to determine the predictive value of findings of coronary computed tomography angiography for incident cardiovascular events. BACKGROUND: Initial studies indicate a prognostic value of the technique; however, the level of evidence as well as exact independent risk estimates remain unclear. METHODS: We searched PubMed, EMBASE, and the Cochrane Library through January 2010 for studies that followed up ≥ 100 subjects for ≥ 1 year and reported at ≥ 1 hazard ratio (HR) of interest. Risk estimates for the presence of significant coronary stenosis (primary endpoint; ≥ 50% diameter stenosis), left main coronary artery stenosis, each coronary stenosis, 3-vessel disease, any plaque, per coronary segment containing plaque, and noncalcified plaque were derived in random effect regression analysis, and causes of heterogeneity were determined in meta-regression analysis. RESULTS: We identified 11 eligible articles including 7,335 participants (age 59.1 ± 2.6 years, 62.8% male) with suspected coronary artery disease. The presence of ≥ 1 significant coronary stenosis (9 studies, 3,670 participants, and 252 outcome events [6.8%] with 62% revascularizations) was associated with an annualized event rate of 11.9% (6.4% in studies excluding revascularization). The corresponding HR was 10.74 (98% confidence interval [CI]: 6.37 to 18.11) and 6.15 (95% CI: 3.22 to 11.74) in studies excluding revascularization. Adjustment for coronary calcification did not attenuate the prognostic significance (p = 0.79). The estimated HRs for left main stenosis, presence of plaque, and each coronary segment containing plaque were 6.64 (95% CI: 2.6 to 17.3), 4.51 (95% CI: 2.2 to 9.3), and 1.23 (95% CI: 1.17 to 1.29), respectively. CONCLUSIONS: Presence and extent of coronary artery disease on coronary computed tomography angiography are strong, independent predictors of cardiovascular events despite heterogeneity in endpoints, categorization of computed tomography findings, and study population.

14 Review Methods of plaque quantification and characterization by cardiac computed tomography. 2009

Maurovich-Horvat, Pal / Ferencik, Maros / Bamberg, Fabian / Hoffmann, Udo. ·Department of Radiology, Cardiac MR PET CT Program, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA. maurovich.horvat@gmail.com ·J Cardiovasc Comput Tomogr · Pubmed #20129522.

ABSTRACT: The pathologic evolution of coronary artery atherosclerosis occurs slowly over decades, which may provide an opportunity for diagnostic imaging to identify patients before clinical events evolve. Cardiac computed tomography (CT) is an emerging noninvasive imaging tool, which can visualize the entire coronary tree with submillimeter resolution. We reviewed the current status of cardiac CT to qualitatively and quantitatively determine coronary plaque dimensions and composition, and its potential to improve our understanding of the natural history of coronary artery disease as well as prevention of cardiovascular events.

15 Clinical Trial Serum oxidized low-density lipoprotein decreases in response to statin therapy and relates independently to reductions in coronary plaque in patients with HIV. 2016

Nou, Eric / Lu, Michael T / Looby, Sara E / Fitch, Kathleen V / Kim, Elli A / Lee, Hang / Hoffmann, Udo / Grinspoon, Steven K / Lo, Janet. ·aProgram in Nutritional Metabolism bCardiovascular Imaging Section, Department of Radiology cBiostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA. ·AIDS · Pubmed #26558731.

ABSTRACT: OBJECTIVE: Circulating oxidized low-density lipoprotein (oxLDL) levels are elevated in HIV-infected patients and have been associated with atherosclerosis. Statins have been shown to reduce plaque on coronary computed tomography angiography (cCTA) in HIV-infected individuals. Thus, we investigated the effect of statins on serum oxLDL levels and the relationship between changes in oxLDL and coronary atherosclerosis on cCTA in patients with HIV. DESIGN: We previously conducted a 12-month randomized, placebo-controlled trial with atorvastatin in 40 HIV-infected patients on stable antiretroviral therapy with subclinical coronary atherosclerosis and low-density lipoprotein (LDL)-cholesterol less than 130 mg/dl. METHODS: In the current analysis, patients underwent cCTA and measurements of serum oxLDL, sCD14, sCD163, lipoprotein phospholipase-A2, and fasting lipids at baseline and end of the study. RESULTS: Nineteen patients were randomized to atorvastatin and 21 patients to placebo. Serum oxLDL decreased -22.7% (95% CI -28.7 to -16.7) in the atorvastatin group and increased 7.5% (95% CI -3.3 to 18.4) in the placebo group (P < 0.0001). Change in oxLDL significantly correlated with changes in noncalcified plaque volume, total plaque volume, positively remodeled plaque, and low attenuation plaque. The association between changes in oxLDL and noncalcified plaque volume was independent of the baseline 10-year Framingham risk, LDL, CD4 cell count, and viral load. CONCLUSION: Statins lower oxLDL levels in HIV-infected patients, and reductions in oxLDL are related to improvements in coronary atherosclerosis, independent of traditional cardiovascular risk factors. Reductions in oxLDL may be one mechanism through which statins exert beneficial effects on reducing atherosclerosis in HIV-infected individuals.

16 Clinical Trial QCT Volumetric Bone Mineral Density and Vascular and Valvular Calcification: The Framingham Study. 2015

Chan, Jimmy J / Cupples, L Adrienne / Kiel, Douglas P / O'Donnell, Christopher J / Hoffmann, Udo / Samelson, Elizabeth J. ·Albert Einstein College of Medicine, Bronx, NY, USA. · Boston University School of Public Health, Boston, MA, USA. · National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA. · Harvard Medical School, Boston, MA, USA. · Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA. · Beth Israel Deaconess Medical Center, Boston, MA, USA. · Massachusetts General Hospital, Boston, MA, USA. ·J Bone Miner Res · Pubmed #25871790.

ABSTRACT: There is increasing evidence that bone and vascular calcification share common pathogenesis. Little is known about potential links between bone and valvular calcification. The purpose of this study was to determine the association between spine bone mineral density (BMD) and vascular and valvular calcification. Participants included 1317 participants (689 women, 628 men) in the Framingham Offspring Study (mean age 60 years). Integral, trabecular, and cortical volumetric bone density (vBMD) and arterial and valvular calcification were measured from computed tomography (CT) scans and categorized by sex-specific quartiles (Q4 = high vBMD). Calcification of the coronary arteries (CAC), abdominal aorta (AAC), aortic valve (AVC), and mitral valve (MVC) were quantified using the Agatston Score (AS). Prevalence of any calcium (AS >0) was 69% for CAC, 81% for AAC, 39% for AVC, and 20% for MVC. In women, CAC increased with decreasing quartile of trabecular vBMD: adjusted mean CAC = 2.1 (Q4), 2.2 (Q3), 2.5 (Q2), 2.6 (Q1); trend p = 0.04. However, there was no inverse trend between CAC and trabecular vBMD in men: CAC = 4.3 (Q4), 4.3 (Q3), 4.2 (Q2), 4.3 (Q1); trend p = 0.92. AAC increased with decreasing quartile of trabecular vBMD in both women (AAC = 4.5 [Q4], 4.8 [Q3], 5.4 [Q2], 5.1 [Q1]; trend p = 0.01) and men (AAC = 5.5 [Q4], 5.8 [Q3], 5.9 [Q2], 6.2 [Q1]; trend p = 0.01). We observed no association between trabecular vBMD and AVC or MVC in women or men. Finally, cortical vBMD was unrelated to vascular calcification and valvular calcification in women and men. Women and men with low spine vBMD have greater severity of vascular calcification, particularly at the abdominal aorta. The inverse relation between AAC and spine vBMD in women and men may be attributable to shared etiology and may be an important link on which to focus treatment efforts that can target individuals at high risk of both fracture and cardiovascular events.

17 Clinical Trial Potential for coronary CT angiography to tailor medical therapy beyond preventive guideline-based recommendations: insights from the ROMICAT I trial. 2015

Pursnani, Amit / Schlett, Christopher L / Mayrhofer, Thomas / Celeng, Csilla / Zakroysky, Pearl / Bamberg, Fabian / Nagurney, John T / Truong, Quynh A / Hoffmann, Udo. ·Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA; Cardiology Division, Evanston Hospital, Walgreen Building 3rd Floor, 2650 Ridge Ave, Evanston, IL 60201, USA. Electronic address: apursnani@northshore.org. · Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany. · Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA. · Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Department of Clinical Radiology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany. · Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, NY, USA. ·J Cardiovasc Comput Tomogr · Pubmed #25846248.

ABSTRACT: BACKGROUND: Coronary CT angiography (CCTA) is used in the emergency department to rule out acute coronary syndrome in low-intermediate risk patients. OBJECTIVES: We evaluated the potential of CCTA to tailor aspirin (ASA) and statin therapy in acute chest pain patients. METHODS: We included all patients in the ROMICAT I trial who underwent CCTA before admission. Results of CCTA were blinded to caretakers. We documented ASA and statin therapy at admission and discharge and determined change in medications during hospitalization, agreement of discharge medications with contemporaneous guidelines, and agreement with the presence and severity of coronary artery disease (CAD) as determined by CCTA. RESULTS: We included 368 patients (53 ± 12 years; 61% male). Baseline medical therapy at presentation included 27% on ASA and 24% on statin. Most patients who qualified for secondary prevention were on ASA and statin therapy at discharge (95% and 80%, respectively), whereas among those qualifying for primary prevention therapy, only 59% of patients were on aspirin and 33% were on statin at discharge. Excluding secondary prevention patients, among those with CCTA-detected CAD, only 66/131 (50%) were on ASA at discharge and only 53/131 (40%) were on statin. Conversely, in those without CCTA-detected CAD, 54/156 (35%) were on ASA and 20/151 (13%) were on statin at discharge. CONCLUSION: There are significant discrepancies between discharge prescription of statin and ASA with the presence and extent of CAD. CCTA presents an efficient opportunity to tailor medical therapy to CAD in patients undergoing CCTA as part of their acute chest pain evaluation.

18 Clinical Trial High-risk coronary plaque at coronary CT angiography is associated with nonalcoholic fatty liver disease, independent of coronary plaque and stenosis burden: results from the ROMICAT II trial. 2015

Puchner, Stefan B / Lu, Michael T / Mayrhofer, Thomas / Liu, Ting / Pursnani, Amit / Ghoshhajra, Brian B / Truong, Quynh A / Wiviott, Stephen D / Fleg, Jerome L / Hoffmann, Udo / Ferencik, Maros. ·From the Department of Radiology (S.B.P., M.T.L., T.M., T.L., A.P., B.B.G., Q.A.T., U.H., M.F.), Cardiac MR PET CT Program (S.B.P., M.T.L., T.M., T.L., A.P., B.B.G., Q.A.T., U.H., M.F.), and Cardiology Division (Q.A.T., M.F.), Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St, Suite 400, Boston, MA 02114 · Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (S.B.P.) · Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.D.W.) · and Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Md (J.L.F.). ·Radiology · Pubmed #25369449.

ABSTRACT: PURPOSE: To determine the association between nonalcoholic fatty liver disease (NAFLD) and the presence of high-risk coronary atherosclerotic plaque as assessed with coronary computed tomographic (CT) angiography. MATERIALS AND METHODS: This study was approved by the local ethics committees; informed consent was obtained. Patients randomized to the coronary CT angiography arm of the Rule Out Myocardial Infarction using Computer Assisted Tomography, or ROMICAT, II trial who underwent both nonenhanced CT to assess calcium score and contrast material-enhanced coronary CT angiography were included. Readers assessed coronary CT angiography images for the presence of coronary plaque, significant stenosis (≥50%), and high-risk plaque features (positive remodeling, CT attenuation < 30 HU, napkin-ring sign, spotty calcium). NAFLD was defined as hepatic steatosis at nonenhanced CT (liver minus spleen CT attenuation < 1 HU) without evidence of clinical liver disease, liver cirrhosis, or alcohol abuse. To determine the association between high-risk plaque and NAFLD, univariable and multivariable logistic regression analyses were performed, with high-risk plaque as a dependent variable and NAFLD, traditional risk factors, and extent of coronary atherosclerosis as independent variables. RESULTS: Overall, 182 (40.9%) of 445 patients had CT evidence of NAFLD. High-risk plaque was more frequent in patients with NAFLD than in patients without NAFLD (59.3% vs 19.0%, respectively; P < .001). The association between NAFLD and high-risk plaque (odds ratio, 2.13; 95% confidence interval: 1.18, 3.85) persisted after adjusting for the extent and severity of coronary atherosclerosis and traditional risk factors. CONCLUSION: NAFLD is associated with advanced high-risk coronary plaque, independent of traditional cardiovascular risk factors and the extent and severity of coronary artery disease.

19 Clinical Trial Aortic distensibility and its relationship to coronary and thoracic atherosclerosis plaque and morphology by MDCT: insights from the ROMICAT Trial. 2013

Siegel, Emily / Thai, Wai-Ee / Techasith, Tust / Major, Gyongyi / Szymonifka, Jackie / Tawakol, Ahmed / Nagurney, John T / Hoffmann, Udo / Truong, Quynh A. ·Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. ·Int J Cardiol · Pubmed #22578738.

ABSTRACT: BACKGROUND: Multi-detector cardiac computed tomography (CT) allows for simultaneous assessment of aortic distensibility (AD), coronary atherosclerosis, and thoracic aortic atherosclerosis. OBJECTIVES: We sought to determine the relationship of AD to the presence and morphological features in coronary and thoracic atherosclerosis. METHODS: In 293 patients (53 ± 12 years, 63% male), retrospectively-gated MDCT were performed. We measured intraluminal aortic areas across 10 phases of the cardiac cycle (multiphase reformation 10% increments) at pre-defined locations to calculate the ascending, descending, and local AD (at locations of thoracic plaque). AD was calculated as maximum change in area/(minimum area × pulse pressure). Coronary and thoracic plaques were categorized as calcified, mixed, or non-calcified. RESULTS: Ascending and descending AD were lower in patients with any coronary plaque, calcified or mixed plaque than those without (all p<0.0001) but not with non-calcified coronary plaque (p ≥ 0.46). Per 1mm Hg(-1) 10(-3) increase in ascending and descending AD, there was an 18-29% adjusted risk reduction for having any coronary, calcified plaque, or mixed coronary plaque (ascending AD only) (all p ≤ 0.04). AD was not associated with non-calcified coronary plaque or when age was added to the models (all p>0.39). Local AD was lower at locations of calcified and mixed thoracic plaque when compared to non-calcified thoracic atherosclerosis (p<0.04). CONCLUSIONS: A stiffer, less distensible aorta is associated with coronary and thoracic atherosclerosis, particularly in the presence of calcified and mixed plaques, suggesting that the mechanism of atherosclerosis in small and large vessels is similar and influenced by advancing age.

20 Clinical Trial Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography. 2012

Jensen, Jesper K / Medina, Hector M / Nørgaard, Bjarne L / Øvrehus, Kristian A / Jensen, Jesper M / Nielsen, Lene H / Maurovich-Horvat, Pal / Engel, Leif-Christopher / Januzzi, James L / Hoffmann, Udo / Truong, Quynh A. ·Department of Cardiology, Vejle Hospital, Denmark. jesperkjensen@dadlnet.dk ·Int J Cardiol · Pubmed #21543126.

ABSTRACT: BACKGROUND: While patients with coronary artery disease (CAD) and cerebrovascular disease share similar risk factor profiles, data on whether IS can be considered a "CAD equivalent" are limited. We aimed to determine whether ischemic stroke is an independent predictor of CAD by using cardiac computed tomography angiography (CTA). METHODS: We analyzed the CTA in 392 patients with no history of CAD (24 patients with acute IS and 368 patients with acute chest pain). Extent of plaque burden was additionally dichotomized into 0-4 versus >4 segments. RESULTS: Patients with IS had a near 5-fold increase odds of having coronary artery plaque (odds ratio [OR] 4.9, P<0.01) as compared to those without IS. After adjustment for age, gender, and traditional cardiac risk factors, there remained a near 4-fold increase odds for coronary plaque (adjusted OR 3.7, P=0.04). When stratified by extent of plaque, patients with IS had over 18-fold increase odds of having >4 segments of plaque than 0-4 segments as compared to patients without stroke (OR 18.3, P<0.01), which remained significantly associated in adjusted analysis (adjusted OR 12.1, P<0.001). CONCLUSION: Acute IS is independently associated with higher risk and greater extent of CAD compared to patients with acute chest pain at low-to-intermediate risk for acute coronary syndrome.

21 Clinical Trial Influence of pericoronary adipose tissue on local coronary atherosclerosis as assessed by a novel MDCT volumetric method. 2011

Maurovich-Horvat, Pál / Kallianos, Kimberly / Engel, Leif-Christopher / Szymonifka, Jackie / Fox, Caroline S / Hoffmann, Udo / Truong, Quynh A. ·Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, United States. ·Atherosclerosis · Pubmed #21782176.

ABSTRACT: OBJECTIVE: Pericoronary adipose tissue (PCAT) may create a pro-inflammatory state, contributing to the development of coronary artery disease (CAD). We sought to evaluate the feasibility of a novel volumetric PCAT quantification method using a novel threshold based computed tomography approach. In addition we determined the relation between PCAT volumes and CAD. METHODS: In 51 patients (49.5±5.1 years, 64.8% male) who underwent 64-slice MDCT, we measured threshold-based PCAT volumes using distance and anatomic-based methods. Using the most reproducible method, we performed the proximal 40-mm distance measurement in three groups as stratified by coronary plaque and high-sensitivity C-reactive protein (hs-CRP) levels: Group 1 (presence of coronary plaque, hs-CRP >2.0 mg/L); an intermediate group (Group 2, no plaque, hs-CRP >2.0 mg/L); and Group 3 (no plaque, hs-CRP<1.0 mg/L). We compared PCAT volumes to the presence of coronary plaque on a patient (n=51) and vessel (n=153) basis. On a subsegment basis (n=1224), we compared PCAT volume to the presence of plaque as well as plaque morphology. RESULTS: Distance-based PCAT volume measurements yielded excellent reproducibility with intra-observer intraclass correlation (ICC) of 0.997 and inter-observer ICC of 0.951. On a both a per-patient and per-vessel analysis, adjusted PCAT volume was greater in patients with plaque (Group 1) than without plaque (Groups 2 and 3, p<0.001). No difference in PCAT volume was seen between high and low hs-CRP groups without plaque (p=0.51). Adjusted PCAT volumes were higher in subsegments with plaque as compared without (p<0.001). Additionally, adjusted PCAT volume was greatest in subsegments with mixed plaque followed by non-calcified plaque, calcified plaque, and the lowest volume in segments with no plaque (p<0.001). CONCLUSION: In this proof-of-concept study, threshold based PCAT volume assessment is feasible and highly reproducible. PCAT volume is increased in patients and vessels with coronary plaques. Surrounding vessel subsegments with coronary plaque, particularly mixed plaques, have greatest PCAT volume and highlight the effect of local PCAT in the development of coronary atherosclerosis.

22 Article Secondary cardiac risk stratifying tests after coronary computed tomography angiography in emergency department patients. 2018

Verheij, Vincent A / Scholtz, Jan-Erik / Meyersohn, Nandini M / Parry, Blair A / Hoffmann, Udo / Ghoshhajra, Brian B / Nagurney, John T. ·Department of Emergency Medicine, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: v.a.verheij@gmail.com. · Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: jscholtz@mgh.harvard.edu. · Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: nmeyersohn@partners.org. · Department of Emergency Medicine and Division of Research, Massachusetts General Hospital, 5 Emerson Place, Boston, MA, 02114, USA. Electronic address: bparry@mgh.harvard.edu. · Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: uhoffmann@mgh.harvard.edu. · Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: bghoshhajra@mgh.harvard.edu. · Department of Emergency Medicine, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: jnagurney@mgh.harvard.edu. ·J Cardiovasc Comput Tomogr · Pubmed #30340962.

ABSTRACT: BACKGROUND: Several large trials demonstrated that coronary computed tomography angiography (CTA) in a triage strategy could lead to increased secondary cardiac risk stratifying testing (SCRST). Whether this is true for routine clinical care remains unclear. We measured SCRSTs after coronary CTA was implemented in our emergency department (ED) practice by CTA result, and if locally existing management recommendations for a structured post CTA diagnostic strategy were followed. METHODS: This single site retrospective cohort study included all our ED patients who received coronary CTA between October 1, 2012 and September 30, 2016. SCRST's included functional cardiac tests and invasive coronary angiography (ICA), performed during the ED coronary CTA visit or related admission. RESULTS: A total of 1916 subjects were included with a mean age of 52.9 ± 10.8 years. Of their coronary CTAs, 179 were positive (severe stenosis, occlusion or ventricular wall motion abnormalities; 9.3%), 105 intermediate (moderate stenosis; 5.5%), 1611 negative (no to mild obstructive CAD; 84.1%) and 21 non-diagnostic (1.1%). SCRSTs were performed in 237 (overall 12.4%, noninvasive in 5.6%, ICA in 6.7%). After positive coronary CTA, 73.7% of subjects received SCRSTs. For intermediate, negative and non-diagnostic CTAs this was 72.4%, 1.1% and 47.6% respectively. Management conformed to local management recommendations in 96.2% of cases. CONCLUSION: In spite of previous trials, rates of secondary cardiac risk stratifying tests after routine clinical ED coronary CTA are low, especially in patients with negative coronary CTA. Structured management guidelines for post coronary CTA, and adherence to these guidelines, appear essential.

23 Article Brief Report: Statin Effects on Myocardial Fibrosis Markers in People Living With HIV. 2018

deFilippi, Christopher / Christenson, Robert / Joyce, Jessica / Park, Elli A / Wu, Ashley / Fitch, Kathleen V / Looby, Sara E / Lu, Michael T / Hoffmann, Udo / Grinspoon, Steven K / Lo, Janet. ·Inova Heart and Vascular Institute, Falls Church, VA. · Department of Pathology, University of Maryland School of Medicine, Baltimore, MD. · Endocrine Division, Department of Medicine, Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, MA. · Department of Radiology, Cardiovascular Imaging Section, Massachusetts General Hospital, Boston, MA. ·J Acquir Immune Defic Syndr · Pubmed #29419569.

ABSTRACT: BACKGROUND: In observational studies, patients with HIV have higher levels of soluble ST2 (sST2), galectin-3, and growth differentiation factor-15 (GDF-15) than non-HIV controls. As statins exert pleiotropic immunomodulatory effects that may affect markers of myocardial fibrosis, the objective of the current study is to determine whether biomarkers of myocardial fibrosis reflecting subclinical pathology may be modified by statin therapy in patients with HIV. SETTING AND METHODS: Forty HIV+ men and women participated in a single center 12-month randomized, double-blind placebo-controlled trial of atorvastatin 40 mg every day vs. placebo. At baseline and 12-months, sST2, GDF-15, galectin-3 were measured. RESULTS: The changes in sST2 were -0.310 (-4.195, 2.075) vs. 1.163 (0.624, 4.715) ng/mL, median (interquartile range) atorvastatin vs. placebo (P = 0.04). The change in sST2 was significantly related to changes in monocyte activation marker sCD14 (r = 0.63, P < 0.0001) and MCP (r = 0.52, P = 0.0009), markers of generalized inflammation hs-IL-6 (r = 0.58, P = 0.0002), oxLDL (r = 0.49, P = 0.002), and GDF-15 (r = 0.54, P = 0.0008). CONCLUSIONS: sST2, a member of the IL-1 receptor family and a marker of fibrosis and inflammation increases over time among patients with HIV and this increase is attenuated by statin therapy in HIV. This effect may relate to immunomodulatory mechanisms of statins.

24 Article Central Core Laboratory versus Site Interpretation of Coronary CT Angiography: Agreement and Association with Cardiovascular Events in the PROMISE Trial. 2018

Lu, Michael T / Meyersohn, Nandini M / Mayrhofer, Thomas / Bittner, Daniel O / Emami, Hamed / Puchner, Stefan B / Foldyna, Borek / Mueller, Martin E / Hearne, Steven / Yang, Clifford / Achenbach, Stephan / Truong, Quynh A / Ghoshhajra, Brian B / Patel, Manesh R / Ferencik, Maros / Douglas, Pamela S / Hoffmann, Udo. ·From the Cardiac PET MR CT Program, Massachusetts General Hosp and Harvard Medical School, Boston, Mass (M.T.L., N.M.M., T.M., D.O.B., H.E., S.B.P., B.B.G., B.F., M.E.M., M.F., U.H.) · School of Business Studies, Stralsund Univ of Applied Sciences, Stralsund, Germany (T.M.) · Dept of Internal Medicine (Cardiology), Friedrich Alexander Univ Hosp, Erlangen, Germany (D.O.B., S.A.) · Dept of Angiography and Interventional Radiology, Medical Univ Vienna, Vienna, Austria (S.B.P.) · Delmarva Health LLC, Salisbury, Md (S.H.) · Dept of Radiology, Univ of Connecticut Health Ctr, Farmington, Conn (C.Y.) · Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College, New York, NY (Q.A.T.) · Duke Clinical Research Inst, Duke Univ School of Medicine, Durham, NC (M.R.P., P.S.D.) · and Knight Cardiovascular Inst, Oregon Health & Science Univ, Portland, Ore (M.F.). ·Radiology · Pubmed #29178815.

ABSTRACT: Purpose To assess concordance and relative prognostic utility between central core laboratory and local site interpretation for significant coronary artery disease (CAD) and cardiovascular events. Materials and Methods In the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial, readers at 193 North American sites interpreted coronary computed tomographic (CT) angiography as part of the clinical evaluation of stable chest pain. Readers at a central core laboratory also interpreted CT angiography blinded to clinical data, site interpretation, and outcomes. Significant CAD was defined as stenosis greater than or equal to 50%; cardiovascular events were defined as a composite of cardiovascular death or myocardial infarction. Results In 4347 patients (51.8% women; mean age ± standard deviation, 60.4 years ± 8.2), core laboratory and site interpretations were discordant in 16% (683 of 4347), most commonly because of a finding of significant CAD by site but not by core laboratory interpretation (80%, 544 of 683). Overall, core laboratory interpretation resulted in 41% fewer patients being reported as having significant CAD (14%, 595 of 4347 vs 23%, 1000 of 4347; P < .001). Over a median follow-up period of 25 months, 1.3% (57 of 4347) sustained myocardial infarction or cardiovascular death. The C statistic for future myocardial infarction or cardiovascular death was 0.61 (95% confidence interval [CI]: 0.54, 0.68) for the core laboratory and 0.63 (95% CI: 0.56, 0.70) for the sites. Conclusion Compared with interpretation by readers at 193 North American sites, standardized core laboratory interpretation classified 41% fewer patients as having significant CAD.

25 Article Longitudinal Associations of Pericardial and Intrathoracic Fat With Progression of Coronary Artery Calcium (from the Framingham Heart Study). 2018

Lee, Jane J / Pedley, Alison / Hoffmann, Udo / Massaro, Joseph M / O'Donnell, Christopher J / Benjamin, Emelia J / Long, Michelle T. ·National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts. · Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts. · Department of Biostatistics, Boston University, Boston, Massachusetts. · National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts; Cardiology Section, Boston Veterans Administration Healthcare, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts. · National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts; Department of Medicine, Sections of Cardiovascular Medicine and Preventive Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts. · National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts; Department of Medicine, Section of Gastroenterology, Boston University School of Medicine, Boston, Massachusetts. Electronic address: mtlong@bu.edu. ·Am J Cardiol · Pubmed #29146023.

ABSTRACT: Cross-sectional studies have shown that pericardial fat is associated with atherosclerotic burden above and beyond generalized and central adiposity. Whether pericardial fat is longitudinally associated with coronary artery calcium (CAC) has not been firmly established. We examined the associations between cardiac ectopic fat including pericardial and intrathoracic fat with CAC progression and incidence in a community-based study setting. Study participants were from the Framingham Heart Study Offspring and Third Generation Cohorts who underwent multidetector computed tomography at 2 consecutive examinations (2002 to 2005 and 2008 to 2011) for the assessment of CAC. Multivariable-adjusted regression models were used to evaluate the associations between cardiac ectopic fat with CAC. Nonlinear associations were also examined. We included 1,732 participants (49.6% women, mean age 49.9 years). Of the 1,024 participants with a CAC score = 0 at baseline, 197 individuals developed a CAC score > 0 (19.2%) during 6.1 years of follow-up. The remaining 708 participants with a CAC score > 0 at baseline were eligible for CAC progression analysis. We identified nonlinear association between pericardial fat and CAC progression. Higher pericardial fat was associated with higher CAC progression only for those participants with pericardial fat higher than the median value (β = 56.0, p = 0.04). Intrathoracic fat was linearly associated with CAC progression (β = 23.0, p = 0.02). However, all of these associations did not persist after additional adjustment for body mass index, abdominal visceral adipose tissue, or waist circumference (all p ≥ 0.14). Neither pericardial nor intrathoracic fat were associated with CAC incidence (all p ≥ 0.33). Overall, both of the cardiac ectopic fat measures were longitudinally associated with CAC progression.

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