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Coronary Artery Disease: HELP
Articles by Sang Eun Lee
Based on 28 articles published since 2010
(Why 28 articles?)
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Between 2010 and 2020, Sang-Eun Lee wrote the following 28 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 / Anonymous7470967. ·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 Review Should CT replace IVUS for evaluation of CAD in large-scale clinical trials: Effects of medical therapy on atherosclerotic plaque. 2019

Lee, Sang-Eun / Villines, Todd C / Chang, Hyuk-Jae. ·Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Cardiac CT Program and Cardiovascular Research, Walter Reed National Military Medical Center, Bethesda, MD, USA. Electronic address: todd.c.villines.mil@mail.mil. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. ·J Cardiovasc Comput Tomogr · Pubmed #31351840.

ABSTRACT: Clinical trials assessing the effect of medical therapies on atherosclerotic plaques have hitherto employed invasive imaging techniques such as intravascular ultrasound (IVUS). This has limited the study population to high-risk patients in whom invasive coronary angiography is indicated; moreover, IVUS typically is performed utilizing a target lesion-based analysis. Recently, comprehensive quantitative analysis of all atherosclerotic plaques in the complete coronary artery network has become possible through the use of coronary computed tomography angiography (CCTA). Excellent inter-observer and inter-scan reproducibility of CCTA has been reported. Several studies have already tested the applicability of CCTA-measured plaque volume changes as an imaging surrogate endpoint in clinical trials and have found positive results. Further, substantial evidence supports the use of CCTA as a novel imaging surrogate that can accurately assess the changes in plaque characteristics according to medical treatment. In this review, we summarize current evidences that support the use of CCTA as a novel imaging surrogate that can replace IVUS in evaluating the results of treatment. We also attempt to determine whether the technological advances in CCTA will extend its application beyond use as a diagnostic method in clinical practice to use in large-scale clinical trials.

3 Clinical Trial Rationale and design of the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry: A comprehensive exploration of plaque progression and its impact on clinical outcomes from a multicenter serial coronary computed tomographic angiography study. 2016

Lee, Sang-Eun / Chang, Hyuk-Jae / Rizvi, Asim / Hadamitzky, Martin / Kim, Yong-Jin / Conte, Edoardo / Andreini, Daniele / Pontone, Gianluca / Volpato, Valentina / Budoff, Matthew J / Gottlieb, Ilan / Lee, Byoung Kwon / Chun, Eun Ju / Cademartiri, Filippo / Maffei, Erica / Marques, Hugo / Leipsic, Jonathon A / Shin, Sanghoon / Choi, Jung Hyun / Chung, Namsik / Min, James K. ·Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University Health System, Seoul, South Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA. · Division of Cardiology, University of Munich, Munich, Germany. · Seoul National University Hospital, South Korea. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA. · Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil. · Gangnam Severance Hospital, South Korea. · Seoul National University Bundang Hospital, South Korea. · Department of Radiology, Montréal Heart Institute/Université de Montréal, Montréal, Quebec, Canada. · Hospital da Luz, Lisbon, Portugal. · Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, Canada. · National Health Insurance Service Ilsan Hospital, South Korea. · Busan University Hospital, South Korea. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA. Electronic address: jkm2001@med.cornell.edu. ·Am Heart J · Pubmed #27914502.

ABSTRACT: BACKGROUND: The natural history of coronary artery disease (CAD) in patients with low-to-intermediate risk is not well characterized. Although earlier invasive serial studies have documented the progression of atherosclerotic burden, most were focused on high-risk patients only. The PARADIGM registry is a large, prospective, multinational dynamic observational registry of patients undergoing serial coronary computed tomographic angiography (CCTA). The primary aim of PARADIGM is to characterize the natural history of CAD in relation to clinical and laboratory data. DESIGN: The PARADIGM registry (ClinicalTrials.govNCT02803411) comprises ≥2,000 consecutive patients across 9 cluster sites in 7 countries. PARADIGM sites were chosen on the basis of adequate CCTA volume, site CCTA proficiency, local demographic characteristics, and medical facilities to ensure a broad-based sample of patients. Patients referred for clinically indicated CCTA will be followed up and enrolled if they had a second CCTA scan. Patients will also be followed up beyond serial CCTA performance to identify adverse CAD events that include cardiac and noncardiac death, myocardial infarction, unstable angina, target vessel revascularization, and CAD-related hospitalization. SUMMARY: The results derived from the PARADIGM registry are anticipated to add incremental insight into the changes in CCTA findings in accordance with the progression or regression of CAD that confer prognostic value beyond demographic and clinical characteristics.

4 Article Machine Learning Framework to Identify Individuals at Risk of Rapid Progression of Coronary Atherosclerosis: From the PARADIGM Registry. 2020

Han, Donghee / Kolli, Kranthi K / Al'Aref, Subhi J / Baskaran, Lohendran / van Rosendael, Alexander R / Gransar, Heidi / Andreini, Daniele / Budoff, Matthew J / Cademartiri, Filippo / Chinnaiyan, Kavitha / Choi, Jung Hyun / Conte, Edoardo / Marques, Hugo / de Araújo Gonçalves, Pedro / Gottlieb, Ilan / Hadamitzky, Martin / Leipsic, Jonathon A / Maffei, Erica / Pontone, Gianluca / Raff, Gilbert L / Shin, Sangshoon / Kim, Yong-Jin / Lee, Byoung Kwon / Chun, Eun Ju / Sung, Ji Min / Lee, Sang-Eun / Virmani, Renu / Samady, Habib / Stone, Peter / Narula, Jagat / Berman, Daniel S / Bax, Jeroen J / Shaw, Leslee J / Lin, Fay Y / Min, James K / Chang, Hyuk-Jae. ·Division of Cardiology Severance Cardiovascular Hospital Yonsei University College of Medicine Yonsei University Health System Seoul South Korea. · Department of Radiology NewYork-Presbyterian Hospital and Weill Cornell Medicine New York NY. · Department of Imaging Cedars Sinai Medical Center Los Angeles CA. · Centro Cardiologico Monzino IRCCS Milan Italy. · Department of Medicine Los Angeles Biomedical Research Institute Torrance CA. · Cardiovascular Imaging Center SDN IRCCS Naples Italy. · Department of Cardiology William Beaumont Hospital Royal Oak MI. · Pusan National University Hospital Busan South Korea. · UNICA Unit of Cardiovascular Imaging Hospital da Luz Lisboa Portugal. · Department of Radiology Casa de Saude São Jose Rio de Janeiro Brazil. · Department of Radiology and Nuclear Medicine German Heart Center Munich Germany. · Department of Medicine and Radiology University of British Columbia Vancouver BC Canada. · Department of Radiology Area Vasta 1/ASUR Urbino Italy. · Ewha Womans University Seoul Hospital Seoul South Korea. · Seoul National University Hospital Seoul South Korea. · Gangnam Severance Hospital Yonsei University College of Medicine Seoul Korea. · Seoul National University Bundang Hospital Sungnam South Korea. · Department of Pathology CVPath Institute Gaithersburg MD. · Division of Cardiology Emory University School of Medicine Atlanta GA. · Cardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston MA. · Icahn School of Medicine at Mount Sinai Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health New York NY. · Department of Imaging and Medicine Cedars Sinai Medical Center Los Angeles CA. · Department of Cardiology Leiden University Medical Center Leiden the Netherlands. ·J Am Heart Assoc · Pubmed #32089046.

ABSTRACT: Background Rapid coronary plaque progression (RPP) is associated with incident cardiovascular events. To date, no method exists for the identification of individuals at risk of RPP at a single point in time. This study integrated coronary computed tomography angiography-determined qualitative and quantitative plaque features within a machine learning (ML) framework to determine its performance for predicting RPP. Methods and Results Qualitative and quantitative coronary computed tomography angiography plaque characterization was performed in 1083 patients who underwent serial coronary computed tomography angiography from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) registry. RPP was defined as an annual progression of percentage atheroma volume ≥1.0%. We employed the following ML models: model 1, clinical variables; model 2, model 1 plus qualitative plaque features; model 3, model 2 plus quantitative plaque features. ML models were compared with the atherosclerotic cardiovascular disease risk score, Duke coronary artery disease score, and a logistic regression statistical model. 224 patients (21%) were identified as RPP. Feature selection in ML identifies that quantitative computed tomography variables were higher-ranking features, followed by qualitative computed tomography variables and clinical/laboratory variables. ML model 3 exhibited the highest discriminatory performance to identify individuals who would experience RPP when compared with atherosclerotic cardiovascular disease risk score, the other ML models, and the statistical model (area under the receiver operating characteristic curve in ML model 3, 0.83 [95% CI 0.78-0.89], versus atherosclerotic cardiovascular disease risk score, 0.60 [0.52-0.67]; Duke coronary artery disease score, 0.74 [0.68-0.79]; ML model 1, 0.62 [0.55-0.69]; ML model 2, 0.73 [0.67-0.80]; all

5 Article Coronary artery bypass graft versus percutaneous coronary intervention in acute heart failure. 2020

Lee, Sang Eun / Lee, Hae-Young / Cho, Hyun-Jai / Choe, Won-Seok / Kim, Hokon / Choi, Jin Oh / Jeon, Eun-Seok / Kim, Min-Seok / Hwang, Kyung-Kuk / Chae, Shung Chull / Baek, Sang Hong / Kang, Seok-Min / Choi, Dong-Ju / Yoo, Byung-Su / Kim, Kye Hun / Cho, Myeong-Chan / Kim, Jae-Joong / Oh, Byung-Hee. ·Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. · Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. · Sungkyunkwan University College of Medicine, Seoul, Korea. · Chungbuk National University College of Medicine, Cheongju, Korea. · Kyungpook National University College of Medicine, Daegu, Korea. · The Catholic University of Korea, Seoul, Korea. · Yonsei University College of Medicine, Seoul, Korea. · Seoul National University Bundang Hospital, Seongnam, Korea. · Yonsei University Wonju College of Medicine, Wonju, Korea. · Heart Research Center of Chonnam National University, Gwangju, Korea. ·Heart · Pubmed #30209124.

ABSTRACT: OBJECTIVE: Myocardial ischaemia is a leading cause of acute heart failure (AHF). However, optimal revascularisation strategies in AHF are unclear. We aimed to compare two revascularisation strategies, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), in patients with AHF. METHODS: Among 5625 consecutive patients enrolled prospectively in the Korean Acute Heart Failure registry from March 2011 to February 2014, 717 patients who received CABG or PCI during the index hospitalisation for AHF were included in this analysis. We compared adverse outcomes (death, rehospitalisation for HF aggravation or cardiovascular causes, ischaemic stroke and a composite outcome of death and rehospitalisation for HF aggravation or cardiovascular causes) with the use of propensity score matching. RESULTS: For the propensity score-matched cohort with 190 patients, CABG had a lower risk of all-cause mortality than PCI (83 vs 147 deaths per 1000 patient-years; HR 0.57, 95% CI 0.34 to 0.96, p=0.033) during the median follow-up of 4 years. There was also a trend towards lower rates of rehospitalisation due to cardiovascular events or HF aggravation. Subgroup analysis revealed that the adverse outcomes were significantly lower in the CABG group than in PCI group, especially in patients with old age, three-vessel diseases, significant proximal left anterior descending artery disease and those without left main vessel disease or chronic total occlusion. CONCLUSIONS: Compared with PCI, CABG is associated with significant lower all-cause mortality in patients with AHF. Further studies should evaluate proper revascularisation strategies in AHF. CLINICAL TRIAL REGISTRATION: NCT01389843; Results.

6 Article Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA. 2019

Lee, Sang-Eun / Sung, Ji Min / Andreini, Daniele / Al-Mallah, Mouaz H / Budoff, Matthew J / Cademartiri, Filippo / Chinnaiyan, Kavitha / Choi, Jung Hyun / Chun, Eun Ju / Conte, Edoardo / Gottlieb, Ilan / Hadamitzky, Martin / Kim, Yong Jin / Lee, Byoung Kwon / Leipsic, Jonathon A / Maffei, Erica / Marques, Hugo / de Araújo Gonçalves, Pedro / Pontone, Gianluca / Raff, Gilbert L / Shin, Sanghoon / Stone, Peter H / Samady, Habib / Virmani, Renu / Narula, Jagat / Berman, Daniel S / Shaw, Leslee J / Bax, Jeroen J / Lin, Fay Y / Min, James K / Chang, Hyuk-Jae. ·Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy. · Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas. · Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California. · Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy. · Department of Cardiology, William Beaumont Hospital, Royal Oak, Minnesota. · Pusan University Hospital, Busan, South Korea. · Seoul National University Bundang Hospital, Seongnam, South Korea. · Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil. · Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. · Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. · Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. · Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Radiology, Area Vasta 1/ Azienda Sanitaria Unica Regionale (ASUR) Marche, Urbino, Italy. · UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal. · Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea. · Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts. · Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. · Department of Pathology, CVPath Institute, Gaithersburg, Maryland. · Icahn School of Medicine at Mount Sinai, New York, New York. · Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California. · Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. · Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. ·JACC Cardiovasc Imaging · Pubmed #31734214.

ABSTRACT: OBJECTIVES: This study explored whether the pattern of nonobstructive lesion progression into obstructive lesions would differ according to the presence of high-risk plaque (HRP). BACKGROUND: It is still debatable whether HRP simply represents a certain phase during the natural history of coronary atherosclerotic plaques or if disease progression would differ according to the presence of HRP. METHODS: Patients with nonobstructive coronary artery disease, defined as percent diameter stenosis (%DS) <50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. HRP was defined as lesions with ≥2 features of positive remodeling, spotty calcification, or low-attenuation plaque. Quantitative total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions. RESULTS: A total of 3,049 nonobstructive lesions were identified from 1,297 patients (mean age 60.3 ± 9.3 years; 56.8% men). There were 2,624 non-HRP and 425 HRP lesions. HRP lesions had a greater total PAV and all noncalcified components of PAV and %DS at baseline compared with non-HRP lesions. However, the annualized total PAV changes were greater in non-HRP lesions than in HRP lesions. On multivariate analysis adjusted for clinical risk factors, drug use, change in lipid level, total PAV, %DS, and HRP, only the baseline total PAV and %DS independently predicted the development of obstructive lesions (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02 to 1.07, and HR: 1.07; 95% CI: 1.04 to 1.10, respectively, all p < 0.05), whereas the presence of HRP did not (p > 0.05). CONCLUSIONS: The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV, not the presence of HRP features, was the most important predictor of lesions developing into obstructive lesions. (Progression of Atherosclerotic Plaque Determined By Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411).

7 Article PM2.5 concentration in the ambient air is a risk factor for the development of high-risk coronary plaques. 2019

Yang, Seokhun / Lee, Seung-Pyo / Park, Jun-Bean / Lee, Heesun / Kang, Si-Hyuck / Lee, Sang-Eun / Kim, Juyong Brian / Choi, Su-Yeon / Kim, Yong-Jin / Chang, Hyuk-Jae. ·Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. · Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 737, Yeoksam-dong, Gangnam-gu, Seoul 06236, Korea. · Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. · Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA. ·Eur Heart J Cardiovasc Imaging · Pubmed #31410457.

ABSTRACT: AIMS: We aimed to investigate whether long-term exposure to particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) in the ambient air is related to the development or growth of coronary plaques. METHODS AND RESULTS: This study involved 364 residents of Seoul, Korea, who underwent serial coronary computed tomographic angiography (CCTA) at an interval of ≥2 years. Each participant's average concentration of residential PM2.5 between the two CCTAs was calculated. Primary endpoint was the development of high-risk plaque (HRP), defined as a plaque with low attenuation, spotty calcium, and positive remodelling. Secondary endpoints were the volume increase of total plaque and its component volume. Among those without HRP at baseline (n = 341), 20 patients developed HRP at follow-up CCTA, the residential PM2.5 concentration of which was significantly higher than those without HRP at follow-up (25.8 ± 2.0 vs. 25.0 ± 1.7 μg/m3 for patients with newly developed HRP vs. patients without HRP at follow-up; P = 0.047). An increase in PM2.5 concentration was associated with increased incidence of HRP at follow-up [adjusted hazard ratio (aHR) 1.62, 95% confidence interval (CI) 1.22-2.15, P < 0.001]. In a secondary analysis, the PM2.5 concentration was associated with an increased risk of the formation of either fibrofatty or necrotic core component in newly developed plaques (aHR 1.41, 95% CI 1.23-1.61, P < 0.001), and with a higher risk of total plaque volume progression in the pre-existing plaques (aHR 1.14, 95% CI 1.05-1.23, P = 0.002). CONCLUSION: Exposure to higher concentration of PM2.5 in the ambient air is significantly associated with the development of high-risk coronary plaques.

8 Article Longitudinal assessment of coronary plaque volume change related to glycemic status using serial coronary computed tomography angiography: A PARADIGM (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging) substudy. 2019

Won, Ki-Bum / Lee, Sang-Eun / Lee, Byoung Kwon / Park, Hyung-Bok / Heo, Ran / Rizvi, Asim / Lin, Fay Y / Kumar, Amit / Hadamitzky, Martin / Kim, Yong-Jin / Sung, Ji Min / Conte, Edoardo / Andreini, Daniele / Pontone, Gianluca / Budoff, Matthew J / Gottlieb, Ilan / Chun, Eun Ju / Cademartiri, Filippo / Maffei, Erica / Marques, Hugo / Leipsic, Jonathon A / Shin, Sanghoon / Choi, Jung Hyun / Virmani, Renu / Samady, Habib / Chinnaiyan, Kavitha / Raff, Gilbert L / Stone, Peter H / Berman, Daniel S / Narula, Jagat / Shaw, Leslee J / Bax, Jeroen J / Min, James K / Chang, Hyuk-Jae. ·Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea; Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. · Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Department of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea. · Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Department of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea. · Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA; Department of Radiology, Mayo Clinic, Rochester, MN, USA. · Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA. · Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. · Seoul National University Hospital, Seoul, South Korea. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA. · Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil. · Department of Radiology, Seoul National University Bundang Hospital, Sungnam, South Korea. · Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy. · Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy. · UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal. · Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada. · Department of Cardiology, National Health Insurance Service Ilsan Hospital, South Korea. · Department of Cardiology, Busan University Hospital, Busan, South Korea. · Department of Pathology, CVPath Institute, Gaithersburg, MD, USA. · Department of Cardiology, Emory University School of Medicine, Atlanta, GA, USA. · Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA. · Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. · Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA. · Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, And Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA. · Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. · Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. ·J Cardiovasc Comput Tomogr · Pubmed #30580992.

ABSTRACT: BACKGROUND: Data on the impact of glycemic status on coronary plaque progression have been limited. This study evaluated the association between glycemic status and coronary plaque volume change (PVC) using coronary computed tomography angiography (CCTA). METHODS: A total of 1296 subjects (61 ± 9, 56.9% male) who underwent serial CCTA with available glycemic status were enrolled and analyzed from the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry. The median inter-scan period was 3.2 (2.6-4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were categorized into the following groups according to glycemic status: normal, pre-diabetes (pre-DM), and diabetes mellitus (DM). RESULTS: During the follow-up, significant differences in PVC (normal: 51.3 ± 83.3 mm CONCLUSION: DM had an incremental impact on coronary PP, but pre-DM appeared to have no significant association with an increased risk of coronary PP after adjusting for confounding factors. CLINICAL TRIAL REGISTRATION: ClinicalTrials.govNCT02803411.

9 Article Selective Referral Using CCTA Versus Direct Referral for Individuals Referred to Invasive Coronary Angiography for Suspected CAD: A Randomized, Controlled, Open-Label Trial. 2019

Chang, Hyuk-Jae / Lin, Fay Y / Gebow, Dan / An, Hae Young / Andreini, Daniele / Bathina, Ravi / Baggiano, Andrea / Beltrama, Virginia / Cerci, Rodrigo / Choi, Eui-Young / Choi, Jung-Hyun / Choi, So-Yeon / Chung, Namsik / Cole, Jason / Doh, Joon-Hyung / Ha, Sang-Jin / Her, Ae-Young / Kepka, Cezary / Kim, Jang-Young / Kim, Jin-Won / Kim, Sang-Wook / Kim, Woong / Pontone, Gianluca / Valeti, Uma / Villines, Todd C / Lu, Yao / Kumar, Amit / Cho, Iksung / Danad, Ibrahim / Han, Donghee / Heo, Ran / Lee, Sang-Eun / Lee, Ji Hyun / Park, Hyung-Bok / Sung, Ji-Min / Leflang, David / Zullo, Joseph / Shaw, Leslee J / Min, James K. ·Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. · MDDX, San Francisco, California. · Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · CARE Hospital and FACTS Foundation, Hyderabad, India. · Quanta Diagnostico Nuclear, Curitiba, Brazil. · Gangnam Severance Hospital, Seoul, South Korea. · Pusan National University Hospital, Busan, South Korea. · Ajou University Hospital, Gyeonggi-do, South Korea. · Cardiology Associates of Mobile, Mobile, Alabama. · Inje University, Ilsan Paik Hospital, Gyeonggi-do, South Korea. · Gangneung Asan Hospital, Gangwon-do, South Korea. · Kangwon National University Hospital, Gangwon-do, South Korea. · Institute of Cardiology, Warsaw, Poland. · Wonju Severance Hospital, Gangwon-do, South Korea. · Korea University Guro Hospital, Seoul, South Korea. · Chung-Ang University Hospital, Seoul, South Korea. · Yeungnam University Hospital, Daegu, South Korea. · University of Minnesota, Minneapolis, Minnesota. · Walter Reed Medical Center, Bethesda, Maryland. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; VU Medical Center, Amsterdam, the Netherlands. · Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. · Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. · Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, South Korea. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. Electronic address: https://twitter.com/lesleejshaw. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. Electronic address: jkm2001@med.cornell.edu. ·JACC Cardiovasc Imaging · Pubmed #30553687.

ABSTRACT: OBJECTIVES: This study compared the safety and diagnostic yield of a selective referral strategy using coronary computed tomographic angiography (CCTA) compared with a direct referral strategy using invasive coronary angiography (ICA) as the index procedure. BACKGROUND: Among patients presenting with signs and symptoms suggestive of coronary artery disease (CAD), a sizeable proportion who are referred to ICA do not have a significant, obstructive stenosis. METHODS: In a multinational, randomized clinical trial of patients referred to ICA for nonemergent indications, a selective referral strategy was compared with a direct referral strategy. The primary endpoint was noninferiority with a multiplicative margin of 1.33 of composite major adverse cardiovascular events (blindly adjudicated death, myocardial infarction, unstable angina, stroke, urgent and/or emergent coronary revascularization or cardiac hospitalization) at a median follow-up of 1-year. RESULTS: At 22 sites, 823 subjects were randomized to a selective referral and 808 to a direct referral strategy. At 1 year, selective referral met the noninferiority margin of 1.33 (p = 0.026) with a similar event rate between the randomized arms of the trial (4.6% vs. 4.6%; hazard ratio: 0.99; 95% confidence interval: 0.66 to 1.47). Following CCTA, only 23% of the selective referral arm went on to ICA, which was a rate lower than that of the direct referral strategy. Coronary revascularization occurred less often in the selective referral group compared with the direct referral to ICA (13% vs. 18%; p < 0.001). Rates of normal ICA were 24.6% in the selective referral arm compared with 61.1% in the direct referral arm of the trial (p < 0.001). CONCLUSIONS: In stable patients with suspected CAD who are eligible for ICA, the comparable 1-year major adverse cardiovascular events rates following a selective referral and direct referral strategy suggests that both diagnostic approaches are similarly effective. In the selective referral strategy, the reduced use of ICA was associated with a greater diagnostic yield, which supported the usefulness of CCTA as an efficient and accurate method to guide decisions of ICA performance. (Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization [CONSERVE]; NCT01810198).

10 Article Consistency of quantitative analysis of coronary computed tomography angiography. 2019

Lee, Sang-Eun / Park, Hyung-Bok / Xuan, Dongchun / Lee, Byoung Kwon / Hong, Myeong-Ki / Jang, Yangsoo / Chang, Hyuk-Jae. ·Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea. · Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea; Division of Cardiology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea. · Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea. · Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. ·J Cardiovasc Comput Tomogr · Pubmed #30342980.

ABSTRACT: BACKGROUND: The present study aimed to assess the reliability and reproducibility of coronary computed tomography angiography (CCTA) for the serial quantitative assessment of plaque volume. METHODS: Patients who underwent repeated CCTA scans within 90 days were retrospectively screened and enrolled. Clinical data and CCTA imaging data were collected. Paired CCTA scans were analyzed using the quantitative method by separate observers blinded to the other paired CCTA scans. Results were compared between the index CCTA and follow-up CCTA. RESULTS: Paired CT scans of 95 patients (61 ± 13 years; 56.8% men) with same tube voltages (kVp) at both CCTAs and 24 patients (57 ± 19 years; 48.3% men) with different kVp at two CCTAs were analyzed. In patients with same kVp at both CCTAs, there were no difference in PV and PVs of each components in per-segment analysis and per-lesion analysis (all p > 0.05). In per-lesion analysis of CCTAs from patients who used different kVp between two CCTAs, lesion length, area and diameter stenosis, and PVs were not different between index and follow-up CCTAs (all p > 0.05). Segment length and PV were also showed no difference between two serial CCTAs in per-segment analysis. CONCLUSION: We showed the reproducibility and reliability of quantitative analysis of CCTA for assessment of coronary plaques. CCTA can be applied for the serial quantitative assessment of coronary artery disease progression, regardless of differences in the image acquisition protocol.

11 Article Three-Hour Delayed Imaging Improves Assessment of Coronary 2019

Kwiecinski, Jacek / Berman, Daniel S / Lee, Sang-Eun / Dey, Damini / Cadet, Sebastien / Lassen, Martin L / Germano, Guido / Jansen, Maurits A / Dweck, Marc R / Newby, David E / Chang, Hyuk-Jae / Yun, Mijin / Slomka, Piotr J. ·Cedars-Sinai Medical Center, Los Angeles, California. · BHF Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, United Kingdom; and. · Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea. · Cedars-Sinai Medical Center, Los Angeles, California piotr.slomka@cshs.org. ·J Nucl Med · Pubmed #30213848.

ABSTRACT: Coronary

12 Article Feasibility of Coronary 2018

Kwiecinski, Jacek / Adamson, Philip D / Lassen, Martin L / Doris, Mhairi K / Moss, Alastair J / Cadet, Sebastian / Jansen, Maurits A / Dey, Damini / Lee, Sang-Eun / Yun, Mijin / Chang, Hyuk-Jae / Dweck, Marc R / Newby, David E / Berman, Daniel S / Slomka, Piotr J. ·Cedars-Sinai Medical Center, Los Angeles, CA (J.K., M.L.L., S.C., D.D., D.S.B., P.J.S.). · BHF Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, United Kingdom (J.K., P.D.A., M.K.D., A.J.M., M.A.J., M.R.D., D.E.N.). · Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (S.-E.L., M.Y., H.-J.C.). ·Circ Cardiovasc Imaging · Pubmed #30558496.

ABSTRACT: BACKGROUND: We assessed the feasibility of utilizing previously acquired computed tomography angiography (CTA) with subsequent positron-emission tomography (PET)-only scan for the quantitative evaluation of METHODS AND RESULTS: Forty-five patients (age 67.1±6.9 years; 76% males) underwent CTA (CTA1) and combined CONCLUSIONS: Coronary CTA/PET protocol with CTA first followed by PET-only allows for reliable and reproducible quantification of

13 Article Quantification of Coronary Atherosclerosis in the Assessment of Coronary Artery Disease. 2018

Lee, Sang-Eun / Sung, Ji Min / Rizvi, Asim / Lin, Fay Y / Kumar, Amit / Hadamitzky, Martin / Kim, Yong-Jin / Conte, Edoardo / Andreini, Daniele / Pontone, Gianluca / Budoff, Matthew J / Gottlieb, Ilan / Lee, Byoung Kwon / Chun, Eun Ju / Cademartiri, Filippo / Maffei, Erica / Marques, Hugo / Leipsic, Jonathon A / Shin, Sanghoon / Hyun Choi, Jung / Chinnaiyan, Kavitha / Raff, Gilbert / Virmani, Renu / Samady, Habib / Stone, Peter H / Berman, Daniel S / Narula, Jagat / Shaw, Leslee J / Bax, Jeroen J / Min, James K / Chang, Hyuk-Jae. ·Division of Cardiology, Severance Cardiovascular Hospital (H.-J.C., S.-E.L., J.M.S.). · Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center (H.-J.C., S.-E.L., J.M.S.). · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (A.K., A.R., F.Y.L., J.K.M.). · Department of Radiology and Nuclear Medicine, German Heart Center Munich (M.H.). · Seoul National University College of Medicine, Seoul National University Hospital, South Korea (Y.-J.K.). · Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico Milan, Italy (E.C., G.A., G.P.). · Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.). · Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.). · Gangnam Severance Hospital (B.K.L.), Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Seoul National University Bundang Hospital, South Korea (E.J.C.). · Cardiovascular Imaging Center, SDN Foundation IRCCS, Naples, Italy (F.C.). · Department of Radiology, Area Vasta 1/Azienda Sanitaria Unica Regionale Marche Marche, Urbino, Italy (E.M.). · Hospital da Luz, Lisbon, Portugal (H.M.). · Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, Canada (J.A.L.). · National Health Insurance Service Ilsan Hospital, South Korea (S.S.). · Busan University Hospital, South Korea (J.H.C.). · Department of Cardiology, William Beaumont Hospital, Royal Oak, MI (G.R., K.C.). · Department of Pathology, CVPath Institute, Gaithersburg, MD (R.V.). · Division of Cardiology, Emory University School of Medicine, Atlanta, GA (H.S., L.J.S.). · Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (P.H.S.). · Department of Imaging, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.S.B.). · Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY (J.N.). · Department of Cardiology, Leiden University Medical Center, The Netherlands (J.J.B.). · Division of Cardiology, Severance Cardiovascular Hospital (H.-J.C., S.-E.L., J.M.S.) hjchang@yuhs.ac. ·Circ Cardiovasc Imaging · Pubmed #30012825.

ABSTRACT: BACKGROUND: Diagnosis of coronary artery disease and management strategies have relied solely on the presence of diameter stenosis ≥50%. We assessed whether direct quantification of plaque burden (PB) and plaque characteristics assessed by coronary computed tomography angiography could provide additional value in terms of predicting rapid plaque progression. METHODS AND RESULTS: From a 13-center, 7-country prospective observational registry, 1345 patients (60.4±9.4 years old; 57.1% male) who underwent repeated coronary computed tomography angiography >2 years apart were enrolled. For conventional angiographic analysis, the presence of stenosis ≥50%, number of vessel involved, segment involvement score, and the presence of high-risk plaque feature were determined. For quantitative analyses, PB and annual change in PB (△PB/y) in the entire coronary tree were assessed. Clinical outcomes (cardiac death, nonfatal myocardial infarction, and coronary revascularization) were recorded. Rapid progressors, defined as a patient with ≥median value of △PB/y (0.33%/y), were older, more frequently male, and had more clinical risk factors than nonrapid progressors (all CONCLUSIONS: Direct quantification of atherosclerotic PB in addition to conventional angiographic assessment of coronary artery disease might be beneficial for improving risk stratification of coronary artery disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02803411.

14 Article Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study. 2018

Lee, Sang-Eun / Chang, Hyuk-Jae / Sung, Ji Min / Park, Hyung-Bok / Heo, Ran / Rizvi, Asim / Lin, Fay Y / Kumar, Amit / Hadamitzky, Martin / Kim, Yong Jin / Conte, Edoardo / Andreini, Daniele / Pontone, Gianluca / Budoff, Matthew J / Gottlieb, Ilan / Lee, Byoung Kwon / Chun, Eun Ju / Cademartiri, Filippo / Maffei, Erica / Marques, Hugo / Leipsic, Jonathon A / Shin, Sanghoon / Choi, Jung Hyun / Chinnaiyan, Kavitha / Raff, Gilbert / Virmani, Renu / Samady, Habib / Stone, Peter H / Berman, Daniel S / Narula, Jagat / Shaw, Leslee J / Bax, Jeroen J / Min, James K. ·Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. · Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Department of Internal Medicine, Division of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea. · Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York. · Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. · Seoul National University College of Medicine, Seoul National University Hospital, South Korea. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California. · Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil. · Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. · Seoul National University Bundang Hospital, Seoul, South Korea. · Cardiovascular Imaging Center, SDN Foundation IRCCS, Naples, Italy. · Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy. · UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal. · Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada. · National Health Insurance Service Ilsan Hospital, Goyang, South Korea. · Busan University Hospital, Busan, South Korea. · Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan. · Department of Pathology, CVPath Institute, Gaithersburg, Maryland. · Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. · Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California. · Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New York. · Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. ·JACC Cardiovasc Imaging · Pubmed #29909109.

ABSTRACT: OBJECTIVES: This study sought to describe the impact of statins on individual coronary atherosclerotic plaques. BACKGROUND: Although statins reduce the risk of major adverse cardiovascular events, their long-term effects on coronary atherosclerosis remain unclear. METHODS: We performed a prospective, multinational study consisting of a registry of consecutive patients without history of coronary artery disease who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. Atherosclerotic plaques were quantitatively analyzed for percent diameter stenosis (%DS), percent atheroma volume (PAV), plaque composition, and presence of high-risk plaque (HRP), defined by the presence of ≥2 features of low-attenuation plaque, positive arterial remodeling, or spotty calcifications. RESULTS: Among 1,255 patients (60 ± 9 years of age; 57% men), 1,079 coronary artery lesions were evaluated in statin-naive patients (n = 474), and 2,496 coronary artery lesions were evaluated in statin-taking patients (n = 781). Compared with lesions in statin-naive patients, those in statin-taking patients displayed a slower rate of overall PAV progression (1.76 ± 2.40% per year vs. 2.04 ± 2.37% per year, respectively; p = 0.002) but more rapid progression of calcified PAV (1.27 ± 1.54% per year vs. 0.98 ± 1.27% per year, respectively; p < 0.001). Progression of noncalcified PAV and annual incidence of new HRP features were lower in lesions in statin-taking patients (0.49 ± 2.39% per year vs. 1.06 ± 2.42% per year and 0.9% per year vs. 1.6% per year, respectively; all p < 0.001). The rates of progression to >50% DS were not different (1.0% vs. 1.4%, respectively; p > 0.05). Statins were associated with a 21% reduction in annualized total PAV progression above the median and 35% reduction in HRP development. CONCLUSIONS: Statins were associated with slower progression of overall coronary atherosclerosis volume, with increased plaque calcification and reduction of high-risk plaque features. Statins did not affect the progression of percentage of stenosis severity of coronary artery lesions but induced phenotypic plaque transformation. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411).

15 Article Impact of optimal glycemic control on the progression of coronary artery calcification in asymptomatic patients with diabetes. 2018

Won, Ki-Bum / Han, Donghee / Lee, Ji Hyun / Lee, Sang-Eun / Sung, Ji Min / Choi, Su-Yeon / Chun, Eun Ju / Park, Sung Hak / Han, Hae-Won / Sung, Jidong / Jung, Hae Ok / Chang, Hyuk-Jae. ·Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea; Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, South Korea. · Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, South Korea. · Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea. · Division of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea. · Division of Radiology, Gangnam Heartscan Clinic, Seoul, South Korea. · Department of Internal Medicine, Gangnam Heartscan Clinic, Seoul, South Korea. · Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul, South Korea. · Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. · Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, South Korea. Electronic address: hjchang@yuhs.ac. ·Int J Cardiol · Pubmed #29887457.

ABSTRACT: BACKGROUND: Data on the impact of optimal glycemic control (OGC) on the progression of coronary artery calcification, an important marker for future adverse cardiovascular events in individuals with diabetes are limited. METHODS: We investigated 1637 asymptomatic adults with diabetes (56 ± 8 years, 88.8% men) and no history of coronary artery disease or stroke, who underwent serial coronary artery calcium (CAC) screening. The median inter-scan period was 3.0 (2.0-4.4) years. The change in CAC was compared base on OGC status. OGC was defined as a follow-up hemoglobin A1C (HbA1C) of <7.0%, and CAC progression was defined by a square root (√) transformed difference between the baseline and follow-up CAC scores (Δ √transformed CAC) of ≥2.5. RESULTS: Despite no significant difference in the baseline CAC scores, the incidence of CAC progression was lower in the OGC group than in the non-OGC group (45.4% vs. 51.7%; p < 0.013). The two groups differed in the Δ √transformed (OGC, 3.8 ± 6.4; non-OGC, 4.7 ± 6.9; p = 0.016) and annualized Δ √transformed CAC (OGC, 1.1 ± 2.4; non-OGC, 1.4 ± 2.6; p = 0.010) scores. Subgroup analysis showed that OGC significantly reduced the risk of CAC progression in patients aged <65 years and in: smokers, and patients with a body mass index of <25 kg/m CONCLUSION: OGC attenuated the progression of coronary artery calcification in asymptomatic patients with diabetes.

16 Article Coronary Atherosclerotic Precursors of Acute Coronary Syndromes. 2018

Chang, Hyuk-Jae / Lin, Fay Y / Lee, Sang-Eun / Andreini, Daniele / Bax, Jeroen / Cademartiri, Filippo / Chinnaiyan, Kavitha / Chow, Benjamin J W / Conte, Edoardo / Cury, Ricardo C / Feuchtner, Gudrun / Hadamitzky, Martin / Kim, Yong-Jin / Leipsic, Jonathon / Maffei, Erica / Marques, Hugo / Plank, Fabian / Pontone, Gianluca / Raff, Gilbert L / van Rosendael, Alexander R / Villines, Todd C / Weirich, Harald G / Al'Aref, Subhi J / Baskaran, Lohendran / Cho, Iksung / Danad, Ibrahim / Han, Donghee / Heo, Ran / Lee, Ji Hyun / Rivzi, Asim / Stuijfzand, Wijnand J / Gransar, Heidi / Lu, Yao / Sung, Ji Min / Park, Hyung-Bok / Berman, Daniel S / Budoff, Matthew J / Samady, Habib / Shaw, Leslee J / Stone, Peter H / Virmani, Renu / Narula, Jagat / Min, James K. ·Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea. · Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. · Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands. · Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy. · Department of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan. · Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada. · Baptist Cardiac and Vascular Institute, Miami, Florida. · Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. · Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. · Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea. · Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy. · UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal. · Cardiology Service, Walter Reed National Military Center, Bethesda, Maryland. · Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea; Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Chung-Ang University Hospital, Seoul, South Korea. · VU University Medical Center, Amsterdam, the Netherlands. · Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea; Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. · Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. · Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Department of Radiology, Mayo Clinic, Rochester, Minnesota. · Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, California. · Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California. · Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. · Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts. · CVPath Institute, Gaithersburg, Maryland. · Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New York. · Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. Electronic address: jkm2001@med.cornell.edu. ·J Am Coll Cardiol · Pubmed #29852975.

ABSTRACT: BACKGROUND: The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden. OBJECTIVES: The purpose of this study was to identify atherosclerotic features associated with precursors of ACS. METHODS: We performed a nested case-control study within a cohort of 25,251 patients undergoing coronary computed tomographic angiography (CTA) with follow-up over 3.4 ± 2.1 years. Patients with ACS and nonevent patients with no prior coronary artery disease (CAD) were propensity matched 1:1 for risk factors and coronary CTA-evaluated obstructive (≥50%) CAD. Separate core laboratories performed blinded adjudication of ACS and culprit lesions and quantification of baseline coronary CTA for percent diameter stenosis (%DS), percent cross-sectional plaque burden (PB), plaque volumes (PVs) by composition (calcified, fibrous, fibrofatty, and necrotic core), and presence of high-risk plaques (HRPs). RESULTS: We identified 234 ACS and control pairs (age 62 years, 63% male). More than 65% of patients with ACS had nonobstructive CAD at baseline, and 52% had HRP. The %DS, cross-sectional PB, fibrofatty and necrotic core volume, and HRP increased the adjusted hazard ratio (HR) of ACS (1.010 per %DS, 95% confidence interval [CI]: 1.005 to 1.015; 1.008 per percent cross-sectional PB, 95% CI: 1.003 to 1.013; 1.002 per mm CONCLUSIONS: Although ACS increases with %DS, most precursors of ACS cases and culprit lesions are nonobstructive. Plaque evaluation, including HRP, PB, and plaque composition, identifies high-risk patients above and beyond stenosis severity and aggregate plaque burden.

17 Article Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy. 2018

Weir-McCall, Jonathan R / Blanke, Philipp / Sellers, Stephanie L / Ahmadi, Amir A / Andreini, Daniele / Budoff, Matthew J / Cademartiri, Filippo / Chinnaiyan, Kavitha / Choi, Jung Hyun / Chun, Eun Ju / Conte, Edoardo / Gottlieb, Ilan / Hadamitzky, Martin / Kim, Yong Jin / Lee, Byoung Kwon / Lee, Sang-Eun / Maffei, Erica / Marques, Hugo / Pontone, Gianluca / Raff, Gilbert L / Shin, Sanghoon / Sung, Ji Min / Stone, Peter / Samady, Habib / Virmani, Renu / Narula, Jagat / Berman, Daniel S / Shaw, Leslee J / Bax, Jeroen J / Lin, Fay Y / Min, James K / Chang, Hyuk-Jae / Leipsic, Jonathon A. ·St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada. · St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada. · Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA. · Cardiovascular Imaging Center, IRCCS SDN Foundation, Naples, Italy. · Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA. · Busan University Hospital, Busan, South Korea. · Seoul National University Bundang Hospital, South Korea. · Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil. · Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. · Seoul National University College of Medicine, Seoul National University Hospital, South Korea. · Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy. · UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal. · National Health Insurance Service Ilsan Hospital, South Korea. · Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA. · Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA. · Department of Pathology, CVPath Institute, Gaithersburg, Maryland, USA. · Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA. · Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA. · St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada. Electronic address: jleipsic@providencehealth.bc.ca. ·J Cardiovasc Comput Tomogr · Pubmed #29802032.

ABSTRACT: BACKGROUND: The aim of the study is examine the impact of non-obstructive (<50%stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA). METHODS: CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque. RESULTS: Of 944 (62 ± 9 years, 60% male) who had evidence of CAD at baseline, 444 (47%) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5% versus 13%, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components. CONCLUSION: The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies.

18 Article The relationship of insulin resistance estimated by triglyceride glucose index and coronary plaque characteristics. 2018

Won, Ki-Bum / Kim, Yun Seok / Lee, Byoung Kwon / Heo, Ran / Han, Donghee / Lee, Ji Hyun / Lee, Sang-Eun / Sung, Ji Min / Cho, Iksung / Park, Hyung-Bok / Cho, In-Jeong / Chang, Hyuk-Jae. ·Division of Cardiology, Ulsan University Hospital. · Division of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan. · Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine. · Division of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System. · Division of Cardiology, Chung-Ang University Hospital. · Division of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea. ·Medicine (Baltimore) · Pubmed #29794749.

ABSTRACT: The triglyceride glucose (TyG) index is a useful surrogate marker for insulin resistance, which is an important risk factor for coronary artery disease (CAD). However, data on the relationship of the TyG index and coronary plaque characteristics are limited.This study included 2840 participants with near-normal renal function who underwent coronary computed tomography angiography. CAD was defined as the presence of any plaques, and obstructive CAD was defined as the presence of plaques with ≥50% stenosis. The relationship between the TyG index and noncalcified plaque (NCP), calcified or mixed plaque (CMP), and coronary artery calcium score (CACS) was evaluated.All participants were stratified into 4 groups based on the quartiles of the TyG index. The prevalence of CAD and obstructive CAD significantly increased with increasing quartiles. The risk for NCP and obstructive NCP was not different among all groups. However, compared with group I (lowest quartile), the risk for CMP was higher in groups III (odds ratio [OR]: 1.438) and IV (highest quartile) (OR: 1.895) (P < .05), and that for obstructive CMP was higher in groups II (OR: 1.469), III (OR: 1.595), and IV (OR: 2.168) (P < .05). Multivariate regression analysis showed that the TyG index was associated with an increased risk for CAD (OR: 1.700), obstructive CAD (OR: 1.692), and CACS >400 (OR: 1.448) (P < .05).The TyG index was independently associated with the presence and severity of CAD due to an increased risk for CMP.

19 Article Evaluation of the impact of glycemic status on the progression of coronary artery calcification in asymptomatic individuals. 2018

Won, Ki-Bum / Han, Donghee / Lee, Ji Hyun / Lee, Sang-Eun / Sung, Ji Min / Choi, Su-Yeon / Chun, Eun Ju / Park, Sung Hak / Han, Hae-Won / Sung, Jidong / Jung, Hae Ok / Chang, Hyuk-Jae. ·Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. · Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, South Korea. · Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea. · Division of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea. · Division of Radiology, Gangnam Heartscan Clinic, Seoul, South Korea. · Department of Internal Medicine, Gangnam Heartscan Clinic, Seoul, South Korea. · Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul, South Korea. · Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea. · Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, South Korea. hjchang@yuhs.ac. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. hjchang@yuhs.ac. ·Cardiovasc Diabetol · Pubmed #29301531.

ABSTRACT: BACKGROUND: Data on the influence of glycemic status on the progression of coronary calcification, an important marker for future adverse cardiovascular events, are limited. METHODS: Data from the Korea Initiatives on Coronary Artery Calcification (KOICA) registry on 12,441 asymptomatic Korean adults (52 ± 9 years, 84.2% males) without previous history of coronary artery disease and stroke, who underwent serial coronary artery calcification (CAC) screening examinations, were included in this study. The median inter-scan period was 3.0 (2.0-4.8) years. All participants were categorized into three groups based on their glycemic status: normal (n = 6578), pre-diabetes (n = 4146), and diabetes (n = 1717). CAC progression was defined as a difference ≥ 2.5 between the square roots (√) of the baseline and follow-up CAC scores. RESULTS: The incidence of CAC progression was significantly different between the three groups (normal, 26.3%; pre-diabetes, 30.9%; and diabetes, 46.9%; p < 0.001). In the univariate logistic analysis, the risk of CAC progression was higher in the pre-diabetes (odds ratio [OR] 1.253; 95% confidential interval [CI] 1.150-1.366) and diabetes (OR 2.471; 95% CI 2.215-2.758) groups than in the normal group (p < 0.001, both). In the multivariate logistic analysis, the risk of CAC progression was not significantly different between the normal and pre-diabetes groups but was significantly higher in the diabetes group than in the normal group. CONCLUSIONS: In asymptomatic subjects, diabetes had an incremental impact on CAC progression; however, pre-diabetes did not increase the risk of CAC progression after adjusting for confounding factors.

20 Article Rationale and design of the Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization: Relation to Cardiovascular Outcomes, Cost Effectiveness and Quality of Life (CONSERVE) trial. 2017

Lee, Sang-Eun / Lin, Fay Y / Lu, Yao / Chang, Hyuk-Jae / Min, James K. ·Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY. · Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY. Electronic address: jkm2001@med.cornell.edu. ·Am Heart J · Pubmed #28454832.

ABSTRACT: Although coronary computed tomography angiography (CCTA) has shown promise as a "gatekeeper" to invasive coronary angiography (ICA) in longitudinal cohort studies, it remains unknown whether the strategy of selective ICA by initial performance of CCTA is either safe or effective when compared with a direct ICA strategy in patients with an American Heart Association (AHA)/American College of Cardiology (ACC) guideline-directed indication for ICA. OBJECTIVES: The CONSERVE trial is a prospective randomized multicenter trial to determine the clinical effectiveness of "selective catheterization" vs "direct catheterization" strategies for stable patients with suspected but without known coronary artery disease, who meet AHA/ACC guideline indication for ICA. METHODS: Patients being referred for clinically indicated nonemergent ICA with an AHA/ACC class II guideline indication for ICA will be randomized to either direct catheterization or selective catheterization strategy. Patients in the direct catheterization arm will proceed directly to ICA as planned, whereas patients in the select catheterization arm will undergo initial CCTA, followed by ICA at the discretion of the site physician. All CCTAs and ICAs will be interpreted on site. Follow-up testing and/or therapy after CCTA or ICA will be at the discretion of the site physician. RESULTS: This trial will report a primary clinical end point of noninferiority rates of major adverse cardiac events, as defined by the composite of death, nonfatal myocardial infarction, unstable angina, stroke, urgent or emergent coronary revascularization, or cardiac hospitalization. CONCLUSION: The CONSERVE trial will determine whether selective catheterization strategy, based on initial CCTA in patients being referred to ICA, is safe and effective.

21 Article Discrimination of stress (Takotsubo) cardiomyopathy from acute coronary syndrome with clinical risk factors and coronary evaluation in real-world clinical practice. 2017

Lee, So-Ryoung / Lee, Sang Eun / Rhee, Tae-Min / Park, Jin Joo / Cho, Hyunjai / Lee, Hae-Young / Choi, Dong-Ju / Oh, Byung-Hee. ·Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea. · Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: se2se2@snu.ac.kr. · Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. ·Int J Cardiol · Pubmed #28268082.

ABSTRACT: BACKGROUND: Diagnosing stress cardiomyopathy (SCMP) apart from acute coronary syndrome (ACS) is challenging since coronary evaluation is not always feasible in real-world clinical practice. We explored the current practice pattern of coronary evaluation in patients suspected to have SCMP and divulged the distinguishable features of SCMP from ACS. METHODS AND RESULTS: From 2010 to 2015, only 219 out of 691 (32%) hospitalized patients suspected to have SCMP have received coronary evaluation in two tertiary hospitals. After the evaluation, 66 patients (30%) turned out to have ACS. Coronary evaluation was performed based on coronary risk factors, clinical presentations, and test results including electrocardiograms (ECG), cardiac biomarkers, and echocardiography. Whereas initial presentations, ECG changes, cardiac biomarkers, and regional wall motion abnormality patterns were not significantly different, multivariate logistic regression analysis showed that age (≥70years), diabetes, a history of percutaneous coronary intervention (PCI), and the absence of evident triggers were significant factors discriminating ACS from SCMP. A decision tree based on classification and regression analysis also revealed the consistent results. CONCLUSIONS: Although it is hard to differentiate SCMP from ACS merely based on clinical features, a substantial proportion of patients suspected to have SCMP did not undergo coronary evaluation to exclude ACS in real-world clinical practice. Coronary evaluation should be more actively performed in patients with old age, prior PCI history, diabetes, and less evident trigger.

22 Article Noninvasive measurement of pressure gradient across a coronary stenosis using phase contrast (PC)-MRI: A feasibility study. 2017

Deng, Zixin / Fan, Zhaoyang / Lee, Sang-Eun / Nguyen, Christopher / Xie, Yibin / Pang, Jianing / Bi, Xiaoming / Yang, Qi / Choi, Byoung-Wook / Kim, Jung-Sun / Berman, Daniel / Chang, Hyuk-Jae / Li, Debiao. ·Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA. · Department of Bioengineering, University of California, Los Angeles, California, USA. · Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea. · Siemens Healthcare R&D, Los Angeles, USA. · Department of Radiology, Severance Hospital, Seoul, South Korea. · Department of Medicine, University of California, Los Angeles, California, USA. ·Magn Reson Med · Pubmed #28019028.

ABSTRACT: PURPOSE: To investigate the feasibility of blood pressure difference measurement, ΔP, across the coronary artery using phase contrast (PC)-MRI for potential noninvasive assessment of the functional significance of coronary artery stenosis. METHODS: Three-directional velocities in the coronary arteries acquired using 2D-PC-MRI were used with the Navier-Stokes equations to derive ΔP. Repeat phantom studies were performed to assess the reproducibility of flow velocity and ΔP. ΔP derived using PC-MRI (ΔP RESULTS: Phantom: Good overall reproducibility of flow velocity and ΔP measurements and excellent correlation (ΔP CONCLUSION: ΔP

23 Article Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry. 2016

Lee, Joo Myung / Kang, Jeehoon / Lee, Euijae / Hwang, Doyeon / Rhee, Tae-Min / Park, Jonghanne / Kim, Hack-Lyoung / Lee, Sang Eun / Han, Jung-Kyu / Yang, Han-Mo / Park, Kyung Woo / Na, Sang-Hoon / Kang, Hyun-Jae / Koo, Bon-Kwon / Kim, Hyo-Soo. ·Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea. · Department of Medicine, Seoul National University Hospital, Seoul, Korea; Molecular Medicine & Biopharmaceutical Science, Graduate School of Convergence Science & Technology, Seoul National University, Seoul, Korea. · Department of Medicine, Seoul National University Hospital, Seoul, Korea. · Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul, Korea. · Department of Internal Medicine and Emergency Medical Center, Seoul National University Hospital, Seoul, Korea; Institute of Aging, Seoul National University, Seoul, Korea. · Department of Medicine, Seoul National University Hospital, Seoul, Korea; Institute of Aging, Seoul National University, Seoul, Korea. · Department of Medicine, Seoul National University Hospital, Seoul, Korea; Molecular Medicine & Biopharmaceutical Science, Graduate School of Convergence Science & Technology, Seoul National University, Seoul, Korea. Electronic address: hyosoo@snu.ac.kr. ·JACC Cardiovasc Interv · Pubmed #27692820.

ABSTRACT: OBJECTIVES: The purpose of this study was to evaluate the clinical impact of chronic kidney disease (CKD) on clinical outcomes in contemporary practice of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES). BACKGROUND: Although second-generation DES have improved the safety and efficacy issues in PCI, data regarding the performance of second-generation DES in patients with CKD are still limited. METHODS: We performed a patient-level pooled analysis on 12,426 patients undergoing PCI using second-generation DES from the Korean Multicenter Drug-Eluting Stent Registry. Endpoints were stent-oriented outcomes (target lesion failure [TLF]) and patient-oriented composite outcomes (POCO) during a median follow-up of 35 months. CKD patients were stratified by the estimated glomerular filtration rate (eGFR) from mild CKD to end-stage renal disease patients, and by the coexistence of diabetes mellitus (DM). RESULTS: A total of 2,927 patients had CKD (23.6%), who showed a significantly higher risk of TLF (adjusted hazard ratio [HR CONCLUSIONS: In the era of second-generation DES, CKD patients were at a significantly higher risk of clinical outcomes only in severe CKD and end-stage renal disease patients.

24 Article Association of Thoracic Aorta Calcium Score With Exercise Blood Pressure Response and Clinical Outcomes in Elderly Individuals: Differential Impact of Aorta Calcification Compared With Coronary Artery Calcification. 2016

Cho, In-Jeong / Chang, Hyuk-Jae / Cho, Iksung / Heo, Ran / Lee, Sang-Eun / Shim, Chi Young / Hong, Geu-Ru / Chung, Namsik. ·Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea hjchang@yuhs.ac. ·J Am Heart Assoc · Pubmed #27107130.

ABSTRACT: BACKGROUND: The structure of the aorta is considered to influence exercise systolic blood pressure (SBP) response, which, in turn, might impact upon adverse outcomes. The current study sought to investigate the relationship of aortic calcification and exercise SBP with adverse outcomes among elderly individuals. METHODS AND RESULTS: We retrospectively reviewed 702 elderly individuals (>65 years of age) without obstructive coronary artery disease (CAD; luminal stenosis <50%) who underwent coronary computed tomography (CT) and exercise treadmill testing. ΔSBPstage2 and ΔSBPpeak were defined as the difference in systolic blood pressure (SBP) between rest and stage 2 or peak exercise, respectively. Thoracic aortic calcium score (TACS) and coronary artery calcium score (CACS) were measured using CT scanning procedures. The primary endpoints were defined as all-cause death, admission for heart failure, obstructive CAD requiring coronary intervention, and stroke. In multivariable models, ΔSBPstage2 and ΔSBPpeak were positively related with log(TACS+1), even after adjusting for various clinical variables, baseline SBP, and CACS (P<0.001). During a median follow-up period of 65 months, there were 59 events (8.4%). In a multivariate Cox regression model, independent predictors for all events were age (hazard ratio [HR], 1.12; 95% CI, 1.05-1.19; P<0.001), dyslipidemia (HR, 1.96; 95% CI, 1.14-3.37; P=0.015), and the 4th quartile of TACS (HR, 1.24; 95% CI, 1.03-1.49; P=0.024). Among individual events, the 4th quartile of TACS was the only independent predictor for stroke (HR, 2.15; 95% CI, 1.09-5.13; P=0.044), whereas CACS ≥400 mm(3) was an independent predictor for obstructive CAD requiring intervention (HR, 7.04; 95% CI, 1.58-31.36; P=0.010). CONCLUSIONS: Aortic calcification was related to SBP response during exercise and was an independent predictor for outcomes, especially stroke, regardless of resting SBP or CACS.

25 Article Differential Prognostic Value of Coronary Computed Tomography Angiography in Relation to Exercise Electrocardiography in Asymptomatic Subjects. 2015

Lee, Sang-Eun / Cho, Iksung / Hong, Geu-Ru / Chang, Hyuk-Jae / Sung, Ji Min / Cho, In-Jeong / Shim, Chi Young / Choi, Byoung Wook / Chung, Namsik. ·Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.; Severance Biomedical Science Institute, Yonsei University Health System, Seoul, Korea. · Department of Research Affairs, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. · Division of Radiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. ·J Cardiovasc Ultrasound · Pubmed #26755933.

ABSTRACT: BACKGROUND: To explore the prognostic performance of coronary computed tomography angiography (CCTA) and exercise electrocardiography (XECG) in asymptomatic subjects. METHODS: We retrospectively enrolled 812 (59 ± 9 years, 60.8% male) asymptomatic subjects who underwent CCTA and XECG concurrently from 2003 through 2009. Subjects were followed-up for major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, unstable angina, and revascularization after 90 days from index CCTA. RESULTS: The prevalence of occult coronary artery disease (CAD) detected by CCTA was 17.5% and 120 subjects (14.8%) had positive XECG. During a mean follow-up of 37 ± 16 months, nine subjects experienced MACE. In multivariable Cox-regression analysis, only the presence of CAD by CCTA independently predicted future MACE (p = 0.002). Moreover, CAD by CCTA improved the predictive value when added to a clinical risk factor model using the likelihood ratio test (p < 0.001). Notably, the prognostic value of CCTA persisted in the moderate-to-high-risk group as classified by the Duke treadmill score (p = 0.040), but not in the low-risk group (p = 0.991). CONCLUSION: CCTA provides incremental prognostic benefit over and above XECG in an asymptomatic population, especially for those in a moderate-to-high-risk group as classified by the Duke treadmill score. Risk stratification using XECG may prove valuable for identifying asymptomatic subjects who can benefit from CCTA.

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