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Coronary Artery Disease: HELP
Articles by Stamatios Lerakis
Based on 15 articles published since 2008
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Between 2008 and 2019, Stamatios Lerakis wrote the following 15 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review Imaging the myocardial ischemic cascade. 2018

Stillman, Arthur E / Oudkerk, Matthijs / Bluemke, David A / de Boer, Menko Jan / Bremerich, Jens / Garcia, Ernest V / Gutberlet, Matthias / van der Harst, Pim / Hundley, W Gregory / Jerosch-Herold, Michael / Kuijpers, Dirkjan / Kwong, Raymond Y / Nagel, Eike / Lerakis, Stamatios / Oshinski, John / Paul, Jean-François / Slart, Riemer H J A / Thourani, Vinod / Vliegenthart, Rozemarijn / Wintersperger, Bernd J. ·Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Rd NE, Atlanta, GA, 30322, USA. aestill@emory.edu. · Center of Medical Imaging, University Medical Center Groningen, Groningen, The Netherlands. · Department of Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA. · Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. · Department of Radiology, University of Basel Hospital, Basel, Switzerland. · Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Rd NE, Atlanta, GA, 30322, USA. · Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany. · Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands. · Departments of Internal Medicine & Radiology, Wake Forest University, Winston-Salem, NC, USA. · Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA. · Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands. · Department of Cardiology, Brigham and Women's Hospital, Boston, MA, USA. · Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital, Frankfurt/Main, Germany. · Department of Medicine, Emory University, Atlanta, GA, USA. · Department of Radiology, Institut Mutualiste Montsouris, Paris, France. · Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. · Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA. · Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands. · Department of Medical Imaging, University of Toronto, Toronto, Canada. ·Int J Cardiovasc Imaging · Pubmed #29556943.

ABSTRACT: Non-invasive imaging plays a growing role in the diagnosis and management of ischemic heart disease from its earliest manifestations of endothelial dysfunction to myocardial infarction along the myocardial ischemic cascade. Experts representing the North American Society for Cardiovascular Imaging and the European Society of Cardiac Radiology have worked together to organize the role of non-invasive imaging along the framework of the ischemic cascade. The current status of non-invasive imaging for ischemic heart disease is reviewed along with the role of imaging for guiding surgical planning. The issue of cost effectiveness is also considered. Preclinical disease is primarily assessed through the coronary artery calcium score and used for risk assessment. Once the patient becomes symptomatic, other imaging tests including echocardiography, CCTA, SPECT, PET and CMR may be useful. CCTA appears to be a cost-effective gatekeeper. Post infarction CMR and PET are the preferred modalities. Imaging is increasingly used for surgical planning of patients who may require coronary artery bypass.

2 Review High-density lipoprotein functionality in coronary artery disease. 2014

Kosmas, Constantine E / Christodoulidis, Georgios / Cheng, Jeh-wei / Vittorio, Timothy J / Lerakis, Stamatios. ·Zena and Michael A. Wiener Cardiovascular Institute (CEK), Icahn School of Medicine at Mount Sinai, New York, New York · Department of Internal Medicine (GC), Winthrop University Hospital, Mineola, New York · Department of Medicine (JWC, SL), Emory University School of Medicine, Atlanta, Georgia · and St. Francis Hospital-The Heart Center (TJV), Division of Cardiology, Center of Advanced Cardiac Therapeutics, Roslyn, New York. ·Am J Med Sci · Pubmed #24603157.

ABSTRACT: The role of high-density lipoprotein (HDL) in cardiovascular atheroprotection is well established. Epidemiological data have clearly demonstrated an inverse relationship between HDL levels and the risk for coronary artery disease, which is independent of the low-density lipoprotein levels. However, more recent data provide evidence that high HDL levels are not always protective and that under certain conditions may even confer an increased risk. Thus, a new concept has arisen, which stresses the importance of HDL functionality, rather than HDL concentration per se, in the assessment of cardiovascular risk. HDL functionality is genetically defined but can also be modified by several environmental and lifestyle factors, such as diet, smoking or certain pharmacologic interventions. Furthermore, HDL is consisted of a heterogeneous group of particles with major differences in their structural, biological and functional properties. Recently, the cholesterol efflux capacity from macrophages was proven to be an excellent metric of HDL functionality, because it was shown to have a strong inverse relationship with the risk of angiographically documented coronary artery disease, independent of the HDL and apolipoprotein A-1 levels, although it may not actually predict the prospective risk for cardiovascular events. Thus, improving the quality of HDL may represent a better therapeutic target than simply raising the HDL level, and assessment of HDL function may prove informative in refining our understanding of HDL-mediated atheroprotection.

3 Review Inflammation in coronary artery disease. 2014

Christodoulidis, Georgios / Vittorio, Timothy J / Fudim, Marat / Lerakis, Stamatios / Kosmas, Constantine E. ·From the *Department of Internal Medicine, Winthrop University Hospital, Mineola, NY; †St. Francis Hospital, The Heart Center, Division of Cardiology, Center of Advanced Cardiac Therapeutics, Roslyn, NY; ‡Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, TN; §Department of Medicine, Emory University School of Medicine, Atlanta, GA; and ¶Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY. ·Cardiol Rev · Pubmed #24441047.

ABSTRACT: Coronary artery disease (CAD) is the leading cause of death in the United States. Although CAD was formerly considered a lipid accumulation-mediated disease, it has now been clearly shown to involve an ongoing inflammatory response. Advances in basic science research have established the crucial role of inflammation in mediating all stages of CAD. Today, there is convincing evidence that multiple interrelated immune mechanisms interact with metabolic risk factors to initiate, promote, and ultimately activate lesions in the coronary arteries. This review aims to provide current evidence pertaining to the role of inflammation in the pathogenesis of CAD and discusses the impact of inflammatory markers and their modification on clinical outcomes.

4 Review The prominent role of cardiac magnetic resonance imaging in coronary artery disease. 2014

Palios, John / Karangelis, Dimos / Roubelakis, Apostolos / Lerakis, Stamatios. ·Department of Cardiology, Emory University Hospital, Atlanta, GA, USA. ·Expert Rev Cardiovasc Ther · Pubmed #24417312.

ABSTRACT: The role of cardiac magnetic resonance (CMR) in coronary artery disease is prominent. CMR provides functional and structural heart disease assessment with high accuracy. It allows accurate cardiac volume and flow quantification and wall motion analysis both at rest and at stress. CMR myocardial perfusion studies detect myocardial ischemia and provide insights into the morphology of the myocardial tissue. CMR imaging noninvasively differentiates causes of myocardial injury such as ischemia or inflammation; stages of myocardial injury, such as acute or chronic; grade of myocardial damage, such as reversible or irreversible; myocardial fibrosis or scar. There is an emerging role of CMR in patients with acute chest presentation since it can demonstrate causes of chest pain other than coronary artery disease such as myocarditis, pericarditis, aortic dissection and pulmonary embolism. CMR is noninvasive and radiation-free. It's combined approach of functional and structural cardiac assessment makes it unique compared with other imaging modalities.

5 Review Differences in drug-eluting stents used in coronary artery disease. 2011

Synetos, Andreas / Toutouzas, Konstantinos / Karanasos, Antonis / Stathogiannis, Konstantinos / Triantafyllou, Georgia / Tsiamis, Eleutherios / Lerakis, Stamatios / Stefanadis, Christodoulos. ·First Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece. ·Am J Med Sci · Pubmed #21629039.

ABSTRACT: The introduction of drug-eluting stents (DES) has improved the efficacy of percutaneous coronary intervention by addressing the issue of neointimal proliferation, a pathology contributing to restenosis. First-generation stents eluting sirolimus or paclitaxel were joined by second-generation stents, such as the everolimus- and the zotarolimus-eluting stents, promising increased safety and efficacy. As a result, there is a plethora of drug-eluting stents available, with differences in the stent platform, the polymer coating and the eluted drug, which translate into differences in biological markers of efficacy, such as late loss. However, it remains controversial whether these discrepancies have an impact on clinical markers of safety and efficacy, or if the improved efficacy of DES is a class effect. This article reviews the differences between DES by looking into the biological differences and into trials and registries of DES.

6 Review Imaging of the vulnerable plaque: noninvasive and invasive techniques. 2008

Lerakis, Stamatios / Synetos, Andreas / Toutouzas, Konstantinos / Vavuranakis, Manolis / Tsiamis, Eleftherios / Stefanadis, Chistodoulos. ·First Department of Cardiology, Hippokration Hospital, University of Athens, Greece. stam_lerakis@emoryhealthcare.org ·Am J Med Sci · Pubmed #18854678.

ABSTRACT: In a large proportion of previously asymptomatic individuals, sudden coronary death or acute myocardial infarction occurs as the first manifestation of coronary atherosclerosis. Imaging of coronary atheromatous plaques has traditionally centered on assessing the degree of luminal stenosis. The angiographic techniques that are routinely used to identify stenotic atherosclerotic lesions are unable to identify high-risk plaques; plaques prone to rupture and cause a cardiovascular event. This is partly due to the fact that the majority of culprit lesions that produce acute cardiovascular syndromes are not severely stenotic, possibly due to significant positive remodeling and reduced protective collateral circulation as well as because the risk of plaque rupture is more closely related to plaque content than plaque size. Recently, the focus of new imaging techniques is to identify the high risk plaques; the "vulnerable plaques." In this review, we will refer to the noninvasive and invasive techniques that can detect the vulnerable plaque.

7 Review Mechanisms of benefit of angiotensin receptor blockers in coronary atherosclerosis. 2008

Vaccari, Christopher S / Lerakis, Stamatios / Hammoud, Ramadan / Khan, Bobby V. ·Emory University School of Medicine, Atlanta, GA 30322, USA. ·Am J Med Sci · Pubmed #18794623.

ABSTRACT: There is mounting evidence that dysfunction of the renin angiotensin system is a vital contributor to the development of atherosclerosis. Nonetheless, the efficacy of angiotensin receptor blockers on clinical outcomes in patients with coronary atherosclerosis has been limited. This review will examine the potential mechanisms by which angiotensin receptor blockers potentially affect several key steps in the atherosclerotic process: endothelial function, inflammation, and thrombosis. Despite the mounting evidence for these agents on multiple processes in the development of atherosclerosis, their clinical utility in patients with coronary artery disease remains unclear.

8 Article Pathway-Specific Aggregate Biomarker Risk Score Is Associated With Burden of Coronary Artery Disease and Predicts Near-Term Risk of Myocardial Infarction and Death. 2017

Ghasemzedah, Nima / Hayek, Salim S / Ko, Yi-An / Eapen, Danny J / Patel, Riyaz S / Manocha, Pankaj / Al Kassem, Hatem / Khayata, Mohamed / Veledar, Emir / Kremastinos, Dimitrios / Thorball, Christian W / Pielak, Tomasz / Sikora, Sergey / Zafari, A Maziar / Lerakis, Stamatios / Sperling, Laurence / Vaccarino, Viola / Epstein, Stephen E / Quyyumi, Arshed A. ·From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.) · Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.) · Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.) · Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.) · Department of Biostatistics, Florida International University, Miami (E.V.) · Department of Cardiology, University of Athens School of Medicine, Greece (D.K.) · Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.) · Stemedica Cell Technologies, Inc., San Diego, CA (S.S.) · Department of Epidemiology, Emory University, Atlanta, GA (V.V.) · and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.). ·Circ Cardiovasc Qual Outcomes · Pubmed #28280039.

ABSTRACT: BACKGROUND: Inflammation, coagulation, and cell stress contribute to atherosclerosis and its adverse events. A biomarker risk score (BRS) based on the circulating levels of biomarkers C-reactive protein, fibrin degradation products, and heat shock protein-70 representing these 3 pathways was a strong predictor of future outcomes. We investigated whether soluble urokinase plasminogen activator receptor (suPAR), a marker of immune activation, is predictive of outcomes independent of the aforementioned markers and whether its addition to a 3-BRS improves risk reclassification. METHODS AND RESULTS: C-reactive protein, fibrin degradation product, heat shock protein-70, and suPAR were measured in 3278 patients undergoing coronary angiography. The BRS was calculated by counting the number of biomarkers above a cutoff determined using the Youden's index. Survival analyses were performed using models adjusted for traditional risk factors. A high suPAR level ≥3.5 ng/mL was associated with all-cause death and myocardial infarction (hazard ratio, 1.83; 95% confidence interval, 1.43-2.35) after adjustment for risk factors, C-reactive protein, fibrin degradation product, and heat shock protein-70. Addition of suPAR to the 3-BRS significantly improved the C statistic, integrated discrimination improvement, and net reclassification index for the primary outcome. A BRS of 1, 2, 3, or 4 was associated with a 1.81-, 2.59-, 6.17-, and 8.80-fold increase, respectively, in the risk of death and myocardial infarction. The 4-BRS was also associated with severity of coronary artery disease and composite end points. CONCLUSIONS: SuPAR is independently predictive of adverse outcomes, and its addition to a 3-BRS comprising C-reactive protein, fibrin degradation product, and heat shock protein-70 improved risk reclassification. The clinical utility of using a 4-BRS for risk prediction and management of patients with coronary artery disease warrants further study.

9 Article Soluble urokinase plasminogen activator receptor level is an independent predictor of the presence and severity of coronary artery disease and of future adverse events. 2014

Eapen, Danny J / Manocha, Pankaj / Ghasemzadeh, Nima / Patel, Riyaz S / Al Kassem, Hatem / Hammadah, Muhammad / Veledar, Emir / Le, Ngoc-Anh / Pielak, Tomasz / Thorball, Christian W / Velegraki, Aristea / Kremastinos, Dimitrios T / Lerakis, Stamatios / Sperling, Laurence / Quyyumi, Arshed A. ·Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (D.J.E., P.M., N.G., R.S.P., H.A.K., M.H., E.V., N.A.L., S.L., L.S., A.A.Q.). · Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (D.J.E., P.M., N.G., R.S.P., H.A.K., M.H., E.V., N.A.L., S.L., L.S., A.A.Q.) Department of Medicine, Cardiff University, Cardiff, UK (R.S.P.). · Clinical Research Center, Copenhagen University Hospital Copenhagen, Denmark (T.P., C.W.T.). · Medical School of Athens, Athens, Greece (A.V., D.T.K., S.L.). · Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (D.J.E., P.M., N.G., R.S.P., H.A.K., M.H., E.V., N.A.L., S.L., L.S., A.A.Q.) Medical School of Athens, Athens, Greece (A.V., D.T.K., S.L.). ·J Am Heart Assoc · Pubmed #25341887.

ABSTRACT: INTRODUCTION: Soluble urokinase plasminogen activator receptor (suPAR) is an emerging inflammatory and immune biomarker. Whether suPAR level predicts the presence and the severity of coronary artery disease (CAD), and of incident death and myocardial infarction (MI) in subjects with suspected CAD, is unknown. METHODS AND RESULTS: We measured plasma suPAR levels in 3367 subjects (67% with CAD) recruited in the Emory Cardiovascular Biobank and followed them for adverse cardiovascular (CV) outcomes of death and MI over a mean 2.1±1.1 years. Presence of angiographic CAD (≥50% stenosis in ≥1 coronary artery) and its severity were quantitated using the Gensini score. Cox's proportional hazard survival and discrimination analyses were performed with models adjusted for established CV risk factors and C-reactive protein levels. Elevated suPAR levels were independently associated with the presence of CAD (P<0.0001) and its severity (P<0.0001). A plasma suPAR level ≥3.5 ng/mL (cutoff by Youden's index) predicted future risk of MI (hazard ratio [HR]=3.2; P<0.0001), cardiac death (HR=2.62; P<0.0001), and the combined endpoint of death and MI (HR=1.9; P<0.0001), even after adjustment of covariates. The C-statistic for a model based on traditional risk factors was improved from 0.72 to 0.74 (P=0.008) with the addition of suPAR. CONCLUSION: Elevated levels of plasma suPAR are associated with the presence and severity of CAD and are independent predictors of death and MI in patients with suspected or known CAD.

10 Article Prognostic value of adenosine stress cardiovascular magnetic resonance and dobutamine stress echocardiography in patients with low-risk chest pain. 2012

Hartlage, Gregory / Janik, Matthew / Anadiotis, Athanasios / Veledar, Emir / Oshinski, John / Kremastinos, Dimitrios / Stillman, Arthur / Lerakis, Stamatios. ·Department of Medicine and Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA. GHartla@emory.edu ·Int J Cardiovasc Imaging · Pubmed #21562726.

ABSTRACT: Excluding obstructive coronary artery disease (CAD) as the etiology of acute chest pain in patients without diagnostic electrocardiographic changes or elevated serum cardiac biomarkers is challenging. Stress testing is a valuable risk-stratifying technique reserved for the subset of these patients with low-risk chest pain who have an intermediate clinical probability of obstructive CAD. Given the risks of radiation inherent to nuclear and computed tomography imaging, both adenosine stress cardiovascular magnetic resonance (AS-CMR) imaging and dobutamine stress echocardiography (DSE) are attractive alternative stress modalities. An essential characteristic of stress modalities is their negative prognostic value; as one must exclude clinically-relevant CAD such that patients can be discharged safely. Therefore, the aim of this study was to validate a favorable negative prognostic value for both AS-CMR and DSE in patients presenting with low-risk acute chest pain. This retrospective study included 255 patients with low-risk acute chest pain and no prior history of CAD presenting to the emergency department at our institution, with 89 patients evaluated by AS-CMR and 166 by DSE. Median follow-up was 292 days, and consisted of medical record review. The primary end-point was the composite of cardiac death, nonfatal acute myocardial infarction, obstructive CAD on invasive coronary angiography (ICA) or recurrent chest pain requiring hospital admission. Test characteristics such as sensitivity and specificity could not be evaluated as patients were not routinely evaluated with ICA. All patients completed the stress protocol without adverse events during testing. 82/89 patients (92.1%) and 164/166 patients (98.8%) had negative AS-CMR and DSE studies, respectively. Both AS-CMR and DSE had excellent negative prognostic values for the primary endpoint, 100 and 99%, respectively. Both AS-CMR and DSE are effective stress modalities for excluding clinically significant coronary artery disease in patients presenting acute low-risk chest pain. Patients without findings to suggest ischemia have an excellent intermediate-term prognosis.

11 Article Time-resolved analysis of coronary vein motion and cross-sectional area. 2011

Suever, Jonathan D / Watson, Pierre J / Eisner, Robert L / Lerakis, Stamatios / O'Donnell, Robert E / Oshinski, John N. ·Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology / Emory University, Atlanta, Georgia, USA. ·J Magn Reson Imaging · Pubmed #21769971.

ABSTRACT: PURPOSE: To quantify periods of low motion and cross-sectional area changes of the coronary veins during the cardiac cycle for planning magnetic resonance coronary venograms (MRCV). MATERIALS AND METHODS: Images were acquired from 19 patients with coronary artery disease (CAD) and 13 patients scheduled for cardiac resynchronization therapy (CRT). The displacement and cross-sectional area of the coronary sinus was tracked, and periods of low motion were defined as consecutive time points during which the position of the coronary sinus remained within a 0.67-mm diameter region. Patients were classified as systolic dominant or diastolic dominant based on the relative duration of their low motion periods. RESULTS: All CRT patients were classified as systolic dominant, and 32% of these had no separate diastolic rest period. All CAD patients with ejection fraction < 35% were classified as systolic dominant, while all CAD patients with ejection fraction > 35%were diastolic dominant. In 77% of all subjects, the cross-sectional area of the coronary sinus was larger in systole than in diastole. CONCLUSION: The movement of the coronary sinus can be used to classify patients as either having a longer systolic or diastolic rest period. The classification of the CRT patients as systolic dominant suggests that MRCVs be acquired in systole for CRT planning; however, each patient's low motion periods should be categorized to ensure the correct period is being used to minimize motion artifacts.

12 Article Adenosine stress magnetic resonance imaging in women with low risk chest pain: the Emory University experience. 2010

Lerakis, Stamatios / Janik, Matthew / McLean, Dalton S / Anadiotis, Athanasios V / Zaragoza-Macias, Elisa / Veledar, Emir / Oshinski, John / Stillman, Arthur E. ·Division of Cardiology, Department of Internal Medicine, Emory University, Atlanta, Georgia 30322, USA. Stam.Lerakis@emoryhealthcare.org ·Am J Med Sci · Pubmed #20051822.

ABSTRACT: OBJECTIVES: The purpose of this study was to evaluate the accuracy of adenosine stress magnetic resonance imaging (ASMRI) for the evaluation of women with low-risk chest pain (CP). BACKGROUND: Coronary artery disease (CAD) can present differently among women than among men. There is increased interest in the use of ASMRI for lower risk patients in the emergency department to rule out CAD, and it would be valuable to assess its performance specifically in women. METHODS: This study included 82 women with low-risk CP who presented to the emergency department during a 2-year period at our institution and were evaluated by ASMRI. Clinical events were followed by review of medical records. RESULTS: The specificity of ASMRI for ischemia detection in this small cohort of patients was 100%. Sensitivity was 94.9%, negative predictive value 100%, and positive predictive value 42.9%. CONCLUSIONS: ASMRI may be used as the initial imaging modality for ruling out CAD in women with low-risk CP because of its very high sensitivity, specificity, and negative predictive value for the detection of ischemia. Further randomized controlled trials comparing ASMRI with established noninvasive nuclear and echocardiographic stress modalities are needed.

13 Article Prompt-gamma compensation in Rb-82 myocardial perfusion 3D PET/CT. 2010

Esteves, Fabio P / Nye, Jonathan A / Khan, Akbar / Folks, Russell D / Halkar, Raghuveer K / Garcia, Ernest V / Schuster, David M / Lerakis, Stamatios / Raggi, Paolo / Votaw, John R. ·Department of Radiology, Emory University School of Medicine, 1364 Clifton Road, NE, Atlanta, GA 30322, USA. festeve@emory.edu ·J Nucl Cardiol · Pubmed #19937169.

ABSTRACT: OBJECTIVE: To compare the diagnostic accuracy of Rb-82 myocardial perfusion three-dimensional (3D) PET with and without prompt-gamma compensation (PGC). METHODS AND RESULTS: Retrospective, single center study of 76 patients who had rest and adenosine stress Rb-82 myocardial perfusion 3D PET. All studies were acquired using a Siemens Biograph-40 PET/CT scanner and were reconstructed with and without PGC. Fifty-seven patients (mean age 63 +/- 11 years, 26 men) had coronary angiography within 40 days of Rb-82 imaging. Nineteen patients (mean age 43 +/- 7 years, 10 men) had low likelihood of coronary artery disease (CAD). All PET images were scored by consensus of two blinded readers on a standard 5-point scale using a 17-segment left ventricular model. A normal PET test was defined as a summed stress score of less than four. Obstructive CAD at coronary angiography was used as the gold-standard and was defined as luminal stenoses > or =50% in one or more major coronary arteries. The prevalence of obstructive disease at coronary angiography was 68% (39/57). The mean summed stress score was 12 +/- 12 for PGC images and was 18 +/- 14 for non-PGC images. Sensitivity and specificity for obstructive CAD were 90% (95% CI 88-99) and 72% (95% CI 52-93) for PGC images and 95% (95% CI 88-100) and 22% (95% CI 3-41) for non-PGC images. CONCLUSION: PGC in Rb-82 3D PET improves the specificity for obstructive CAD at coronary angiography with no significant loss in sensitivity.

14 Article Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography. 2009

Santana, Cesar A / Garcia, Ernest V / Faber, Tracy L / Sirineni, Gopi K R / Esteves, Fabio P / Sanyal, Rupan / Halkar, Raghuveer / Ornelas, Mario / Verdes, Liudmila / Lerakis, Stamatios / Ramos, Julie J / Aguadé-Bruix, Santiago / Cuéllar, Hugo / Candell-Riera, Jaume / Raggi, Paolo. ·Department of Radiology, Emory University, 1365 Clifton Road NE, AT-504, Atlanta, GA 30322, USA. ·J Nucl Cardiol · Pubmed #19156478.

ABSTRACT: BACKGROUND: We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50% stenosis) using invasive coronary angiography (ICA) as the gold standard. METHODS: 50 subjects (36 men; 56 +/- 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (<5%) pre-test likelihood (LLK) of disease. Three blinded readers scored the images in sequential sessions using (1) MPI alone (2) MPI and CTA side-by-side, (3) fused CTA/MPI images. RESULTS: One or more critical stenoses during ICA were found in 28 patients and non-critical stenoses were found in 9 patients. MPI, side-by-side MPI-CTA, and fused CTA/MPI showed the same normalcy rate (NR:13/13) in LLK subjects. The fusion technique performed better than MPI and MPI and CTA side-by-side for the presence of CAD in any vessel (overall area under the curve (AUC) for fused images: 0.89; P = .005 vs MPI, P = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P < .001 vs MPI; P = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion. CONCLUSIONS: Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery.

15 Minor Predictive value of normal dobutamine stress echocardiogram in patients with low-risk acute chest pain. 2010

Lerakis, Stamatios / Aznaouridis, Konstantinos / Synetos, Andreas / Masoura, Constantina / Mehta, Puja / Al-Hajj, Mousa / Shukrullah, Irfan / Martin, Randolph. · ·Int J Cardiol · Pubmed #19321209.

ABSTRACT: Dobutamine stress echocardiography (DSE) has been proposed as a tool for risk stratification of patients with acute chest pain (ACP). In this single-center study, we evaluated the negative predictive value of DSE in 178 patients who presented with low-risk ACP (normal or inconclusive electrocardiogram and negative markers of myocardial damage) and were discharged following a maximal DSE that did not reveal ischemia. During the follow-up (median 321 days), 2 of the 178 patients were admitted with an acute coronary syndrome and were diagnosed with obstructive coronary artery disease at angiography. In the time frame of the study, the negative predictive value of a normal and maximal DSE for an adverse cardiac event was 98.9% (95% CI: 96.0-99.8%). Thus, a normal DSE has a high negative predictive value and comprises a safe and effective tool for early risk stratification of patients who present with acute chest pain of low risk.