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Coronary Artery Disease: HELP
Articles by João A. C. Lima
Based on 74 articles published since 2010
(Why 74 articles?)
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Between 2010 and 2020, Joao A. C. Lima wrote the following 74 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review Fractional flow reserve and myocardial perfusion by computed tomography: a guide to clinical application. 2018

Schuijf, Joanne D / Ko, Brian S / Di Carli, Marcelo F / Hislop-Jambrich, Jacqueline / Ihdayhid, Abdul-Rahman / Seneviratne, Sujith K / Lima, João A C. ·Global Research and Development Center, Toshiba Medical Systems Europe BV, Zilverstraat 1, 2718 RP Zoetermeer, The Netherlands. · Department of Medicine, Monash Cardiovascular Research Centre, MonashHEART, Monash Medical Centre, Monash Health, and Monash University, Melbourne, VIC, 246 Clayton Rd, Clayton Victoria, 3168, Australia. · Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, 75 Francis St, Boston, MA 02115, USA. · Global Research and Development Center, Toshiba Medical Australia and New Zealand, Level 2 Building C, 12-24 Talavera Road, North Ryde NSW 2113, Australia. · Departments of Medicine and Radiology, Johns Hopkins Hospital and School of Medicine, 600 N. Wolf Street, Baltimore, MD 21287, USA. ·Eur Heart J Cardiovasc Imaging · Pubmed #29045612.

ABSTRACT: The aim of this paper is to provide a guide to the clinical application of the functional computed tomography (CT) techniques fractional flow reserve (CT FFR) and myocardial perfusion (CTP) in patients presenting for the evaluation of coronary artery disease (CAD). Both techniques have recently been introduced to complement coronary CT angiography (CTA) with physiological information. Evidence supporting their diagnostic accuracy accumulates at a fast pace, and both techniques are moving from research tools to clinical applications for specific subgroups of patients. As a consequence, the question that now emerges is how to optimally implement these techniques in the daily clinical workflow to maximize the benefit to patients. Given the inherent differences between both techniques in their underlying physical principles and methodology, as well as the types of pathophysiological information they provide, these techniques are not interchangeable. Rather, within the broad spectrum of patients presenting for CAD evaluation, both CT FFR and CTP may have their own optimized application where the highest benefit at the lowest risk and cost may be achieved. Therefore, we will review the physical principles and available clinical evidence of each technique, and propose how this information can be applied to the individual patient. Moreover, as techniques continue to mature, the combination of coronary CTA with CT FFR and/or CTP likely will become a powerful and accessible diagnostic tool for the detailed characterization of atherosclerotic disease providing a potentially more precise and personalized approach to patients with suspected CAD.

2 Review Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia. A systematic review and meta-analysis. 2016

Sørgaard, Mathias Holm / Kofoed, Klaus Fuglsang / Linde, Jesper James / George, Richard Thomas / Rochitte, Carlos Eduardo / Feuchtner, Gudrun / Lima, Joao A C / Abdulla, Jawdat. ·Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen-Ø, Denmark. Electronic address: mathiassoergaard@hotmail.com. · Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen-Ø, Denmark; Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen-Ø, Denmark. Electronic address: kkofoed@dadlnet.dk. · Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen-Ø, Denmark. Electronic address: jesper_linde@hotmail.com. · Department of Medicine, Division of Cardiology, John Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, USA. Electronic address: georgeri@medimmune.com. · Heart Institute, Incor, University of São Paulo Medical School, Avenida Dr. Eneas de Carvalho Aguiar, 44 - Pinheiros, São Paulo, SP 05403-900, Brazil. Electronic address: rochitte@gmail.com. · Medical University Innsbruck, Department of Radiology, Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck, Austria. Electronic address: Gudrun.feuchtner@gmail.com. · Department of Medicine, Division of Cardiology, John Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, USA. Electronic address: jlima@jhmi.edu. · Department of Medicine, Division of Cardiology, Glostrup University Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark. Electronic address: jawab@dadlnet.dk. ·J Cardiovasc Comput Tomogr · Pubmed #27773634.

ABSTRACT: OBJECTIVES: The aim of this study is to provide a meta-analysis of all published studies assessing the diagnostic accuracy of stress CT myocardial perfusion imaging (CTP) in patients suspected of or with known coronary artery disease. This analysis is limited to static stress CTP. METHODS: Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography with and without fractional flow reserve (FFR). RESULTS: The search revealed 19 eligible studies including 1188 patients. Pooled results showed that CTP had a good agreement with SPECT and MRP. On a per-patient level, sensitivity, specificity and AUC were 0.85 (95% CI: 0.70-0.93), 0.81 (95% CI: 0.59-0.93), 0.90 (95% CI: 0.87-0.92). On a per-artery level, sensitivity, specificity and AUC were 0.80 (95% CI: 0.67-0.88), 0.81 (95% CI: 0.72-0.88) and 0.87 (95% CI: 0.84-0.90). When invasive coronary angiography was used as reference standard, combined coronary CTA and CTP compared to coronary CTA alone significantly improved the specificity from 0.62 (95% CI: 0.52-0.70) to 0.84 (95% CI: 0.74-0.91) on a per-patient level (p = 0.008) and from 0.72 (95% CI: 0.63-0.79) to 0.90 (95% CI: 0.85-0.93) on a per-artery level (p = 0.0001) without significant decrease in sensitivity (p = 0.59 and p = 0.23, respectively). CONCLUSION: In selected patients, static CT myocardial perfusion has high diagnostic accuracy to detecting myocardial ischemia. Specificity increases significantly when CT myocardial perfusion is combined with coronary CTA.

3 Review Noninvasive Imaging of Atherosclerotic Plaque Progression: Status of Coronary Computed Tomography Angiography. 2015

Sandfort, Veit / Lima, Joao A C / Bluemke, David A. ·From the Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S., D.A.B.) · and Department of Radiology (J.A.C.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, MD. ·Circ Cardiovasc Imaging · Pubmed #26156016.

ABSTRACT: The process of coronary artery disease progression is infrequently visualized. Intravascular ultrasound has been used to gain important insights but is invasive and therefore limited to high-risk patients. For low-to-moderate risk patients, noninvasive methods may be useful to quantitatively monitor plaque progression or regression and to understand and personalize atherosclerosis therapy. This review discusses the potential for coronary computed tomography angiography to evaluate the extent and subtypes of coronary plaque. Computed tomographic technology is evolving and image quality of the method approaches the level required for plaque progression monitoring. Methods to quantify plaque on computed tomography angiography are reviewed as well as a discussion of their use in clinical trials. Limitations of coronary computed tomography angiography compared with competing modalities include limited evaluation of plaque subcomponents and incomplete knowledge of the value of the method especially in patients with low-to-moderate cardiovascular risk.

4 Review Coronary artery calcium score and coronary computed tomographic angiography for cardiovascular risk stratification. 2012

Azevedo, Clerio F / Rochitte, Carlos E / Lima, João A C. ·Instituto D'Or de Pesquisa e Ensino. ·Arq Bras Cardiol · Pubmed #22892694.

ABSTRACT: Cardiovascular disease is the leading mortality cause worldwide. The capacity to identify among the asymptomatic individuals the subgroup at greater risk for developing cardiovascular events is fundamental in any strategy aimed at reducing the rate of cardiovascular events. The first step in cardiovascular risk stratification is the use of global risk scores, the Framingham risk score being the most frequently used. However, previous studies have shown that, although very useful, clinical scores, when used alone, have a limited capacity for stratifying cardiovascular risk in a significant part of the population. In that context, coronary artery calcium score (CACS) and coronary computed tomographic angiography might play an important role as complementary tools for risk stratification of asymptomatic patients. The CACS provides important prognostic information that is incremental to clinical scores based on traditional risk factors and other diagnostic modalities, such as C-reactive protein measurement. In addition, CACS has the potential to change and help the patients' clinical management. On the other hand, coronary computed tomographic angiography provides a detailed assessment of the anatomy of the coronary arteries, allowing visualizing not only the lumen, but also the coronary arterial walls. Compared with conventional invasive coronary angiography, coronary computed tomographic angiography has excellent accuracy to identify and mainly exclude the presence of significant obstructive lesions. In addition, it proved to be able to provide incremental prognostic information to traditional risk factors and CACS.

5 Review A stepwise approach to the visual interpretation of CT-based myocardial perfusion. 2011

Mehra, Vishal C / Valdiviezo, Carolina / Arbab-Zadeh, Armin / Ko, Brian S / Seneviratne, Sujith K / Cerci, Rodrigo / Lima, Joao A C / George, Richard T. ·Johns Hopkins University, Baltimore, MD, USA. ·J Cardiovasc Comput Tomogr · Pubmed #22146495.

ABSTRACT: Cardiovascular anatomic and functional testing have been longstanding and key components of cardiac risk assessment. As part of that strategy, CT-based imaging has made steady progress, with coronary computed tomography angiography (CTA) now established as the most sensitive noninvasive strategy for assessment of significant coronary artery disease. Myocardial CT perfusion imaging (CTP), as the functional equivalent of coronary CTA, is being tested in currently ongoing multicenter trials and is proposed to enhance the accuracy of coronary CTA alone. However, unlike coronary CTA that has published guidelines for interpretation and is rapidly gaining applicability in the noninvasive risk assessment paradigms, myocardial CTP is rapidly evolving, and guidance on a standard approach to its interpretation is lacking. In this article we describe a practical stepwise approach for interpretation of myocardial CTP that should add to the clinical applicability of this modality. These steps include (1) coronary CTA interpretation for potentially obstructive atherosclerosis, (2) reconstruction and preprocessing of myocardial CTP images, (3) image quality assessment and the identification of potentially confounding artifacts, (4) rest and stress image interpretation for enhancement patterns and areas of hypoattenuation, and (5) correlation of coronary anatomy and myocardial perfusion deficits. This systematic review uses already published methods from multiple clinical studies and is intended for general usage, independent of the platform used for image acquisition.

6 Review CT perfusion: ready for prime time. 2011

Ambrose, Marietta S / Valdiviezo, Carolina / Mehra, Vishal / Lardo, Albert C / Lima, Joao A C / George, Richard T. ·Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA. ·Curr Cardiol Rep · Pubmed #21080111.

ABSTRACT: Advancements in computed tomography (CT) technology have revolutionized clinical practice, particularly regarding the noninvasive assessment of coronary artery disease (CAD). The versatility of cardiac CT has rendered multiple applications including assessment of cardiac structure and function, myocardial viability, and coronary anatomy. The merits of cardiac computed tomography angiography (CTA) have been proven for the detection, and particularly the exclusion, of CAD. However, CTA becomes limited in the presence of significant CAD. Its inability to consistently identify lesion-associated ischemia may necessitate additional radionuclide myocardial perfusion imaging. Myocardial computed tomography perfusion imaging (CTP) has emerged as a useful and convenient method to immediately assess myocardial ischemia. In this review, we discuss the current state of CTP including available technology, its performance to date from current literature, and future challenges to this field.

7 Review Quantitative and qualitative analysis and interpretation of CT perfusion imaging. 2010

Valdiviezo, Carolina / Ambrose, Marietta / Mehra, Vishal / Lardo, Albert C / Lima, Joao A C / George, Richard T. ·Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA. ·J Nucl Cardiol · Pubmed #20924735.

ABSTRACT: Coronary artery disease (CAD) remains the leading cause of death in the United States. Rest and stress myocardial perfusion imaging has an important role in the non-invasive risk stratification of patients with CAD. However, diagnostic accuracies have been limited, which has led to the development of several myocardial perfusion imaging techniques. Among them, myocardial computed tomography perfusion imaging (CTP) is especially interesting as it has the unique capability of providing anatomic- as well as coronary stenosis-related functional data when combined with computed tomography angiography (CTA). The primary aim of this article is to review the qualitative, semi-quantitative, and quantitative analysis approaches to CTP imaging. In doing so, we will describe the image data required for each analysis and discuss the advantages and disadvantages of each approach.

8 Clinical Trial Rationale and Design of the CONCERT-HF Trial (Combination of Mesenchymal and c-kit 2018

Bolli, Roberto / Hare, Joshua M / March, Keith L / Pepine, Carl J / Willerson, James T / Perin, Emerson C / Yang, Phillip C / Henry, Timothy D / Traverse, Jay H / Mitrani, Raul D / Khan, Aisha / Hernandez-Schulman, Ivonne / Taylor, Doris A / DiFede, Darcy L / Lima, João A C / Chugh, Atul / Loughran, John / Vojvodic, Rachel W / Sayre, Shelly L / Bettencourt, Judy / Cohen, Michelle / Moyé, Lem / Ebert, Ray F / Simari, Robert D / Anonymous1090945. ·From the Division of Cardiovascular Medicine, University of Louisville, KY (R.B., J.L.). · Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, FL (J.M.H., A.K., R.D.M., I.H.-S.). · Division of Cardiovascular Medicine, UFHealth at University of Florida, Gainesville (K.L.M., C.J.P.). · Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., D.A.T.). · Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.). · Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.). · Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.). · Biological Consulting, LLC, Miami, FL (D.L.D.). · Division of Cardiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.). · Franciscan Saint Francis Health, Indianapolis, IN (A.C.). · Coordinating Center for Clinical Trials, UT Health School of Public Health, Houston, TX (R.W.V., S.L.S., J.B., M.C., L.M.). · Coordinating Center for Clinical Trials, UT Health School of Public Health, Houston, TX (R.W.V., S.L.S., J.B., M.C., L.M.) lemmoye@msn.com. · NIH, National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD (R.F.E.). ·Circ Res · Pubmed #29703749.

ABSTRACT: RATIONALE: Autologous bone marrow mesenchymal stem cells (MSCs) and c-kit OBJECTIVE: CONCERT-HF (Combination of Mesenchymal and c-kit METHODS AND RESULTS: Using a randomized, double-blinded, placebo-controlled, multicenter, multitreatment, and adaptive design, CONCERT-HF examines whether administration of MSCs alone, CPCs alone, or MSCs+CPCs in this population alleviates left ventricular remodeling and dysfunction, reduces scar size, improves quality of life, or augments functional capacity. The 4-arm design enables comparisons of MSCs alone with CPCs alone and with their combination. CONCERT-HF consists of 162 patients, 18 in a safety lead-in phase (stage 1) and 144 in the main trial (stage 2). Stage 1 is complete, and stage 2 is currently randomizing patients from 7 centers across the United States. CONCLUSIONS: CONCERT-HF will provide important insights into the potential therapeutic utility of MSCs and CPCs, given alone and in combination, for patients with HF secondary to ischemic cardiomyopathy. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02501811.

9 Clinical Trial Accuracy of multidetector computed tomography for detection of coronary artery stenosis in acute coronary syndrome compared with stable coronary disease: a CORE64 multicenter trial substudy. 2014

Sara, Leonardo / Rochitte, Carlos E / Lemos, Pedro A / Niinuma, Hiroyuki / Dewey, Marc / Shapiro, Edward P / Gottlieb, Ilan / Mansur, Antônio P / Nicolau, José C / Lardo, Albert C / Azevedo, Clerio F / Kalil-Filho, Roberto / Vavere, Andrea L / Cohn, Silvia / Cox, Christopher / Brinker, Jeffrey / Miller, Julie M / Lima, João A C. ·Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil. · Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: rochitte@incor.usp.br. · Iwate Medical University, Morioka, Japan. · Charité Medical School, Humboldt-Universität zu Berlin and Freie Universität zu Berlin, Berlin. · Johns Hopkins University School of Medicine, Baltimore, MD, United States. · D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil. · Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. ·Int J Cardiol · Pubmed #25281436.

ABSTRACT: BACKGROUND: Multi-detector computed tomography angiography (MDCTA) is a promising method for risk assessment of patients with acute chest pain. However, its diagnostic performance in higher-risk patients has not been investigated in a large international multicenter trial. Therefore, in the present study we sought to estimate the diagnostic accuracy of MDCTA to detect significant coronary stenosis in patients with acute coronary syndrome (ACS). METHODS: Patients included in the CORE64 study were categorized as suspected-ACS or non-ACS based on clinical data. A 64-row coronary MDCTA was performed before invasive coronary angiography (ICA) and both exams were evaluated by blinded, independent core laboratories. RESULTS: From 371 patients included, 94 were categorized as suspected ACS and 277 as non-ACS. Patient-based analysis showed an area under the receiver-operating-characteristic curve (AUC) for detecting ≥ 50% coronary stenosis of 0.95 (95% CI: 0.88-0.98) in ACS and 0.92 (95% CI: 0.88-0.95) in non-ACS group (P=0.29). The sensitivity, specificity, positive and negative predictive values of MDCTA were 0.90(0.80-0.96), 0.88(0.70-0.98), 0.95(0.87-0.99) and 0.77(0.58-0.90) in suspected ACS patients and 0.87(0.81-0.92), 0.86(0.79-0.92), 0.91(0.85-0.95) and 0.82(0.74-0.89) in non-ACS patients (P NS for all comparisons). The mean calcium scores (CS) were 282 ± 449 in suspected ACS and 435 ± 668 in non-ACS group. The accuracy of CS to detect significant coronary stenosis was only moderate and the absence or minimal coronary artery calcification could not exclude the presence of significant coronary stenosis, particularly in ACS patients. CONCLUSIONS: The diagnostic accuracy of MDCTA to detect significant coronary stenosis is high and comparable for both ACS and non-ACS patients.

10 Clinical Trial Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease: a head-to-head comparison from the CORE320 multicenter diagnostic performance study. 2014

George, Richard T / Mehra, Vishal C / Chen, Marcus Y / Kitagawa, Kakuya / Arbab-Zadeh, Armin / Miller, Julie M / Matheson, Matthew B / Vavere, Andrea L / Kofoed, Klaus F / Rochitte, Carlos E / Dewey, Marc / Yaw, Tan S / Niinuma, Hiroyuki / Brenner, Winfried / Cox, Christopher / Clouse, Melvin E / Lima, João A C / Di Carli, Marcelo. ·From the School of Medicine, Johns Hopkins University, 600 N Wolfe St, Blalock 524D2, Baltimore, MD 21287 (R.T.G., V.C.M., A.A.Z., J.M.M., A.L.V., J.A.C.L.) · Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.) · Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.D.C.) · Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.) · National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (V.C.M., M.Y.C.) · Department of Radiology, Iwate Medical University, Morioka, Japan (H.N.) · Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.) · Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.) · Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (M.E.C.) · Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.) · Department of Cardiology, National Heart Center, Singapore, Singapore (T.S.Y.) · and Departments of Radiology (M.D.C.) and Nuclear Medicine (W.B.), Charité-University Medicine Berlin, Berlin, Germany. ·Radiology · Pubmed #24865312.

ABSTRACT: PURPOSE: To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography. MATERIALS AND METHODS: This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (Az). Sensitivity and specificity were calculated with use of prespecified cutoffs. The reference standard was a stenosis of at least 50% at coronary angiography as determined with quantitative methods. RESULTS: CAD was diagnosed in 229 of the 381 patients (60%). The per-patient sensitivity and specificity for the diagnosis of CAD (stenosis ≥50%) were 88% (202 of 229 patients) and 55% (83 of 152 patients), respectively, for CT perfusion imaging and 62% (143 of 229 patients) and 67% (102 of 152 patients) for SPECT, with Az values of 0.78 (95% confidence interval: 0.74, 0.82) and 0.69 (95% confidence interval: 0.64, 0.74) (P = .001). The sensitivity of CT perfusion imaging for single- and multivessel CAD was higher than that of SPECT, with sensitivities for left main, three-vessel, two-vessel, and one-vessel disease of 92%, 92%, 89%, and 83%, respectively, for CT perfusion imaging and 75%, 79%, 68%, and 41%, respectively, for SPECT. CONCLUSION: The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis ≥50%), as demonstrated with the Az, was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease.

11 Clinical Trial Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography: design and implementation of the CORE320 multicenter, multinational diagnostic study. 2011

Vavere, Andrea L / Simon, Gregory G / George, Richard T / Rochitte, Carlos E / Arai, Andrew E / Miller, Julie M / Di Carli, Marcello / Arbab-Zadeh, Armin / Dewey, Marc / Niinuma, Hiroyuki / Laham, Roger / Rybicki, Frank J / Schuijf, Joanne D / Paul, Narinder / Hoe, John / Kuribyashi, Sachio / Sakuma, Hajime / Nomura, Cesar / Yaw, Tan Swee / Kofoed, Klaus F / Yoshioka, Kunihiro / Clouse, Melvin E / Brinker, Jeffrey / Cox, Christopher / Lima, Joao A C. ·The Johns Hopkins University, Baltimore, Maryland 21287, USA. ·J Cardiovasc Comput Tomogr · Pubmed #22146496.

ABSTRACT: Multidetector coronary computed tomography angiography (CTA) is a promising modality for widespread clinical application because of its noninvasive nature and high diagnostic accuracy as found in previous studies using 64 to 320 simultaneous detector rows. It is, however, limited in its ability to detect myocardial ischemia. In this article, we describe the design of the CORE320 study ("Combined coronary atherosclerosis and myocardial perfusion evaluation using 320 detector row computed tomography"). This prospective, multicenter, multinational study is unique in that it is designed to assess the diagnostic performance of combined 320-row CTA and myocardial CT perfusion imaging (CTP) in comparison with the combination of invasive coronary angiography and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). The trial is being performed at 16 medical centers located in 8 countries worldwide. CT has the potential to assess both anatomy and physiology in a single imaging session. The co-primary aim of the CORE320 study is to define the per-patient diagnostic accuracy of the combination of coronary CTA and myocardial CTP to detect physiologically significant coronary artery disease compared with (1) the combination of conventional coronary angiography and SPECT-MPI and (2) conventional coronary angiography alone. If successful, the technology could revolutionize the management of patients with symptomatic CAD.

12 Clinical Trial The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography. 2010

Gottlieb, Ilan / Miller, Julie M / Arbab-Zadeh, Armin / Dewey, Marc / Clouse, Melvin E / Sara, Leonardo / Niinuma, Hiroyuki / Bush, David E / Paul, Narinder / Vavere, Andrea L / Texter, John / Brinker, Jeffery / Lima, João A C / Rochitte, Carlos E. ·Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ·J Am Coll Cardiol · Pubmed #20170786.

ABSTRACT: OBJECTIVES: This study was designed to evaluate whether the absence of coronary calcium could rule out >or=50% coronary stenosis or the need for revascularization. BACKGROUND: The latest American Heart Association guidelines suggest that a calcium score (CS) of zero might exclude the need for coronary angiography among symptomatic patients. METHODS: A substudy was made of the CORE64 (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors) multicenter trial comparing the diagnostic performance of 64-detector computed tomography to conventional angiography. Patients clinically referred for conventional angiography were asked to undergo a CS scan up to 30 days before. RESULTS: In all, 291 patients were included, of whom 214 (73%) were male, and the mean age was 59.3 +/- 10.0 years. A total of 14 (5%) patients had low, 218 (75%) had intermediate, and 59 (20%) had high pre-test probability of obstructive coronary artery disease. The overall prevalence of >or=50% stenosis was 56%. A total of 72 patients had CS = 0, among whom 14 (19%) had at least 1 >or=50% stenosis. The overall sensitivity for CS = 0 to predict the absence of >or=50% stenosis was 45%, specificity was 91%, negative predictive value was 68%, and positive predictive value was 81%. Additionally, revascularization was performed in 9 (12.5%) CS = 0 patients within 30 days of the CS. From a total of 383 vessels without any coronary calcification, 47 (12%) presented with >or=50% stenosis; and from a total of 64 totally occluded vessels, 13 (20%) had no calcium. CONCLUSIONS: The absence of coronary calcification does not exclude obstructive stenosis or the need for revascularization among patients with high enough suspicion of coronary artery disease to be referred for coronary angiography, in contrast with the published recommendations. Total coronary occlusion frequently occurs in the absence of any detectable calcification. (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors [CORE-64]; NCT00738218).

13 Article Comparative effectiveness of coronary artery stenosis and atherosclerotic plaque burden assessment for predicting 30-day revascularization and 2-year major adverse cardiac events. 2020

Kishi, Satoru / Magalhães, Tiago A / Cerci, Rodrigo J / Zimmermann, Elke / Matheson, Matthew B / Vavere, Andrea / Tanami, Yutaka / Kitslaar, Pieter H / George, Richard T / Brinker, Jeffrey / Miller, Julie M / Clouse, Melvin E / Lemos, Pedro A / Niinuma, Hiroyuki / Reiber, Johan H C / Kofoed, Klaus F / Rochitte, Carlos E / Rybicki, Frank J / Di Carli, Marcelo F / Cox, Christopher / Lima, Joao A C / Arbab-Zadeh, Armin. ·Department of Medicine/ Diabetology, Mitsui Memorial Hospital, Tokyo, Japan. · Federal University of Paraná, Hospital de Clínicas (CHC-UFPR), Curitiba, Brazil. · Quanta Diagnostico Nuclear, Curitiba, Brazil. · Department of Radiology, Charité, Berlin, Germany. · Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA. · Department of Medicine, Johns Hopkins University, Baltimore, USA. · Department of Radiology, Keio University, Tokyo, Japan. · Leiden University Medical Center/Medis Medical Imaging Systems, Leiden, The Netherlands. · iDepartment of Radiology, Beth Israel Deaconess Medical Center, Boston, USA. · Heart Institute (InCor), University of Sao Paulo, São Paulo, Brazil. · Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. · Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan. · Department of Medicine, Division of Cardiology, Rigshospitalet, Copenhagen, Denmark. · Department of Radiology, University of Cincinnati, Cincinnati, USA. · Department of Radiology, Brigham and Women's Hosptial, Boston, MA, USA. · Department of Medicine, Johns Hopkins University, Baltimore, USA. azadeh1@jhmi.edu. · Johns Hopkins Hospital, 600 N. Wolfe Street, Halsted 562, Baltimore, MD, 21287-0409, USA. azadeh1@jhmi.edu. ·Int J Cardiovasc Imaging · Pubmed #32361925.

ABSTRACT: PURPOSE: To provide comparative prognostic information of coronary atherosclerotic plaque volume and stenosis assessment in patients with suspected coronary artery disease (CAD). METHODS: We followed 372 patients with suspected or known CAD enrolled in the CORE320 study for 2 years after baseline 320-detector row cardiac CT scanning and invasive quantitative coronary angiography (QCA). CT images were analyzed for coronary calcium scanning (CACS), semi-automatically derived total percent atheroma volume (PAV), segment stenosis score (SSS), in addition to traditional stenosis assessment (≥ 50%) by CT and QCA for (1) 30-day revascularization and (2) major adverse cardiac events (MACE). Area under the receiver operating characteristic curve (AUC) was used to compare accuracy of risk prediction. RESULTS: Sixty percent of patients had obstructive CAD by QCA with 23% undergoing 30-day revascularization and 9% experiencing MACE at 2 years. Most late events (20/32) were revascularization procedures. Prediction of 30-day revascularization was modest (AUC range 0.67-0.78) but improved after excluding patients with known CAD (AUC range 0.73-0.86, p < 0.05 for all). Similarly, prediction of MACE improved after excluding patients with known CAD (AUC range 0.58-0.73 vs. 0.63-0.77). CT metrics of atherosclerosis burden performed overall similarly but stenosis assessment was superior for predicting 30-day revascularization. CONCLUSIONS: Angiographic and coronary atherosclerotic plaque metrics perform only modestly well for predicting 30-day revascularization and 2-year MACE in high risk patients but improve after excluding patients with known CAD. Atherosclerotic plaque metrics did not yield incremental value over stenosis assessment for predicting events that predominantly consisted of revascularization procedures. CLINICAL TRIAL REGISTRATION: NCT00934037.

14 Article Prognostic value of coronary artery calcium score in symptomatic individuals: A meta-analysis of 34,000 subjects. 2020

Lo-Kioeng-Shioe, Mallory S / Rijlaarsdam-Hermsen, Dorine / van Domburg, Ron T / Hadamitzky, Martin / Lima, João A C / Hoeks, Sanne E / Deckers, Jaap W. ·Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. · Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Medical Center Haaglanden Bronovo, The Hague, the Netherlands. · Institut für Radiologie und Nuklearmedizin, Hospital at the Technische Universität München, Munich, Germany. · Department of Cardiology, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA. · Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. Electronic address: j.deckers@erasmusmc.nl. ·Int J Cardiol · Pubmed #31229262.

ABSTRACT: BACKGROUND: Coronary artery calcium (CAC) scanning has evolved into an important subclinical prediction method for cardiovascular diseases in asymptomatic subjects. However, the prognostic implication of CAC scanning in symptomatic individuals is less clear. OBJECTIVES: To assess the prognostic utility of CAC in predicting risk of major adverse cardiac events (MACE) in stable patients with suspected CAD. METHODS: We did a systematic electronic literature search for studies presenting original data in CAC score, and reporting cardiovascular events in stable, symptomatic patients as primary outcome. Primary outcome of the meta-analysis was the occurrence of MACE, a composite of late coronary revascularization, hospitalization for unstable angina or heart failure, nonfatal myocardial infarction, and cardiac death or all-cause mortality. Using random effects models, we pooled relative risk ratios of CAC for MACE, and adjusted hazard ratios (HR) of the associations between different CAC strata (CAC 0-100,100-400, and ≥ 400, versus CAC = 0) and incident MACE. RESULTS: We included 19 observational studies (n = 34,041). In total, 1601 events were analyzed, of which 158 in patients with CAC = 0. The pooled relative risk ratio was 5.71 (95%-CI: 3.98;8.19) for subjects with CAC > 0. The pooled estimate of adjusted HRs demonstrated increasing, positive associations, with the strongest association for CAC > 400 (HR: 4.88; 95%-CI: 2.44;9.27). CONCLUSIONS: This meta-analysis demonstrated that increased levels of CAC are strongly and independently associated with increased risk for MACE in stable, symptomatic patients with suspected CAD, showing increasing risk with greater CAC scores. Application of CAC scanning as a prediction method could be useful for a considerable number of such patients.

15 Article Prognostic implications of QRS dispersion for major adverse cardiovascular events in asymptomatic women and men: the Multi-Ethnic Study of Atherosclerosis. 2019

Jain, Rahul / Gautam, Sandeep / Wu, Colin / Shen, Changyu / Jain, Aditya / Giesdal, Ola / Chahal, Harjit / Lin, Hongbo / Bluemke, David A / Soliman, Elsayed Z / Nazarian, Saman / Lima, João A C. ·Department of Cardiology, Krannert Institute of Cardiology, Indiana University School of Medicine, 1800 N. Capitol Avenue, Indianapolis, IN, 46202, USA. rahujain@iu.edu. · Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA. rahujain@iu.edu. · Division of Cardiovascular Medicine, University of Missouri, Columbia, MO, USA. · Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA. · Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA. · Department of Biostatistics, School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA. · Radiology and Imaging Sciences, National Institute of Health, Bethesda, MD, USA. · Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention and Department of Internal Medicine, Cardiology Section, Wake Forest School of Medicine, Winston-Salem, NC, USA. ·J Interv Card Electrophysiol · Pubmed #31482330.

ABSTRACT: BACKGROUND: QRS dispersion measured as the difference between maximal and minimal QRS duration in the standard 12-lead electrocardiogram has been shown to be associated with increased mortality in heart failure (HF) patients and increased arrhythmic events in patients with cardiomyopathy. AIMS: This study sought to examine the prognostic association between baseline QRS dispersion and future cardiovascular events in individuals without known prior cardiovascular disease. METHODS: The association of QRS dispersion with cardiovascular events was examined in 6510 MESA (Multi-Ethnic Study of Atherosclerosis) participants. Participants with bundle branch block were excluded. Study participants were divided into two groups based on the 95th percentile of QRS dispersion (QRS dispersion < 34 ms [group I] and QRS dispersion ≥ 34 ms [group II]). Cox proportional hazard models adjusting for demographic and clinical risk factors were used to examine the association of QRS dispersion with incident cardiovascular events (major adverse cardiovascular events [MACE]) and mortality. Analysis was repeated by forcing Framingham risk factors. RESULTS: Mean age was 62 ± 10 years in group I and 63 ± 10 years in group II (P = 0.02). QRS dispersion ≥ 34 ms was associated significantly with MACE (HR 1.30; 95% CI 1.04-1.62) and mortality (HR 1.33; 95% CI 1.03-1.73) after adjustment for cardiovascular risk factors and potential cofounders. Similar results were seen for mortality after adjustment for Framingham risk factors. CONCLUSION: QRS dispersion ≥ 34 ms predicts cardiovascular events and mortality.

16 Article Coronary Artery Calcium From Early Adulthood to Middle Age and Left Ventricular Structure and Function. 2019

Yared, Guilherme S / Moreira, Henrique T / Ambale-Venkatesh, Bharath / Vasconcellos, Henrique D / Nwabuo, Chike C / Ostovaneh, Mohammad R / Reis, Jared P / Lloyd-Jones, Donald M / Schreiner, Pamela J / Lewis, Cora E / Sidney, Stephen / Carr, John J / Gidding, Samuel S / Lima, João A C. ·Division of Cardiology, Johns Hopkins University, Baltimore, MD (G.S.Y., H.T.M., B.A.-V., H.D.V., C.C.N., M.R.O., J.A.C.L.). · Division of Cardiology, University of São Paulo, Ribeirão Preto, Brazil (H.T.M.). · Division of Cardiovascular Sciences, National Heart Lung and Blood Institute, Bethesda, MD (J.P.R.). · Department of Preventive Medicine, Northwestern University, Chicago, IL (D.M.L.-J.). · Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (P.J.S.). · Division of Preventive Medicine, University of Alabama at Birmingham (C.E.L.). · Division of Research, Kaiser Permanente Division of Research, Oakland, CA (S.S.). · Departments of Radiology, Biomedical Informatics, and Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (J.J.C.). · The FH Foundation, Pasadena, CA (S.S.G.). ·Circ Cardiovasc Imaging · Pubmed #31195818.

ABSTRACT: Background The relationship of coronary artery calcium (CAC) with adverse cardiac remodeling is not well established. We aimed to study the association of CAC in middle age and change in CAC from early adulthood to middle age with left ventricular (LV) function. Methods CAC score was measured by computed tomography at CARDIA study (Coronary Artery Risk Development in Young Adults) year-15 examination and at year-25 examination (Y25) in 3043 and 3189 participants, respectively. CAC score was assessed as a continuous variable and log-transformed to account for nonlinearity. Change in CAC from year-15 examination to Y25 was evaluated as the absolute difference of log-transformed CAC from year-15 examination to Y25. LV structure and function were evaluated by echocardiography at Y25. Results At Y25, mean age was 50.1±3.6 years, 56.6% women, 52.4% black. In the multivariable analysis at Y25, higher CAC was related to higher LV mass (β=1.218; adjusted P=0.007), higher LV end-diastolic volume (β=0.811; adjusted P=0.007), higher LV end-systolic volume (β=0.350; adjusted P=0.048), higher left atrial volume (β=0.214; adjusted P=0.009), and higher E/e' ratio (β=0.059; adjusted P=0.014). CAC was measured at both year-15 examination and Y25 in 2449 individuals. Higher change in CAC score during follow-up was independently related to higher LV mass index in blacks (β=4.789; adjusted P<0.001), but not in whites (β=1.051; adjusted P=0.283). Conclusions Higher CAC in middle age is associated with higher LV mass and volumes and worse LV diastolic function. Being free of CAC from young adulthood to middle age correlates to better LV function at middle age. Higher change in CAC score during follow-up is independently related to higher LV mass index in blacks.

17 Article Coronary Calcium Characteristics as Predictors of Major Adverse Cardiac Events in Symptomatic Patients: Insights From the CORE 320 Multinational Study. 2019

Lo-Kioeng-Shioe, Mallory S / Vavere, Andrea L / Arbab-Zadeh, Armin / Schuijf, Joanne D / Rochitte, Carlos E / Chen, Marcus Y / Rief, Matthias / Kofoed, Klaus F / Clouse, Melvin E / Scholte, Arthur J / Miller, Julie M / Betoko, Aisha / Blaha, Michael J / Cox, Christopher / Deckers, Jaap W / Lima, Joao A C. ·1 Department of Cardiology Johns Hopkins Hospital and School of Medicine Baltimore MD. · 2 Department of Cardiology Erasmus Medical Center Erasmus University Rotterdam Rotterdam the Netherlands. · 3 Toshiba Medical Systems Europe BV Zoetermeer the Netherlands. · 4 Department of Cardiology InCor Heart Lung and Blood Institute University of Sao Paulo Medical School Sao Paulo Brazil. · 5 National Heart Lung and Blood Institute National Institutes of Health Bethesda MD. · 6 Department of Radiology Charité Medical School Humboldt Berlin, Germany. · 7 Department of Cardiology Heart Center University of Copenhagen Copenhagen Denmark. · 8 Department of Cardiology Beth Israel Deaconess Medical Center Harvard University Boston MA. · 9 Department of Cardiology Leiden University Medical Center Leiden the Netherlands. · 10 Johns Hopkins Bloomberg School of Public Health Baltimore MD. ·J Am Heart Assoc · Pubmed #30879377.

ABSTRACT: Background The predictive value of coronary artery calcium ( CAC ) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE 320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast-enhanced images. The primary outcome of 2-year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4%). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56-68) years, 34% were women, and 56% were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.

18 Article Contemporary Discrepancies of Stenosis Assessment by Computed Tomography and Invasive Coronary Angiography. 2019

Song, Young Bin / Arbab-Zadeh, Armin / Matheson, Matthew B / Ostovaneh, Mohammad R / Vavere, Andrea L / Dewey, Marc / Rochitte, Carlos / Niinuma, Hiroyuki / Laham, Roger / Schuijf, Joanne D / Cox, Christopher / Brinker, Jeffrey / di Carli, Marcelo / Lima, João A C / Miller, Julie M. ·Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.B.S.). · Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.). · Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.B.M., C.C.). · Department of Radiology, Charité Medical School, Humboldt, Berlin, Germany (M.D.). · Department of Medicine, InCor Heart Institute, University of Sao Paulo Medical School, Brazil (C.R.). · Department of Medicine, Division of Cardiology, Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N.). · Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (R.L.). · Canon Medical Systems, Europe, Zoetermeer, the Netherlands (J.D.S.). · Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.d.C.). ·Circ Cardiovasc Imaging · Pubmed #30764641.

ABSTRACT: Background Ongoing advancements of coronary computed tomographic angiography (CTA) continue to challenge the role of invasive coronary angiography (ICA) as the gold standard for the evaluation of coronary artery disease (CAD). We sought to investigate the diagnostic accuracy of 320-slice CTA for detecting obstructive CAD in reference to ICA and nuclear myocardial perfusion imaging using single-photon emission computed tomography. Methods For the CORE320 study (Coronary Artery Evaluation Using 320-Row Multidetector Computed Tomography Angiography and Myocardial Perfusion), 381 patients at 16 centers underwent CTA, nuclear myocardial perfusion imaging by single-photon emission computed tomography, and ICA for the evaluation of CAD. Imaging studies were analyzed in blinded core laboratories, and a stenosis of ≥50% by quantitative coronary angiography was considered obstructive, whereas a stress difference score of ≥1 indicated inducible myocardial ischemia. The area under the receiver operating characteristic curve was used to evaluate diagnostic accuracy. Results Of 381 patients, 229 (60%) had obstructive CAD by quantitative coronary angiography. Diagnostic accuracy of CTA on a per-patient analysis revealed an area under the receiver operating characteristic curve of 0.90 (95% CI, 0.87-0.93). Per-vessel and per-segment analysis revealed lower area under the receiver operating characteristic curve of 0.87 (0.84-0.90) and 0.81 (0.78-0.83), respectively. Median radiation dose was lower for CTA versus ICA: 3.16 (interquartile range, 2.82-3.59) versus 11.97 (interquartile range, 7.60-17.8) mSv ( P<0.001). Accuracy for identifying patients with inducible myocardial ischemia by SPECT-MPI was similar for CTA and ICA (area under the receiver operating characteristic curve, 0.68 versus 0.71 by quantitative coronary angiography and 0.68 by visual angiographic assessment; P>0.05). Furthermore, accuracy for identifying patients who subsequently underwent clinically driven coronary revascularization also was similar for CTA (0.76 [0.71-0.81]) and ICA (0.78 [0.74-0.83]; P=0.20). Conclusions Contemporary CTA accurately identifies patients with obstructive CAD by ICA at lower radiation exposure; however, agreement is lower in vessel- and segment-level analyses. Both CTA and ICA perform similarly for predicting clinically driven revascularization and for detecting myocardial ischemia by myocardial perfusion imaging using single-photon emission computed tomography, suggesting that limitations by both CTA and ICA contribute to variability of stenosis quantification. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT00934037.

19 Article Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia. 2019

Bakhshi, Hooman / Meyghani, Zahra / Kishi, Satoru / Magalhães, Tiago A / Vavere, Andrea / Kitslaar, Pieter H / George, Richard T / Niinuma, Hiroyuki / Reiber, Johan H C / Betoko, Aisha / Matheson, Matthew / Rochitte, Carlos E / Di Carli, Marcelo F / Cox, Christopher / Lima, João A C / Arbab-Zadeh, Armin. ·Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. · Universidade Federal do Paraná, Curitiba, Brazil; Heart Institute (InCor), University of São Paulo, São Paulo, Brazil. · MedImmune, Gaithersburg, Maryland. · Department of Radiology, Leiden University/Medical Imaging Systems, Leiden, the Netherlands. · Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan. · Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland. · Heart Institute (InCor), University of São Paulo, São Paulo, Brazil. · Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. Electronic address: azadeh1@jhmi.edu. ·JACC Cardiovasc Imaging · Pubmed #30031705.

ABSTRACT: OBJECTIVES: This study sought to investigate the performance of various cardiac computed tomography (CT)-derived atherosclerotic plaque metrics for predicting provocable myocardial ischemia. BACKGROUND: The association of coronary arterial diameter stenosis with myocardial ischemia is only modest, but cardiac CT provides several other, readily available atherosclerosis metrics, which may have incremental value. METHODS: The study analyzed 873 nonstented coronary arteries and their myocardial perfusion territories in 356 patients (mean 62 years of age) enrolled in the CORE320 (Coronary Artery Evaluation using 320-row Multidetector Computed Tomography Angiography and Myocardial Perfusion) study. Myocardial perfusion defects in static CT perfusion imaging were graded at rest and after adenosine in 13 myocardial segments using a 4-point scale. The summed difference score was calculated by subtracting the summed rest score from the summed stress score. Reversible ischemia was defined as summed difference score ≥1. In a sensitivity analysis, results were also provided using single-photon emission computed tomography (SPECT) as the reference standard. Vessel based predictor variables included maximum percent diameter stenosis, lesion length, coronary calcium score, maximum cross-sectional calcium arc, percent atheroma volume (PAV), low-attenuation atheroma volume, positive (external) vascular remodeling, and subjective impression of "vulnerable plaque." The study used logistic regression models to assess the association of plaque metrics with myocardial ischemia. RESULTS: In univariate analysis, all plaque metrics were associated with reversible ischemia. In the adjusted logistic model, only maximum percent diameter stenosis (1.26; 95% confidence interval: 1.15 to 1.38) remained an independent predictor. With SPECT as outcome variable, PAV and "vulnerable" plaque remained predictive after adjustment. In vessels with intermediate stenosis (40% to 70%), no single metric had clinically meaningful incremental value. CONCLUSIONS: Various plaque metrics obtained by cardiac CT predict provocable myocardial ischemia by CT perfusion imaging through their association with maximum percent stenosis, while none had significant incremental value. With SPECT as reference standard, PAV and "vulnerable plaque" remained predictors of ischemia after adjustment but the predictive value added to stenosis assessment alone was small.

20 Article Cumulative blood pressure from early adulthood to middle age is associated with left atrial remodelling and subclinical dysfunction assessed by three-dimensional echocardiography: a prospective post hoc analysis from the coronary artery risk development in young adults study. 2018

Vasconcellos, Henrique D / Moreira, Henrique T / Ciuffo, Luisa / Nwabuo, Chike C / Yared, Guilherme S / Ambale-Venkatesh, Bharath / Armstrong, Anderson C / Kishi, Satoru / Reis, Jared P / Liu, Kiang / Lloyd-Jones, Donald M / Colangelo, Laura A / Schreiner, Pamela J / Sidney, Stephen / Gidding, Samuel S / Lima, Joao A C. ·Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA. · Department of Medicine, Federal University of Sao Francisco Valley, Av. Jose de Sa Manicoba, S/N, Centro, Petrolina, PE, Brazil. · Division of Cardiology, Universidade of Sao Paulo, Ribeirao Preto, Av. Bandeirantes, 3.900 Monte Alegre, Ribeirão Preto, SP, Brazil. · Division of Diabetes, Memorial Hospital, 1 Izumicho Kanda, Chiyoda, Tokyo, Japan. · Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, 31 Center Drive, Bethesda, MD, USA. · Department of Preventive Medicine, Northwestern University, 675 N St Clair St STE 19-100, Chicago, IL, USA. · Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Minneapolis, MN, USA. · Division of Research, Department of Pediatrics, Kaiser Permanente Center, 3600 Broadway, Oakland, CA, USA. · Division of Pediatrics Cardiology, Nemours Cardiac Center, 1600 Rockland Road Wilmington, DE, USA. ·Eur Heart J Cardiovasc Imaging · Pubmed #29982431.

ABSTRACT: Aims: To evaluate the association of cumulative blood pressure (BP) from young adulthood to middle age with left atrial (LA) structure/function as assessed by three-dimensional echocardiography (3DE) in a large longitudinal bi-racial population study. Methods and results: We conducted a prospective post hoc analysis of individuals enrolled at the Coronary Artery Risk Development in Young Adults, which is a multi-centre bi-racial cohort with 30 years of follow-up. Cumulative systolic and diastolic BP levels were defined by summing the product of average millimetres of mercury and the years between each two consecutive clinic visits over 30 years of follow-up. Multivariable linear regression analyses were used to assess the relationship between cumulative systolic and diastolic BP with 3DE LA structure and function, adjusting for demographics and traditional cardiovascular risk factors. A total of 1033 participants were included, mean age was 55.4 ± 3.5 years, 55.2% women, 43.9% blacks. Cumulative systolic BP had stronger correlations than cumulative diastolic BP. Higher cumulative systolic BP was independently associated with higher 3D LA volumes: maximum (β = 1.74, P = 0.004), pre-atrial contraction (β = 1.87, P < 0.001), minimum (β = 0.76, P = 0.04), total emptying (β = 0.98, P = 0.006), active emptying (β = 1.12, P < 0.001), and lower magnitude 3D LA early diastolic strain rate (β = 0.05, P = 0.02). Higher cumulative diastolic BP was independently associated with higher 3D LA active emptying volume (β = 0.66, P = 0.002), lower magnitude 3D LA early diastolic strain rate (β = 0.05, P = 0.004), and higher magnitude 3D LA late diastolic strain rate (β = -0.04, P = 0.05). Conclusion: Higher cumulative BP from early adulthood throughout middle age was associated with adverse LA remodelling evaluated by 3D echocardiography.

21 Article Diagnostic accuracy of semi-automatic quantitative metrics as an alternative to expert reading of CT myocardial perfusion in the CORE320 study. 2018

Ostovaneh, Mohammad R / Vavere, Andrea L / Mehra, Vishal C / Kofoed, Klaus F / Matheson, Matthew B / Arbab-Zadeh, Armin / Fujisawa, Yasuko / Schuijf, Joanne D / Rochitte, Carlos E / Scholte, Arthur J / Kitagawa, Kakuya / Dewey, Marc / Cox, Christopher / DiCarli, Marcelo F / George, Richard T / Lima, Joao A C. ·Devision of Cardiology, Johns Hopkins Hospital and School of Medicine Baltimore, MD, USA. · Rigshospitalet, University of Copenhagen, Denmark. · Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · Toshiba Medical Systems Corporation, Japan. · Toshiba Medical Systems Europe B.V., Zoetermeer, The Netherlands. · InCor Heart Institute, University of Sao Paulo Medical School, Brazil. · Leiden University Medical Center, Leiden, The Netherlands. · Mie University Hospital, Tsu, Japan. · Charité Medical School, Humboldt, Berlin, Germany. · Brigham and Women's Hospital, Harvard University, Boston, MA, USA. · Devision of Cardiology, Johns Hopkins Hospital and School of Medicine Baltimore, MD, USA. Electronic address: jlima@jhmi.edu. ·J Cardiovasc Comput Tomogr · Pubmed #29730016.

ABSTRACT: AIMS: To determine the diagnostic accuracy of semi-automatic quantitative metrics compared to expert reading for interpretation of computed tomography perfusion (CTP) imaging. METHODS: The CORE320 multicenter diagnostic accuracy clinical study enrolled patients between 45 and 85 years of age who were clinically referred for invasive coronary angiography (ICA). Computed tomography angiography (CTA), CTP, single photon emission computed tomography (SPECT), and ICA images were interpreted manually in blinded core laboratories by two experienced readers. Additionally, eight quantitative CTP metrics as continuous values were computed semi-automatically from myocardial and blood attenuation and were combined using logistic regression to derive a final quantitative CTP metric score. For the reference standard, hemodynamically significant coronary artery disease (CAD) was defined as a quantitative ICA stenosis of 50% or greater and a corresponding perfusion defect by SPECT. Diagnostic accuracy was determined by area under the receiver operating characteristic curve (AUC). RESULTS: Of the total 377 included patients, 66% were male, median age was 62 (IQR: 56, 68) years, and 27% had prior myocardial infarction. In patient based analysis, the AUC (95% CI) for combined CTA-CTP expert reading and combined CTA-CTP semi-automatic quantitative metrics was 0.87(0.84-0.91) and 0.86 (0.83-0.9), respectively. In vessel based analyses the AUC's were 0.85 (0.82-0.88) and 0.84 (0.81-0.87), respectively. No significant difference in AUC was found between combined CTA-CTP expert reading and CTA-CTP semi-automatic quantitative metrics in patient based or vessel based analyses(p > 0.05 for all). CONCLUSION: Combined CTA-CTP semi-automatic quantitative metrics is as accurate as CTA-CTP expert reading to detect hemodynamically significant CAD.

22 Article Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). 2018

Budoff, Matthew J / Young, Rebekah / Burke, Gregory / Jeffrey Carr, J / Detrano, Robert C / Folsom, Aaron R / Kronmal, Richard / Lima, Joao A C / Liu, Kiang J / McClelland, Robyn L / Michos, Erin / Post, Wendy S / Shea, Steven / Watson, Karol E / Wong, Nathan D. ·Los Angeles Biomedical Research Institute, 1124 W Carson Street, CDCRC, Torrance, CA, USA. · Department of Biostatistics, University of Washington, Bldg. 29, Suite 310, 6200 NE 74th Street, Seattle, WA, USA. · Department of Public Health Sciences, Wake Forest University Health Sciences, 475 Vine St, Winston-Salem, NC, USA. · Department of Radiological Sciences, Vanderbilt University, 2525 West End, Nashville, TN, USA. · Departments of Radiological Sciences and Public Health, University of California, Irvine, Irvine, CA, USA. · Department of Public Health, University of Minnesota, 1300 S 2nd St, Minneapolis, MN, USA. · Department of Internal Medicine, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD, USA. · Department of Preventive Medicine, Northwestern University, 600 N Lake Shore Drive, Chicago, IL, USA. · Department of Medicine, Vagelos College of Physicians & Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, 630 W. 168th Street, New York, NY, USA. · Department of Internal Medicine, UCLA, 200 UCLA Medical Plaza, Los Angeles, CA, USA. ·Eur Heart J · Pubmed #29688297.

ABSTRACT: Aims: While coronary artery calcium (CAC) has been extensively validated for predicting clinical events, most outcome studies of CAC have evaluated coronary heart disease (CHD) rather than atherosclerotic cardiovascular disease (ASCVD) events (including stroke). Also, virtually all CAC studies are of short- or intermediate-term follow-up, so studies across multi-ethnic cohorts with long-term follow-up are warranted prior to widespread clinical use. We sought to evaluate the contribution of CAC using the population-based MESA cohort with over 10 years of follow-up for ASCVD events, and whether the association of CAC with events varied by sex, race/ethnicity, or age category. Methods and results: We utilized MESA, a prospective multi-ethnic cohort study of 6814 participants (51% women), aged 45-84 years, free of clinical CVD at baseline. We evaluated the relationship between CAC and incident ASCVD using Cox regression models adjusted for age, race/ethnicity, sex, education, income, cigarette smoking status, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, diabetes, lipid-lowering medication, systolic blood pressure, antihypertensive medication, intentional physical exercise, and body mass index. Only the first event for each individual was used in the analysis. Overall, 500 incident ASCVD (7.4%) events were observed in the total study population over a median of 11.1 years. Hard ASCVD included 217 myocardial infarction, 188 strokes (not transient ischaemic attack), 13 resuscitated cardiac arrest, and 82 CHD deaths. Event rates in those with CAC = 0 Agatston units ranged from 1.3% to 5.6%, while for those with CAC > 300, the 10-year event rates ranged from 13.1% to 25.6% across different age, gender, and racial subgroups. At 10 years of follow-up, all participants with CAC > 100 were estimated to have >7.5% risk regardless of demographic subset. Ten-year ASCVD event rates increased steadily across CAC categories regardless of age, sex, or race/ethnicity. For each doubling of CAC, we estimated a 14% relative increment in ASCVD risk, holding all other risk factors constant. This association was not significantly modified by age, sex, race/ethnicity, or baseline lipid-lowering use. Conclusions: Coronary artery calcium is associated strongly and in a graded fashion with 10-year risk of incident ASCVD as it is for CHD, independent of standard risk factors, and similarly by age, gender, and ethnicity. While 10-year event rates in those with CAC = 0 were almost exclusively below 5%, those with CAC ≥ 100 were consistently above 7.5%, making these potentially valuable cutpoints for the consideration of preventive therapies. Coronary artery calcium strongly predicts risk with the same magnitude of effect in all races, age groups, and both sexes, which makes it among the most useful markers for predicting ASCVD risk.

23 Article The 10-Year Prognostic Value of Zero and Minimal CAC. 2017

Joshi, Parag H / Blaha, Michael J / Budoff, Matthew J / Miedema, Michael D / McClelland, Robyn L / Lima, Joao A C / Agatston, Arthur S / Blankstein, Ron / Blumenthal, Roger S / Nasir, Khurram. · ·JACC Cardiovasc Imaging · Pubmed #28797418.

ABSTRACT: -- No abstract --

24 Article Association of Coronary Artery Calcium Score vs Age With Cardiovascular Risk in Older Adults: An Analysis of Pooled Population-Based Studies. 2017

Yano, Yuichiro / O'Donnell, Christopher J / Kuller, Lewis / Kavousi, Maryam / Erbel, Raimund / Ning, Hongyan / D'Agostino, Ralph / Newman, Anne B / Nasir, Khurram / Hofman, Albert / Lehmann, Nils / Dhana, Klodian / Blankstein, Ron / Hoffmann, Udo / Möhlenkamp, Stefan / Massaro, Joseph M / Mahabadi, Amir-Abbas / Lima, Joao A C / Ikram, M Arfan / Jöckel, Karl-Heinz / Franco, Oscar H / Liu, Kiang / Lloyd-Jones, Donald / Greenland, Philip. ·Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Department of Preventive Medicine, University of Mississippi Medical Center, Jackson. · National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts. · Associate Editor. · Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. · Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Cardiology, West German Heart and Vascular Center, University Clinic Essen, University of Duisburg-Essen, Essen, Germany. · Biostatistics, Boston University School of Public Health, Boston, Massachusetts. · Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida. · Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. · Institute of Medical Informatics, Biometry, and Epidemiology, University Clinic Essen, University of Duisburg-Essen, Essen, Germany. · Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. · Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Clinic of Cardiology and Intensive Care Medicine, Bethanien Hospital Moers, Moers, Germany. · Department of Cardiology, Johns Hopkins University, Baltimore, Maryland. · Departments of Epidemiology, Radiology, and Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands. ·JAMA Cardiol · Pubmed #28746709.

ABSTRACT: Importance: Besides age, other discriminators of atherosclerotic cardiovascular disease (ASCVD) risk are needed in older adults. Objectives: To examine the predictive ability of coronary artery calcium (CAC) score vs age for incident ASCVD and how risk prediction changes by adding CAC score and removing only age from prediction models. Design, Setting, and Participants: We conducted an analysis of pooled US population-based studies, including the Framingham Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Results were compared with 2 European cohorts, the Rotterdam Study and the Heinz Nixdorf Recall Study. Participants underwent CAC scoring between 1998 and 2006 using cardiac computed tomography. The participants included adults older than 60 years without known ASCVD at baseline. Exposures: Coronary artery calcium scores. Main Outcomes and Measures: Incident ASCVD events including coronary heart disease (CHD) and stroke. Results: The study included 4778 participants from 3 US cohorts, with a mean age of 70.1 years; 2582 (54.0%) were women, and 2431 (50.9%) were nonwhite. Over 11 years of follow-up (44 152 person-years), 405 CHD and 228 stroke events occurred. Coronary artery calcium score (vs age) had a greater association with incident CHD (C statistic, 0.733 vs 0.690; C statistics difference, 0.043; 95% CI of difference, 0.009-0.075) and modestly improved prediction of incident stroke (C statistic, 0.695 vs 0.670; C statistics difference, 0.025; 95% CI of difference, -0.015 to 0.064). Adding CAC score to models including traditional cardiovascular risk factors, with only age being removed, provided improved discrimination for incident CHD (C statistic, 0.735 vs 0.703; C statistics difference, 0.032; 95% CI of difference, 0.002-0.062) but not for stroke. Coronary artery calcium score was more likely than age to provide higher category-free net reclassification improvement among participants who experienced an ASCVD event (0.390; 95% CI, 0.312-0.467 vs 0.08; 95% CI -0.001 to 0.181) and to result in more accurate reclassification of risk for ASCVD events among these individuals. The findings were similar in the 2 European cohorts (n = 4990). Conclusions and Relevance: Coronary artery calcium may be an alternative marker besides age to better discriminate between lower and higher CHD risk in older adults. Whether CAC score can assist in guiding the decision to initiate statin treatment for primary prevention in older adults requires further investigation.

25 Article Aortic Arch Pulse Wave Velocity Assessed by Magnetic Resonance Imaging as a Predictor of Incident Cardiovascular Events: The MESA (Multi-Ethnic Study of Atherosclerosis). 2017

Ohyama, Yoshiaki / Ambale-Venkatesh, Bharath / Noda, Chikara / Kim, Jang-Young / Tanami, Yutaka / Teixido-Tura, Gisela / Chugh, Atul R / Redheuil, Alban / Liu, Chia-Ying / Wu, Colin O / Hundley, W Gregory / Bluemke, David A / Guallar, Eliseo / Lima, Joao A C. ·From the Department of Cardiology (Y.O., C.N., J.-Y.K., Y.T., G.T.-T., A.R.C., J.A.C.L.), Department of Radiology (B.A.-V.), and Department of Epidemiology (E.G.), Johns Hopkins University, Baltimore, MD · Imagerie Cardiovasculaire/Department of Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris (A.R.) · Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (C.-Y.L., D.A.B.) · Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, MD (C.O.W.) · and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.). ·Hypertension · Pubmed #28674039.

ABSTRACT: The predictive value of aortic arch pulse wave velocity (PWV) assessed by magnetic resonance imaging for cardiovascular disease (CVD) events has not been fully established. The aim of the present study was to evaluate the association of arch PWV with incident CVD events in MESA (Multi-Ethnic Study of Atherosclerosis). Aortic arch PWV was measured using magnetic resonance imaging at baseline in 3527 MESA participants (mean age, 62±10 years at baseline; 47% men) free of overt CVD. Cox regression was used to evaluate the risk of incident CVD (coronary heart disease, stroke, transient ischemic attack, or heart failure) in relation to arch PWV adjusted for age, sex, race, and CVD risk factors. The median value of arch PWV was 7.4 m/s (interquartile range, 5.6-10.2). There was significant interaction between arch PWV and age for outcomes, so analysis was stratified by age categories (45-54 and >54 years). There were 456 CVD events during the 10-year follow-up. Forty-five to 54-year-old participants had significant association of arch PWV with incident CVD independent of CVD risk factors (hazard ratio, 1.44; 95% confidence interval, 1.07-1.95;

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