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Coronary Artery Disease: HELP
Articles by João A. C. Lima
Based on 68 articles published since 2008
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Between 2008 and 2019, Joao A. C. Lima wrote the following 68 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 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.

3 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.

4 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.

5 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.

6 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.

7 Review Recent developments in wide-detector cardiac computed tomography. 2009

Choi, Sang Il / George, Richard T / Schuleri, Karl H / Chun, Eun Ju / Lima, Joao A C / Lardo, Albert C. ·Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave./1042 Ross Building, Baltimore, MD 21205, USA. ·Int J Cardiovasc Imaging · Pubmed #19255875.

ABSTRACT: Multidetector computed tomography (MDCT) using 64 detectors is widely used for cardiac imaging in the clinical setting. Despite promising results, 64-slice MDCT has important limitations for cardiac applications related to detector coverage, which leads to longer scan times, image artifacts, increased radiation and the need for higher contrast doses. The advent of wide or full cardiac coverage with 256- or 320-slice MDCT provides important advantages that can potentially improve the status of these limitations and expand the utility of cardiac MDCT imaging beyond coronary imaging. Additionally, the combination of wide-detectors and multi-energy acquisitions offer interesting possibilities of improved coverage and temporal resolution that may improve plaque characterization as well as viability and perfusion imaging. In this review we will discuss the current status of wide-detector MDCT scanners and their advantages for clinical coronary and ventricular imaging. We will also review examples of wide detector coronary angiography imaging and discuss emerging complementary non-coronary applications that have been enabled by wide-detector MDCT imaging.

8 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.

9 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.

10 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.

11 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).

12 Clinical Trial Diagnostic performance of coronary angiography by 64-row CT. 2008

Miller, Julie M / Rochitte, Carlos E / Dewey, Marc / Arbab-Zadeh, Armin / Niinuma, Hiroyuki / Gottlieb, Ilan / Paul, Narinder / Clouse, Melvin E / Shapiro, Edward P / Hoe, John / Lardo, Albert C / Bush, David E / de Roos, Albert / Cox, Christopher / Brinker, Jeffery / Lima, João A C. ·Johns Hopkins University School of Medicine, Baltimore 21287, USA. ·N Engl J Med · Pubmed #19038879.

ABSTRACT: BACKGROUND: The accuracy of multidetector computed tomographic (CT) angiography involving 64 detectors has not been well established. METHODS: We conducted a multicenter study to examine the accuracy of 64-row, 0.5-mm multidetector CT angiography as compared with conventional coronary angiography in patients with suspected coronary artery disease. Nine centers enrolled patients who underwent calcium scoring and multidetector CT angiography before conventional coronary angiography. In 291 patients with calcium scores of 600 or less, segments 1.5 mm or more in diameter were analyzed by means of CT and conventional angiography at independent core laboratories. Stenoses of 50% or more were considered obstructive. The area under the receiver-operating-characteristic curve (AUC) was used to evaluate diagnostic accuracy relative to that of conventional angiography and subsequent revascularization status, whereas disease severity was assessed with the use of the modified Duke Coronary Artery Disease Index. RESULTS: A total of 56% of patients had obstructive coronary artery disease. The patient-based diagnostic accuracy of quantitative CT angiography for detecting or ruling out stenoses of 50% or more according to conventional angiography revealed an AUC of 0.93 (95% confidence interval [CI], 0.90 to 0.96), with a sensitivity of 85% (95% CI, 79 to 90), a specificity of 90% (95% CI, 83 to 94), a positive predictive value of 91% (95% CI, 86 to 95), and a negative predictive value of 83% (95% CI, 75 to 89). CT angiography was similar to conventional angiography in its ability to identify patients who subsequently underwent revascularization: the AUC was 0.84 (95% CI, 0.79 to 0.88) for multidetector CT angiography and 0.82 (95% CI, 0.77 to 0.86) for conventional angiography. A per-vessel analysis of 866 vessels yielded an AUC of 0.91 (95% CI, 0.88 to 0.93). Disease severity ascertained by CT and conventional angiography was well correlated (r=0.81; 95% CI, 0.76 to 0.84). Two patients had important reactions to contrast medium after CT angiography. CONCLUSIONS: Multidetector CT angiography accurately identifies the presence and severity of obstructive coronary artery disease and subsequent revascularization in symptomatic patients. The negative and positive predictive values indicate that multidetector CT angiography cannot replace conventional coronary angiography at present. (ClinicalTrials.gov number, NCT00738218.)

13 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.

14 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.

15 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 --

16 Article Relative atherosclerotic plaque volume by CT coronary angiography trumps conventional stenosis assessment for identifying flow-limiting lesions. 2017

Kato, Nahoko / Kishi, Satoru / Arbab-Zadeh, Armin / Rybicki, Frank J / Tanimoto, Shuzou / Aoki, Jiro / Watanabe, Mika / Horiuchi, Yu / Furui, Koichi / Hara, Kazuhiro / Ibukuro, Kenji / Lima, Joao A C / Tanabe, Kengo. ·Division of Cardiology, Mitsui Memorial Hospital, 1 Kandaizumi-cho, Chiyoda-ku, Tokyo, Japan. · Division of Diabetes Mitsui Memorial Hospital, 1 Kandaizumi-cho Chiyoda-ku, Tokyo, Japan. m980287@gmail.com. · Division of Cardiology, Johns Hopkins Hospital and School of Medicine, Blalock 524, 600N Wolfe Street, Baltimore, MD, 21287, USA. · The Ottawa Hospital Research Institute and Department of Radiology, The University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. · Division of Diagnostic Radiology Mitsui Memorial Hospital, 1 Kandaizumi-cho Chiyoda-ku, Tokyo, Japan. ·Int J Cardiovasc Imaging · Pubmed #28597124.

ABSTRACT: The new methods for diagnosing the ischemia with coronary computed tomographic angiography (CTA) as a noninvasive test have been investigated. To compare the relative plaque volume to quantitative CTA and quantitative coronary angiography (QCA) for detecting flow-limiting coronary artery stenoses. We studied 49 patients with 55 intermediate lesions (30-69% diameter stenosis) who underwent CTA, coronary angiography (CAG), and FFR. CTA and QCA measures included lesion length, percent diameter stenosis (%DS), minimal lumen diameter (MLD), target main vessel percent plaque volume (%PV), lesion %PV, target main vessel percent lumen volume (%LV), and lesion %LV. FFR ≤0.80 was considered diagnostic of a flow-limiting lesion. The area under the receiver-operating characteristic curve (AUC) was used to determine the accuracy of detecting flow-limiting lesions. We also investigated the AUC of discrimination of flow-limiting lesion according to calcium score. Eighteen of 55 lesions (32.7%) had an FFR ≤0.80. Only vessel %PV differentiated between lesions with and without flow obstruction (67.6 vs. 62.7%, p = 0.018). The AUC for vessel %PV was greatest (0.76; 95% CI 0.61-0.87). The AUC for the discrimination of the flow-limiting lesions according to low calcium score (≤400) improved to 0.82 (95% CI 0.57-0.94). In intermediate coronary artery stenoses, vessel %PV is more accurate than conventional stenosis assessment for detecting flow-limiting lesions. In low calcium score, vessel %PV is more useful for diagnosis of ischemic heart disease compared with conventional quantitative measures.

17 Article Factors Associated With Coronary Artery Disease Progression Assessed By Serial Coronary Computed Tomography Angiography. 2017

Camargo, Gabriel Cordeiro / Rothstein, Tamara / Derenne, Maria Eduarda / Sabioni, Leticia / Lima, João A C / Lima, Ronaldo de Souza Leão / Gottlieb, Ilan. ·Casa de Saúde São José; Rio de Janeiro, RJ, Brazil. · Centro de Diagnóstico por Imagem CDPI, Rio de Janeiro, RJ, Brazil. · Johns Hopkins University, Baltimore, USA. · Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro (UFRJ); Rio de Janeiro, RJ - Brazil. · Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brazil. ·Arq Bras Cardiol · Pubmed #28492738.

ABSTRACT: Background: Coronary computed tomography angiography (CCTA) allows for noninvasive coronary artery disease (CAD) phenotyping. Factors related to CAD progression are epidemiologically valuable. Objective: To identify factors associated with CAD progression in patients undergoing sequential CCTA testing. Methods: We retrospectively analyzed 384 consecutive patients who had at least two CCTA studies between December 2005 and March 2013. Due to limitations in the quantification of CAD progression, we excluded patients who had undergone surgical revascularization previously or percutaneous coronary intervention (PCI) between studies. CAD progression was defined as any increase in the adapted segment stenosis score (calculated using the number of diseased segments and stenosis severity) in all coronary segments without stent (in-stent restenosis was excluded from the analysis). Stepwise logistic regression was used to assess variables associated with CAD progression. Results: From a final population of 234 patients, a total of 117 (50%) had CAD progression. In a model accounting for major CAD risk factors and other baseline characteristics, only age (odds ratio [OR] 1.04, 95% confidence interval [95%CI] 1.01-1.07), interstudy interval (OR 1.03, 95%CI 1.01-1.04), and past PCI (OR 3.66, 95%CI 1.77-7.55) showed an independent relationship with CAD progression. Conclusions: A history of PCI with stent placement was independently associated with a 3.7-fold increase in the odds of CAD progression, excluding in-stent restenosis. Age and interstudy interval were also independent predictors of progression.

18 Article Progression of Coronary Artery Calcium and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis. 2017

Bakhshi, Hooman / Ambale-Venkatesh, Bharath / Yang, Xiaoying / Ostovaneh, Mohammad R / Wu, Colin O / Budoff, Matthew / Bahrami, Hossein / Wong, Nathan D / Bluemke, David A / Lima, João A C. ·Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD. · George Washington University, Washington, DC. · Office of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, MD. · Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA. · Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA. · Division of Cardiology, University of California, Irvine, Irvine, CA. · Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD. · Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD jlima@jhmi.edu. ·J Am Heart Assoc · Pubmed #28428195.

ABSTRACT: BACKGROUND: Although the association between coronary artery calcium (CAC) and future heart failure (HF) has been shown previously, the value of CAC progression in the prediction of HF has not been investigated. In this study, we investigated the association of CAC progression with subclinical left ventricular (LV) dysfunction and incident HF in the Multi-Ethnic Study of Atherosclerosis. METHODS AND RESULTS: The Multi-Ethnic Study of Atherosclerosis is a population-based study consisting of 6814 men and women aged 45 to 84, free of overt cardiovascular disease at enrollment, who were recruited from 4 ethnicities. We included 5644 Multi-Ethnic Study of Atherosclerosis participants who had baseline and follow-up cardiac computed tomography and were free of HF and coronary heart disease before the second cardiac computed tomography. Mean (±SD) age was 61.7±10.2 years and 47.2% were male. The Cox proportional hazard models and multivariable linear regression models were deployed to determine the association of CAC progression with incident HF and subclinical LV dysfunction, respectively. Over a median follow-up of 9.6 (interquartile range: 8.8-10.6) years, 182 participants developed incident HF. CAC progression of 10 units per year was associated with 3% of increased risk of HF independent of overt coronary heart disease ( CONCLUSIONS: CAC progression was associated with incident HF and modestly increased LV end diastolic volume and LV end systolic volume at follow-up exam independent of overt coronary heart disease.

19 Article Echocardiographic Pulmonary Artery Systolic Pressure in the Coronary Artery Risk Development in Young Adults (CARDIA) Study: Associations With Race and Metabolic Dysregulation. 2017

Brittain, Evan L / Nwabuo, Chike / Xu, Meng / Gupta, Deepak K / Hemnes, Anna R / Moreira, Henrique T / De Vasconcellos, Henrique Doria / Terry, James G / Carr, Jeffrey J / Lima, Joao A C. ·Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, TN evan.brittain@vanderbilt.edu. · Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN. · Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD. · Harvard Medical School, Mount Auburn Hospital, Cambridge, MA. · Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN. · Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, TN. · Division of Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN. · Division of Cardiology, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. ·J Am Heart Assoc · Pubmed #28360228.

ABSTRACT: BACKGROUND: The determinants of pulmonary artery systolic pressure (PASP) are not fully understood. It is unknown whether racial differences in PASP exist or if other population characteristics are associated with pulmonary pressure in humans. We examined echocardiographically estimated PASP in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a middle-aged, biracial community-based cohort. METHODS AND RESULTS: At the CARDIA year-25 examination, 3469 participants underwent echocardiography, including measurement of tricuspid regurgitant jet velocity to estimate PASP. Clinical features, laboratory values, pulmonary function tests, and measurement of adipose depot volume were analyzed for association with PASP. PASP was estimated in 1311 individuals (61% female, 51% white). Older age, higher blood pressure, and higher body mass index were associated with higher PASP. Black race was associated with higher PASP after adjustment for demographics and left and right ventricular function (β 0.94, 95% CI 0.24-1.64; CONCLUSIONS: In a large biracial cohort of middle-aged adults, we identified associations among black race, insulin resistance, and diastolic dysfunction with higher echocardiographically estimated PASP. Further studies are needed to examine racial differences in PASP and whether insulin resistance directly contributes to pulmonary vascular disease in humans.

20 Article Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging versus Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events: The CORE320 Multicenter Study. 2017

Chen, Marcus Y / Rochitte, Carlos E / Arbab-Zadeh, Armin / Dewey, Marc / George, Richard T / Miller, Julie M / Niinuma, Hiroyuki / Yoshioka, Kunihiro / Kitagawa, Kakuya / Sakuma, Hajime / Laham, Roger / Vavere, Andrea L / Cerci, Rodrigo J / Mehra, Vishal C / Nomura, Cesar / Kofoed, Klaus F / Jinzaki, Masahiro / Kuribayashi, Sachio / Scholte, Arthur J / Laule, Michael / Tan, Swee Yaw / Hoe, John / Paul, Narinder / Rybicki, Frank J / Brinker, Jeffrey A / Arai, Andrew E / Matheson, Matthew B / Cox, Christopher / Clouse, Melvin E / Di Carli, Marcelo F / Lima, João A C. ·From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.) · InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.) · Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.) · Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.) · Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.) · Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.) · Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.) · Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.) · and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.) · From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.) · Keio University School of Medicine, Tokyo, Japan (M.J., S.K.) · Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.) · Department of Cardiology, National Heart Centre, Singapore (S.Y.T.) · Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.) · Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.) · Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.) · Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.) · and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.). ·Radiology · Pubmed #28290782.

ABSTRACT: Purpose To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial perfusion imaging. Materials and Methods This study was approved by all institutional review boards, and written informed consent was obtained. Between November 2009 and July 2011, 381 participants clinically referred for ICA and aged 45-85 years were enrolled in the Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) prospective multicenter diagnostic study. All images were analyzed in blinded independent core laboratories, and a panel of physicians adjudicated all adverse events. MACE was defined as revascularization (>30 days after index ICA), myocardial infarction, or cardiac death; hospitalization for chest pain or congestive heart failure; or arrhythmia. Late MACE was defined similarly, except for patients who underwent revascularization within the first 182 days after ICA, who were excluded. Comparisons of 2-year survival (time to MACE) used standard Kaplan-Meier curves and restricted mean survival times bootstrapped with 2000 replicates. Results An MACE (49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia) occurred in 51 of 379 patients (13.5%). The 2-year MACE-free rates for combined CT angiography and CT perfusion findings were 94% negative for coronary artery disease (CAD) versus 82% positive for CAD and were similar to combined ICA and single photon emission CT findings (93% negative for CAD vs 77% positive for CAD, P < .001 for both). Event-free rates for CT angiography and CT perfusion versus ICA and single photon emission CT for either positive or negative results were not significantly different for MACE or late MACE (P > .05 for all). The area under the receiver operating characteristic curve (AUC) for combined CT angiography and CT perfusion (AUC = 68; 95% confidence interval [CI]: 62, 75) was similar (P = .36) to that for combined ICA and single photon emission CT (AUC = 71; 95% CI: 65, 79) in the identification of MACE at 2-year follow-up. Conclusion Combined CT angiography and CT perfusion enables similar prediction of 2-year MACE, late MACE, and event-free survival similar to that enabled by ICA and single photon emission CT.

21 Article Associations of Coffee, Tea, and Caffeine Intake with Coronary Artery Calcification and Cardiovascular Events. 2017

Miller, P Elliott / Zhao, Di / Frazier-Wood, Alexis C / Michos, Erin D / Averill, Michelle / Sandfort, Veit / Burke, Gregory L / Polak, Joseph F / Lima, Joao A C / Post, Wendy S / Blumenthal, Roger S / Guallar, Eliseo / Martin, Seth S. ·Department of Critical Care Medicine, National Institutes of Health, Bethesda, Md; Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: Elliott.miller@nih.gov. · Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. · Children's Nutrition Research Center, Baylor College of Medicine, Houston, Tex. · Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Md. · Department of Environmental and Occupational Health, University of Washington, Seattle. · Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md. · Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC. · Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass. · Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Md. · Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. ·Am J Med · Pubmed #27640739.

ABSTRACT: BACKGROUND: Coffee and tea are 2 of the most commonly consumed beverages in the world. The association of coffee and tea intake with coronary artery calcium and major adverse cardiovascular events remains uncertain. METHODS: We examined 6508 ethnically diverse participants with available coffee and tea data from the Multi-Ethnic Study of Atherosclerosis. Intake for each was classified as never, occasional (<1 cup per day), and regular (≥1 cup per day). A coronary artery calcium progression ratio was derived from mixed effect regression models using loge(calcium score+1) as the outcome, with coefficients exponentiated to reflect coronary artery calcium progression ratio versus the reference. Cox proportional hazards analyses were used to evaluate the association between beverage intake and incident cardiovascular events. RESULTS: Over a median follow-up of 5.3 years for coronary artery calcium and 11.1 years for cardiovascular events, participants who regularly drank tea (≥1 cup per day) had a slower progression of coronary artery calcium compared with never drinkers after multivariable adjustment. This correlated with a statistically significant lower incidence of cardiovascular events for ≥1 cup per day tea drinkers (adjusted hazard ratio 0.71; 95% confidence interval 0.53-0.95). Compared with never coffee drinkers, regular coffee intake (≥1 cup per day) was not statistically associated with coronary artery calcium progression or cardiovascular events (adjusted hazard ratio 0.97; 95% confidence interval 0.78-1.20). Caffeine intake was marginally inversely associated with coronary artery calcium progression. CONCLUSIONS: Moderate tea drinkers had slower progression of coronary artery calcium and reduced risk for cardiovascular events. Future research is needed to understand the potentially protective nature of moderate tea intake.

22 Article Non-alcoholic fatty liver disease and progression of coronary artery calcium score: a retrospective cohort study. 2017

Sinn, Dong Hyun / Kang, Danbee / Chang, Yoosoo / Ryu, Seungho / Gu, Seonhye / Kim, Hyunkyoung / Seong, Donghyeong / Cho, Soo Jin / Yi, Byoung-Kee / Park, Hyung-Doo / Paik, Seung Woon / Song, Young Bin / Lazo, Mariana / Lima, Joao A C / Guallar, Eliseo / Cho, Juhee / Gwak, Geum-Youn. ·Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea. · Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea. · Center for Cohort Studies, Total Healthcare Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, South Korea. · Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, South Korea. · Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea. · Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea. · Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea. · Department of Medical Informatics, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea. · Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea. · Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA. ·Gut · Pubmed #27599521.

ABSTRACT: BACKGROUND AND AIM: Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, was associated with subclinical atherosclerosis in many cross-sectional studies, but the prospective association between NAFLD and the progression of atherosclerosis has not been evaluated. This study was conducted to evaluate the association between NAFLD and the progression of coronary atherosclerosis. METHODS: This retrospective cohort study included 4731 adult men and women with no history of cardiovascular disease (CVD), liver disease or cancer at baseline who participated in a repeated regular health screening examination between 2004 and 2013. Fatty liver was diagnosed by ultrasound based on standard criteria, including parenchymal brightness, liver-to-kidney contrast, deep beam attenuation and bright vessel walls. Progression of coronary artery calcium (CAC) scores was measured using multidetector CT scanners. RESULTS: The average duration of follow-up was 3.9 years. During follow-up, the annual rate of CAC progression in participants with and without NAFLD were 22% (95% CI 20% to 23%) and 17% (16% to 18%), respectively (p<0.001). The multivariable ratio of progression rates comparing participants with NAFLD with those without NAFLD was 1.04 (1.02 to 1.05; p<0.001). The association between NAFLD and CAC progression was similar in most subgroups analysed, including in participants with CAC 0 and in those with CAC >0 at baseline. CONCLUSIONS: In this large cohort study of adult men and women with no history of CVD, NAFLD was significantly associated with the development of CAC independent of cardiovascular and metabolic risk factors. NAFLD may play a pathophysiological role in atherosclerosis development and may be useful to identify subjects with a higher risk of subclinical disease progression.

23 Article Computed tomography myocardial perfusion vs 2017

Williams, Michelle C / Mirsadraee, Saeed / Dweck, Marc R / Weir, Nicholas W / Fletcher, Alison / Lucatelli, Christophe / MacGillivray, Tom / Golay, Saroj K / Cruden, Nicholas L / Henriksen, Peter A / Uren, Neal / McKillop, Graham / Lima, João A C / Reid, John H / van Beek, Edwin J R / Patel, Dilip / Newby, David E. ·University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB. michelle.williams@ed.ac.uk. · Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK. · University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB. · Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK. · Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK. · Departments of Medicine and Radiology, Johns Hopkins Hospital, Baltimore, MD, USA. ·Eur Radiol · Pubmed #27334015.

ABSTRACT: OBJECTIVES: Computed tomography (CT) can perform comprehensive cardiac imaging. We compared CT coronary angiography (CTCA) and CT myocardial perfusion (CTP) with METHODS: 51 patients (63 (61-65) years, 80 % male) with known/suspected coronary artery disease (CAD) underwent 320-multidetector CTCA followed by "snapshot" adenosine stress CTP. Of these 22 underwent PET and 47 ICA/FFR. Obstructive CAD was defined as CTCA stenosis >50 % and CTP hypoperfusion, ICA stenosis >70 % or FFR <0.80. RESULTS: PET hyperaemic myocardial blood flow (MBF) was lower in obstructive than non-obstructive territories defined by ICA/FFR (1.76 (1.32-2.20) vs 3.11 (2.44-3.79) mL/(g/min), P < 0.001) and CTCA/CTP (1.76 (1.32-2.20) vs 3.12 (2.44-3.79) mL/(g/min), P < 0.001). Baseline and hyperaemic CT attenuation density was lower in obstructive than non-obstructive territories (73 (71-76) vs 86 (84-88) HU, P < 0.001 and 101 (96-106) vs 111 (107-114) HU, P 0.001). PET hyperaemic MBF corrected for rate pressure product correlated with CT attenuation density (r = 0.579, P < 0.001). There was excellent per-patient sensitivity (96 %), specificity (85 %), negative predictive value (90 %) and positive predictive value (94 %) for CTCA/CTP vs ICA/FFR. CONCLUSION: CT myocardial attenuation density correlates with KEY POINTS: •CT myocardial perfusion can aid the assessment of suspected coronary artery disease. • CT attenuation density from "snapshot" imaging is a marker of myocardial perfusion. • CT myocardial attenuation density correlates with

24 Article Computed Tomographic Perfusion Improves Diagnostic Power of Coronary Computed Tomographic Angiography in Women: Analysis of the CORE320 Trial (Coronary Artery Evaluation Using 320-Row Multidetector Computed Tomography Angiography and Myocardial Perfusion) According to Gender. 2016

Penagaluri, Ashritha / Higgins, Angela Y / Vavere, Andrea L / Miller, Julie M / Arbab-Zadeh, Armin / Betoko, Aisha / Steveson, Chloe / Zimmermann, Elke / Cox, Christopher / Rochitte, Carlos E / Dewey, Marc / Kofoed, Klaus F / Niinuma, Hiroyuki / Di Carli, Marcelo F / Lima, João A C / Chen, Marcus Y. ·From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD · National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.) · Toshiba Medical Systems Corporation, Japan (C.S) · Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.) · Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.) · Rigshospitalet, University of Copenhagen, Denmark (K.F.K) · St Luke's International Hospital, Tokyo, Japan (H.N.) · and Brigham and Women's Hospital, Boston, MA (M.F.D.C.). ·Circ Cardiovasc Imaging · Pubmed #27811151.

ABSTRACT: BACKGROUND: Coronary computed tomographic angiography (CTA) and myocardial perfusion imaging (CTP) is a validated approach for detection and exclusion of flow-limiting coronary artery disease (CAD), but little data are available on gender-specific performance of these modalities. In this study, we aimed to evaluate the diagnostic accuracy of combined coronary CTA and CTP in detecting flow-limiting CAD in women compared with men. METHODS AND RESULTS: Three hundred and eighty-one patients who underwent both CTA-CTP and single-photon emission computed tomography myocardial perfusion imaging preceding invasive coronary angiography as part of the CORE320 multicenter study (Coronary Artery Evaluation Using 320-row Multidetector Computed Tomography Angiography and Myocardial Perfusion) were included in this ancillary study. All 4 image modalities were analyzed in blinded, independent core laboratories. Prevalence of flow-limiting CAD defined by invasive coronary angiography equal to 50% or greater with an associated single-photon emission computed tomography myocardial perfusion imaging defect was 45% (114/252) and 23% (30/129) in males and females, respectively. Patient-based diagnostic accuracy defined by the area under the receiver operating curve for detecting flow-limiting CAD by CTA alone in females was 0.83 (0.75-0.89) and for CTA-CTP was 0.92 (0.86-0.97; P=0.003) compared with men where the area under the receiver operating curve for detecting flow-limiting CAD by CTA alone was 0.82 (0.77-0.87) and for CTA-CTP was 0.84 (0.80-0.89; P=0.29). CONCLUSIONS: The combination of CTA-CTP was performed similarly in men and women for identifying flow-limiting coronary stenosis; however, in women, CTP had incremental value over CTA alone, which was not the case in men. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00934037.

25 Article Transitions in Metabolic Risk and Long-Term Cardiovascular Health: Coronary Artery Risk Development in Young Adults (CARDIA) Study. 2016

Murthy, Venkatesh L / Abbasi, Siddique A / Siddique, Juned / Colangelo, Laura A / Reis, Jared / Venkatesh, Bharath A / Carr, J Jeffrey / Terry, James G / Camhi, Sarah M / Jerosch-Herold, Michael / de Ferranti, Sarah / Das, Saumya / Freedman, Jane / Carnethon, Mercedes R / Lewis, Cora E / Lima, Joao A C / Shah, Ravi V. ·Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, MI Nuclear Medicine Division, Department of Radiology, University of Michigan, Ann Arbor, MI rvshah@partners.org vlmurthy@med.umich.edu. · Providence VA Medical Center and Cardiovascular Institute, Alpert Medical School of Brown University, Providence, RI. · Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. · Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD. · Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institute, Johns Hopkins University, Baltimore, MD. · Vanderbilt University, Nashville, TN. · Exercise and Health Sciences Department, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA. · Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA. · Preventative Cardiology, Boston Children's Hospital, Boston, MA. · Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. · Department of Medicine, University of Massachusetts at Worcester, MA. · Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. · Division of Preventative Medicine, University of Alabama at Birmingham, AL. · Department of Medicine, Massachusetts General Hospital, Boston, MA rvshah@partners.org vlmurthy@med.umich.edu. ·J Am Heart Assoc · Pubmed #27737876.

ABSTRACT: BACKGROUND: Despite evidence suggesting that early metabolic dysfunction impacts cardiovascular disease risk, current guidelines focus on risk assessments later in life, missing early transitions in metabolic risk that may represent opportunities for averting the development of cardiovascular disease. METHODS AND RESULTS: In 4420 young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we defined a "metabolic" risk score based on components of the Third Report of the Adult Treatment Panel's definition of metabolic syndrome. Using latent class trajectory analysis adjusted for sex, race, and time-dependent body mass index, we identified 6 distinct metabolic trajectories over time, specified by initial and final risk: low-stable, low-worsening, high-stable, intermediate-worsening, intermediate-stable, and high-worsening. Overall, individuals gained weight over time in CARDIA with statistically but not clinically different body mass index trend over time. Dysglycemia and dyslipidemia over time were highest in initially high or worsening trajectory groups. Divergence in metabolic trajectories occurred in early adulthood (before age 40), with 2 of 3 individuals experiencing an increase in metabolic risk over time. Membership in a higher-risk trajectory (defined as initially high or worsening over time) was associated with greater prevalence and extent of coronary artery calcification, left ventricular mass, and decreased left ventricular strain at year 25. Importantly, despite similar rise in body mass index across trajectories over 25 years, coronary artery calcification and left ventricular structure and function more closely tracked risk factor trajectories. CONCLUSIONS: Transitions in metabolic risk occur early in life. Obesity-related metabolic dysfunction is related to subclinical cardiovascular phenotypes independent of evolution in body mass index, including coronary artery calcification and myocardial hypertrophy and dysfunction.

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