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Coronary Artery Disease: HELP
Articles by Arthur E. Stillman
Based on 15 articles published since 2009
(Why 15 articles?)
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Between 2009 and 2019, Arthur Stillman wrote the following 15 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline ACR Appropriateness Criteria 2017

Anonymous3940905 / Akers, Scott R / Panchal, Vandan / Ho, Vincent B / Beache, Garth M / Brown, Richard K J / Ghoshhajra, Brian B / Greenberg, S Bruce / Hsu, Joe Y / Kicska, Gregory A / Min, James K / Stillman, Arthur E / Stojanovska, Jadranka / Abbara, Suhny / Jacobs, Jill E. ·Principal Author, VA Medical Center, Philadelphia, Pennsylvania. Electronic address: akerssco@me.com. · Research Author, Internal Medicine Resident, Henry Ford Allegiance Health, Jackson, Michigan. · Panel Vice-Chair, Uniformed Services University of the Health Sciences, Bethesda, Maryland. · University of Louisville School of Medicine, Louisville, Kentucky. · University Hospital, Ann Arbor, Michigan. · Massachusetts General Hospital, Boston, Massachusetts. · Arkansas Children's Hospital, Little Rock, Arkansas. · Kaiser Permanente, Los Angeles, California. · University of Washington, Seattle, Washington. · Cedars Sinai Medical Center, Los Angeles, California; American College of Cardiology. · Emory University Hospital, Atlanta, Georgia. · University of Michigan Health System, Ann Arbor, Michigan. · Specialty Chair, UT Southwestern Medical Center, Dallas, Texas. · Panel Chair, New York University Medical Center, New York, New York. ·J Am Coll Radiol · Pubmed #28473096.

ABSTRACT: In patients with chronic chest pain in the setting of high probability of coronary artery disease (CAD), imaging has major and diverse roles. First, imaging is valuable in determining and documenting the presence, extent, and severity of myocardial ischemia, hibernation, scarring, and/or the presence, site, and severity of obstructive coronary lesions. Second, imaging findings are important in determining the course of management of patients with suspected chronic myocardial ischemia and better defining those patients best suited for medical therapy, angioplasty/stenting, or surgery. Third, imaging is also necessary to determine the long-term prognosis and likely benefit from various therapeutic options by evaluating ventricular function, diastolic relaxation, and end-systolic volume. Imaging studies are also required to demonstrate other abnormalities, such as congenital/acquired coronary anomalies and severe left ventricular hypertrophy, that can produce angina in the absence of symptomatic coronary obstructive disease due to atherosclerosis. Clinical risk assessment is necessary to determine the pretest probability of CAD. Multiple methods are available to categorize patients as low, medium, or high risk for developing CAD. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

2 Guideline Coronary Artery Disease - Reporting and Data System (CAD-RADS): An Expert Consensus Document of SCCT, ACR and NASCI: Endorsed by the ACC. 2016

Cury, Ricardo C / Abbara, Suhny / Achenbach, Stephan / Agatston, Arthur / Berman, Daniel S / Budoff, Matthew J / Dill, Karin E / Jacobs, Jill E / Maroules, Christopher D / Rubin, Geoffrey D / Rybicki, Frank J / Schoepf, U Joseph / Shaw, Leslee J / Stillman, Arthur E / White, Charles S / Woodard, Pamela K / Leipsic, Jonathon A. · ·JACC Cardiovasc Imaging · Pubmed #27609151.

ABSTRACT: The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.

3 Guideline CAD-RADS(TM) Coronary Artery Disease - Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. 2016

Cury, Ricardo C / Abbara, Suhny / Achenbach, Stephan / Agatston, Arthur / Berman, Daniel S / Budoff, Matthew J / Dill, Karin E / Jacobs, Jill E / Maroules, Christopher D / Rubin, Geoffrey D / Rybicki, Frank J / Schoepf, U Joseph / Shaw, Leslee J / Stillman, Arthur E / White, Charles S / Woodard, Pamela K / Leipsic, Jonathon A. ·Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 N Kendall Drive, Miami, FL, 33176, United States. Electronic address: rcury@baptisthealth.net. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: Suhny.Abbara@UTSouthwestern.edu. · Friedrich-Alexander-Universität, Erlangen-Nürnberg, Department of Cardiology, Ulmenweg 18, 90154, Erlangen, Germany. Electronic address: Stephan.Achenbach@uk-erlangen.de. · Baptist Health Medical Grp, 1691 Michigan Avenue, Miami, FL, 33139, United States. Electronic address: ArthurSAg@baptisthealth.net. · Cedars-Sinai Med Center, 8700 Beverly Boulevard, Taper Building, Rm 1258, Los Angeles, CA, 90048, United States. Electronic address: bermand@cshs.org. · 1124 W. Carson Street, Torrance, CA, 90502, United States. Electronic address: mbudoff@labiomed.org. · 5841 South Maryland Ave, MC2026, Chicago, IL, 60637, United States. Electronic address: kdill@radiology.bsd.uchicago.edu. · 550 First Avenue, New York, NY, 10016, United States. Electronic address: jill.jacobs@nyumc.org. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: christopher.maroules@gmail.com. · 2400 Pratt Street, Room 8020, DCRI Box 17969, Durham, NC, 27715, United States. Electronic address: grubin@duke.edu. · The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, CA K1H 8L6, Canada. Electronic address: frybicki@toh.on.ca. · 25 Courtenay Dr., Charleston, SC, 29425, United States. Electronic address: schoepf@musc.edu. · 1256 Briarcliff Rd. NE, Rm 529, Atlanta, GA, 30324, United States. Electronic address: lshaw3@emory.edu. · 1364 Clifton Road, NE, Atlanta, GA, 30322, United States. Electronic address: aestill@emory.edu. · University of Maryland, 22 S. Greene St., Baltimore, MD, 21201, United States. Electronic address: cwhite@umm.edu. · Mallinckrodt Instit of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, United States. Electronic address: woodardp@mir.wustl.edu. · Department of Radiology|St. Paul's Hospital, 2nd Floor, Providence Building, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, United States. Electronic address: jleipsic@providencehealth.bc.ca. ·J Cardiovasc Comput Tomogr · Pubmed #27318587.

ABSTRACT: The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.

4 Review Imaging the myocardial ischemic cascade. 2018

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

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

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

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

ABSTRACT: Primary imaging options in patients at low risk for coronary artery disease (CAD) who present with undifferentiated chest pain and without signs of ischemia are functional testing with exercise or pharmacologic stress-based electrocardiography, echocardiography, or myocardial perfusion imaging to exclude myocardial ischemia after rule-out of myocardial infarction and early cardiac CT because of its high negative predictive value to exclude CAD. Although possible, is not conclusive whether triple-rule-out CT (CAD, pulmonary embolism, and aortic dissection) might improve the efficiency of patient management. More advanced noninvasive tests such as cardiac MRI and invasive imaging with transesophageal echocardiography or coronary angiography are rarely indicated. With increased likelihood of noncardiac causes, a number of diagnostic tests, among them ultrasound of the abdomen, MR angiography of the aorta with or without contrast, x-ray rib views, x-ray barium swallow, and upper gastrointestinal series, can also be appropriate. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. This recommendation is based on excellent evidence, including several randomized comparative effectiveness trials and blinded observational cohort studies.

6 Article The Dubious Value of Coronary Calcium Scoring on Lung Cancer Screening CT. 2017

Bernheim, Adam / Auffermann, William F / Stillman, Arthur E. ·Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, Georgia. Electronic address: adam.bernheim@outlook.com. · Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, Georgia. ·J Am Coll Radiol · Pubmed #27717578.

ABSTRACT: -- No abstract --

7 Article CAD-RADS™: Coronary Artery Disease - Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. 2016

Cury, Ricardo C / Abbara, Suhny / Achenbach, Stephan / Agatston, Arthur / Berman, Daniel S / Budoff, Matthew J / Dill, Karin E / Jacobs, Jill E / Maroules, Christopher D / Rubin, Geoffrey D / Rybicki, Frank J / Schoepf, U Joseph / Shaw, Leslee J / Stillman, Arthur E / White, Charles S / Woodard, Pamela K / Leipsic, Jonathon A. ·Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 N Kendall Drive, Miami, FL, 33176, United States. Electronic address: rcury@baptisthealth.net. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: Suhny.Abbara@UTSouthwestern.edu. · Friedrich-Alexander-Universität, Erlangen-Nürnberg, Department of Cardiology, Ulmenweg 18, 90154, Erlangen, Germany. Electronic address: Stephan.Achenbach@uk-erlangen.de. · Baptist Health Medical Grp, 1691 Michigan Avenue, Miami, FL, 33139, United States. Electronic address: ArthurSAg@baptisthealth.net. · Cedars-Sinai Med Center, 8700 Beverly Boulevard, Taper Building, Rm 1258, Los Angeles, CA, 90048, United States. Electronic address: bermand@cshs.org. · 1124 W. Carson Street, Torrance, CA, 90502, United States. Electronic address: mbudoff@labiomed.org. · 5841 South Maryland Ave, MC2026, Chicago, IL, 60637, United States. Electronic address: kdill@radiology.bsd.uchicago.edu. · 550 First Avenue, New York, NY, 10016, United States. Electronic address: jill.jacobs@nyumc.org. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: christopher.maroules@gmail.com. · 2400 Pratt Street, Room 8020, DCRI Box 17969, Durham, NC, 27715, United States. Electronic address: grubin@duke.edu. · The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, CA K1H 8L6, Canada. Electronic address: frybicki@toh.on.ca. · 25 Courtenay Dr., Charleston, SC, 29425, United States. Electronic address: schoepf@musc.edu. · 1256 Briarcliff Rd. NE, Rm 529, Atlanta, GA, 30324, United States. Electronic address: lshaw3@emory.edu. · 1364 Clifton Road, NE, Atlanta, GA, 30322, United States. Electronic address: aestill@emory.edu. · University of Maryland, 22 S. Greene St., Baltimore, MD, 21201, United States. Electronic address: cwhite@umm.edu. · Mallinckrodt Instit of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, United States. Electronic address: woodardp@mir.wustl.edu. · Department of Radiology, St. Paul's Hospital, 2nd Floor, Providence Building, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, United States. Electronic address: jleipsic@providencehealth.bc.ca. ·J Am Coll Radiol · Pubmed #27318576.

ABSTRACT: The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.

8 Article Effect of intensive versus moderate lipid-lowering therapy on epicardial adipose tissue in hyperlipidemic post-menopausal women: a substudy of the BELLES trial (Beyond Endorsed Lipid Lowering with EBT Scanning). 2013

Alexopoulos, Nikolaos / Melek, Bekir H / Arepalli, Chesnal D / Hartlage, Gregory-Randell / Chen, Zhengjia / Kim, Sungjin / Stillman, Arthur E / Raggi, Paolo. ·Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA. ·J Am Coll Cardiol · Pubmed #23500254.

ABSTRACT: OBJECTIVES: This study sought to evaluate the effect of intensive and moderate statin therapy on epicardial adipose tissue (EAT). BACKGROUND: EAT has been associated with coronary artery disease severity and outcome. It is currently unknown whether EAT volume changes over time when patients are exposed to statin therapy. METHODS: Subanalysis of a randomized study of atorvastatin 80 mg/day versus pravastatin 40 mg/day for 1 year in a clinical trial designed to assess the progression of coronary artery calcium (CAC) in hyperlipidemic post-menopausal women. Patients underwent cardiac computed tomography scans at the start and end of the trial period. RESULTS: Of 420 patients, 194 received atorvastatin and 226 pravastatin; the median low-density lipoprotein change was -53.3% and -28.3% with atorvastatin and pravastatin, respectively (p < 0.001). Baseline EAT correlated with age, body mass index, hypertension, diabetes mellitus, high-density lipoprotein, triglyceride levels, and CAC (p < 0.001). At the end of follow-up, EAT regressed more in the atorvastatin than in the pravastatin group (median, -3.38% vs. -0.83%, p = 0.025). The EAT percent change from baseline was significant in the atorvastatin, but not the pravastatin group (p < 0.001 and p = 0.2, respectively). There was no correlation between lipid lowering and EAT regression. CAC progressed significantly in both groups from baseline. CONCLUSIONS: In hyperlipidemic post-menopausal women, statin therapy induced EAT regression, although intensive therapy was more effective than moderate-intensity therapy. This effect does not seem linked to low-density lipoprotein lowering and may be secondary to other actions of statins such as anti-inflammatory effects.

9 Article A phantom study of the effect of heart rate, coronary artery displacement and vessel trajectory on coronary artery calcium score: potential for risk misclassification. 2012

Tigges, Stefan / Arepalli, Chesnal D / Tridandapani, Srini / Oshinski, John / Kurz, Calvin R / Richer, Edward J / Chen, Zhengjia / Stillman, Arthur E / Raggi, Paolo. ·Department of Radiology, Division of Cardiothoracic Imaging, Emory University, Atlanta, GA, USA. ·J Cardiovasc Comput Tomogr · Pubmed #22732199.

ABSTRACT: BACKGROUND: Accurate coronary artery calcium scoring improves risk stratification in some strata of the population. OBJECTIVE: We evaluated individual and combined effects of reader experience, heart rate, vessel displacement, and trajectory on computed tomography (CT) Agatston score, calcium volume, and calcium mass in a cardiac phantom model. METHODS: A cardiac motion phantom was scanned with a 64-slice CT scanner with artificial electrocardiogram gating with combinations of the following: heart rates 60, 80, and 100 beat/min; vessel displacement of 1.25 and 2.5 cm; and multiple vessel trajectories of craniocaudal, right-left, anteroposterior, right coronary artery (RCA), left anterior descending, and left circumflex (LCX). Calcium quantification was done by 2 different readers with the use of 3 methods: Agatston, calcium volume, and calcium mass. RESULTS: Heart rate, coronary displacement, and trajectory had significant effects on all 3 techniques, with a general decrease in score as the heart rate increased. A vessel displacement of 2.5 cm decreased the Agatston score by 16% (P < 0.0001) and LCX motion decreased the score by 17% (P < 0.0001). Combined effects often resulted in larger differences; for example, a heart rate of 60 beat/min, vessel displacement of 1.25 cm, and RCA motion resulted in an Agatston score of 907, whereas with a heart rate of 100 beat/min, vessel displacement of 2.5 cm, and LCX motion the score was 604. CONCLUSION: The calcium score is affected by heart rate, vessel displacement, and trajectory.

10 Article Reproducibility of pulse wave velocity measurements with phase contrast magnetic resonance and applanation tonometry. 2012

Suever, Jonathan D / Oshinski, John / Rojas-Campos, Enrique / Huneycutt, David / Cardarelli, Francesca / Stillman, Arthur E / Raggi, Paolo. ·Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, 1364 Cilfton Road, Suite AG30, Atlanta, GA 30322, USA. suever@gatech.edu ·Int J Cardiovasc Imaging · Pubmed #21805314.

ABSTRACT: Increased aortic pulse wave velocity (PWV) results from loss of arterial compliance and is associated with unfavorable outcomes. Applanation tonometry (AT) is the most frequently applied method to assess PWV and deduce aortic compliance. The goal of this study was to compare the reproducibility of PWV measurements obtained with: (1) cross-correlation analysis of phase contrast magnetic resonance (PCMR) velocity data, and (2) applanation tonometry (AT). PWV was measured twice with each modality in 13 normal young volunteers (controls) and 9 older patients who had undergone a CT exam to evaluate coronary artery calcium. The coefficient of variation (CoV) between measurements was computed for each modality. There was no significant difference in PWV values obtained with AT and PCMR in controls or patients. The inter-scan reproducibility of PCMR was superior to AT in the controls (CoV: 3.4 ± 2.3% vs. 6.3 ± 4.0%, P = 0.03) but not in the older patients (7.4 ± 8.0% vs. 9.9 ± 9.6%, P = 0.32). PWV values were higher in patients than controls (5.6 ± 1.2 vs. 9.7 ± 2.8, P = 0.002). PCMR and AT yielded similar values for PWV in patients and volunteers. PCMR showed a superior reproducibility in young subjects but not in older patients.

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

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

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

12 Article Absent coronary artery calcium excludes inducible myocardial ischemia on computed tomography/positron emission tomography. 2011

Esteves, Fabio P / Khan, Akbar / Correia, Luis C L / Nye, Jonathon A / Halkar, Raghuveer K / Schuster, David M / Stillman, Arthur / Raggi, Paolo. ·Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322, USA. festeve@emory.edu ·Int J Cardiol · Pubmed #19892417.

ABSTRACT: OBJECTIVE: We set out to determine whether a coronary artery calcium (CAC) score of zero on computed tomography (CT) would predict a normal myocardial perfusion positron emission tomography (PET) in a population mostly at intermediate pretest likelihood of coronary artery disease (CAD). METHODS: We enrolled 206 outpatients (36% men, mean age 60 ± 13 years) referred for Rb-82 myocardial perfusion PET/CT for suspected CAD. CAC scoring was performed by the Agatston method. The PET images were scored on a 5-point scale using a 17-segment left ventricular model. A summed stress score ≥ 2 was considered abnormal. Multivariable logistic regression analysis was used to test the independent predictive value of a CAC score of zero to exclude inducible myocardial ischemia. RESULTS: Ninety-nine of 206 patients (48%) had a CAC score of zero and of these only 1 had inducible ischemia on PET. This yielded a negative predictive value of 99% (95% CI 95%-100%). CAC score of zero was the strongest independent predictor of a normal myocardial perfusion PET (OR = 0.05; 95% CI = 0.006-0.38; p = 0.004). CONCLUSION: In a population of predominately intermediate likelihood of CAD, a CAC score of zero excludes inducible ischemia on myocardial perfusion PET.

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

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

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

14 Article Epicardial adipose tissue and coronary artery plaque characteristics. 2010

Alexopoulos, Nikolaos / McLean, Dalton S / Janik, Matthew / Arepalli, Chesnal D / Stillman, Arthur E / Raggi, Paolo. ·Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, United States. ·Atherosclerosis · Pubmed #20031133.

ABSTRACT: OBJECTIVE: Epicardial adipose tissue (EAT) has been implicated in the pathogenesis of coronary atherosclerosis. The association of EAT volume with type of coronary artery plaque on computed tomography angiography (CTA) is not known. METHODS: Coronary artery calcium (CAC) scoring and EAT volume measurement were performed on 214 consecutive patients (mean age 54+/-14 years) referred for coronary CTA. CAC was performed on non-contrast images, while EAT volume, the severity of luminal stenoses, and plaque characterization were assessed using contrast-enhanced CTA images. EAT volume was also indexed to body surface area (EAT-i). RESULTS: EAT volume correlated with age, height, body mass index (BMI), and CAC score. EAT volume increased significantly with the severity of luminal stenosis (p<0.001), and in patients with no plaques, calcified, mixed, and non-calcified plaques (62+/-33mL, 63+/-22mL, 98+/-47mL, and 99+/-36mL, respectively, p<0.001). The EAT volume was significantly larger in patients with mixed or non-calcified plaques compared to patients with calcified plaques or no plaques (all p<0.01 or smaller). The trend remained significant after adjustment for traditional risk factors for coronary artery disease. In adjusted models EAT was an independent predictor of CAC [exp(B)=3.916, p<0.05], atherosclerotic plaques of any type [exp(B)=4.532, p<0.01], non-calcified plaques [exp(B)=3.849, p<0.01], and obstructive CAD [exp(B)=3.824, p<0.05]. The above results were unchanged after replacing EAT with EAT-i. CONCLUSION: EAT volume was larger in the presence of obstructive CAD and non-calcified plaques. These data suggest that EAT is associated with the development of coronary atherosclerosis and potentially the most dangerous types of plaques.

15 Article Cardiovascular risk factors and coronary atherosclerosis in retired National Football League players. 2009

Chang, Alice Y / FitzGerald, Shannon J / Cannaday, John / Zhang, Song / Patel, Amit / Palmer, M Dean / Reddy, Gautham P / Ordovas, Karen G / Stillman, Arthur E / Janowitz, Warren / Radford, Nina B / Roberts, Arthur J / Levine, Benjamin D. ·Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. ·Am J Cardiol · Pubmed #19733715.

ABSTRACT: A high prevalence of obesity exists in National Football League (NFL) players as determined by body mass index (BMI). It is not established whether increased BMI is associated with a greater prevalence of cardiovascular (CV) risk factors or coronary atherosclerosis in former NFL players than in nonathletes. This study compared CV risk factors and coronary atherosclerosis in retired NFL players to 2 groups of community controls, the population-based Dallas Heart Study and the preventive medicine cohort, the Aerobics Center Longitudinal Study. Retired NFL players (n = 201) were matched for ethnicity, age, and BMI (Aerobics Center Longitudinal Study, age only). CV risk factors were assessed by survey and screening visit. Coronary atherosclerosis was measured by computed tomography as coronary artery calcium (CAC). Compared to population-based controls, retired NFL players had a significantly lower prevalence of diabetes, hypertension, sedentary lifestyle, and metabolic syndrome, yet a higher prevalence of impaired fasting glucose and hyperlipidemia. However, there was no significant difference in the prevalence of detectable CAC (46% vs 48.3%, p = 0.69) or distribution of CAC (0 to 10, 10 to 100, 100 to 400, > or =400, p = 0.11). Comparing retired NFL players to the physically active preventive medicine controls, there was no difference in the amount of CAC. In retired NFL players, age and hyperlipidemia, not body size, were the most significant predictors of CAC. In conclusion, despite their large body size, retired NFL players do not have a greater prevalence of CV risk factors or amount of CAC than community controls.