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Coronary Artery Disease: HELP
Articles by Louise E. J. Thomson
Based on 30 articles published since 2010
(Why 30 articles?)
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Between 2010 and 2020, L. E. J. Thomson wrote the following 30 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review SPECT/PET myocardial perfusion imaging versus coronary CT angiography in patients with known or suspected CAD. 2010

Berman, D S / Shaw, L J / Min, J K / Hachamovitch, R / Abidov, A / Germano, G / Hayes, S W / Friedman, J D / Thomson, L E J / Kang, X / Slomka, P / Rozanski, A. ·Department of Imaging, Cedars-Sinai Medical Center, CSMC Burns and Allen Research Institute, Los Angeles, California 90048, USA. bermand@cshs.org ·Q J Nucl Med Mol Imaging · Pubmed #20592682.

ABSTRACT: Stress SPECT myocardial perfusion imaging (MPI) is the most commonly utilized stress imaging technique for patients with suspected or known coronary artery disease (CAD) and has a robust evidence base including the support of numerous clinical guidelines. Gated SPECT is a well-established noninvasive imaging modalities that is a core element in evaluation of patients with both acute and stable chest pain syndromes. Over the past decade, PET has become increasingly used for the same applications. By comparison, cardiac computed tomography (CT) is a more recently developed method, providing non-invasive approaches for imaging coronary atherosclerosis and coronary artery stenosis. Non-contrast CT for imaging the extent of coronary artery calcification (CAC), in clinical use since the mid-1990's, has a very extensive evidence base supporting its use in CAD prevention. While contrast-enhanced CT for noninvasive CT coronary angiography (CCTA) is relatively new, it has already developed an extensive base of evidence regarding diagnosing obstructive CAD and more recently evidence has emerged regarding its prognostic value. It is likely that non-contrast CT or CCTA for assessment of extent of atherosclerosis will become an increasing part of mainstream cardiovascular imaging practices as a first line test. In some patients, further ischemia testing with MPI will be required. Similarly, MPI will continue to be widely used as a first-line test, and in some patients, further anatomic definition of atherosclerosis with CT will also be appropriate. This review will provide a synopsis of the available literature on imaging that integrates both CT and MPI in strategies for the assessment of asymptomatic patients for their atherosclerotic coronary disease burden and risk as well as symptomatic patients for diagnosis and guiding management. We propose possible strategies through which imaging might be used to identify asymptomatic candidates for more intensive prevention and risk factor modification strategies as well as symptomatic patients who would benefit from referral to invasive coronary angiography for consideration of revascularization.

2 Article Progression of coronary microvascular dysfunction to heart failure with preserved ejection fraction: a case report. 2019

Joung, Sandy / Wei, Janet / Nelson, Michael D / Aldiwani, Haider / Shufelt, Chrisandra / Tamarappoo, Balaji / Berman, Daniel / Thomson, Louise E J / Bairey Merz, C Noel. ·Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA, 90048, USA. · Applied Physiology and Advanced Imaging Laboratory, Arlington, TX, 76019, USA. · Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. · Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA, 90048, USA. Noel.BaireyMerz@cshs.org. ·J Med Case Rep · Pubmed #31056078.

ABSTRACT: BACKGROUND: In women with evidence of ischemia and no obstructive coronary artery disease the underlying mechanism is most often attributed to coronary microvascular dysfunction. Higher rates of adverse cardiovascular events, specifically heart failure with preserved ejection fraction, are present in women with coronary microvascular dysfunction, leading to the hypothesis that coronary microvascular dysfunction may contribute to the progression of heart failure with preserved ejection fraction. A 55-year-old, Caucasian woman with a past medical history of chest pain and shortness of breath was referred to our tertiary care center and diagnosed as having coronary microvascular dysfunction by invasive coronary reactivity testing. After 10 years of follow-up care for coronary microvascular dysfunction, she presented to an emergency room in acute heart failure and was diagnosed as having heart failure with preserved ejection fraction. DISCUSSION: The current case report provides a specific example in support of existing studies that demonstrate that coronary microvascular dysfunction may be a precursor of heart failure with preserved ejection fraction. Further research is needed to establish causality and management. TRIAL REGISTRATION: Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02582021 .

3 Article Late sodium channel blockade improves angina and myocardial perfusion in patients with severe coronary microvascular dysfunction: Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction ancillary study. 2019

Rambarat, Cecil A / Elgendy, Islam Y / Handberg, Eileen M / Bairey Merz, C Noel / Wei, Janet / Minissian, Margo B / Nelson, Michael D / Thomson, Louise E J / Berman, Daniel S / Shaw, Leslee J / Cook-Wiens, Galen / Pepine, Carl J. ·Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA. · Barbara Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA. · Departments of Medicine and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Program in Cardiovascular Outcomes Research and Epidemiology, Emory University, Atlanta, GA, USA. · Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA. Electronic address: carl.pepine@medicine.ufl.edu. ·Int J Cardiol · Pubmed #30293664.

ABSTRACT: BACKGROUND: In a prior trial of late sodium channel inhibition (ranolazine) among symptomatic subjects without obstructive coronary artery disease (CAD) and limited myocardial perfusion reserve index (MPRI), we observed no improvement in angina or MPRI, overall. Here we describe the clinical characteristics and myocardial perfusion responses of a pre-defined subgroup who had coronary flow reserve (CFR) assessed invasively. METHODS: Symptomatic patients without obstructive CAD and limited MPRI in a randomized, double-blind, crossover trial of ranolazine vs. placebo were subjects of this prespecified substudy. Because we had previously observed that adverse outcomes and beneficial treatment responses occurred in those with lower CFR, patients were subgrouped by CFR <2.5 vs ≥2.5. Symptoms were assessed using the Seattle Angina Questionnaire and the SAQ-7, and left-ventricular volume and MPRI were assessed by magnetic resonance imaging (MRI). Coronary angiograms, CFR, and MRI data were analyzed by core labs masked to treatment and patient characteristics. RESULTS: During qualifying coronary angiography, 81 patients (mean age 55 years, 98% women) had invasively determined CFR 2.69 ± 0.65 (mean ± SD; range 1.4-5.5); 43% (n = 35) had CFR <2.5. Demographic and symptomatic findings did not differ comparing CFR subgroups. Those with low CFR had improved angina (p = 0.04) and midventricular MPRI (p = 0.03) with ranolazine vs placebo. Among patients with low CFR, reduced left-ventricular end-diastolic volume predicted a beneficial angina response. CONCLUSIONS: Symptomatic patients with CFR <2.5 and no obstructive CAD had improved angina and myocardial perfusion with ranolazine, supporting the hypothesis that the late sodium channel is important in management of coronary microvascular dysfunction. TRIAL REGISTRATION: clinicaltrials.gov Identifier NCT01342029.

4 Article Inverse association of MRI-derived native myocardial T1 and perfusion reserve index in women with evidence of ischemia and no obstructive CAD: A pilot study. 2018

Shaw, Jaime L / Nelson, Michael D / Wei, Janet / Motwani, Manish / Landes, Sofy / Mehta, Puja K / Thomson, Louise E J / Berman, Daniel S / Li, Debiao / Bairey Merz, C Noel / Sharif, Behzad. ·Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Bioengineering, University of California Los Angeles, CA, United States. · Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States. · Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States. · Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States. · Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States. · Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States; David Geffen School of Medicine, University of California Los Angeles, CA, United States. · Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Bioengineering, University of California Los Angeles, CA, United States; David Geffen School of Medicine, University of California Los Angeles, CA, United States. · Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States; David Geffen School of Medicine, University of California Los Angeles, CA, United States. · Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Bioengineering, University of California Los Angeles, CA, United States; David Geffen School of Medicine, University of California Los Angeles, CA, United States. Electronic address: behzad.sharif@cshs.org. ·Int J Cardiol · Pubmed #30041981.

ABSTRACT: BACKGROUND: It has recently been shown that magnetic resonance (MR) "native T1" mapping is capable of characterizing abnormal microcirculation in patients with obstructive coronary artery disease (CAD). In studies involving women with signs and symptoms of ischemia and no obstructive CAD (INOCA), however, the potential role of native T1 as an imaging marker and its association with indices of diastolic function or vasodilator-induced myocardial ischemia have not been explored. We investigated whether native T1 in INOCA is associated with reduced myocardial perfusion reserve index (MPRI) or with diastolic dysfunction. METHODS: Twenty-two female patients with INOCA and twelve female reference controls with matching age and body-mass index were studied. The patients had evidence of vasodilator-induced ischemia without obstructive CAD or any prior infarction. All 34 subjects underwent stress/rest MR including native T1 mapping (MOLLI 5(3)3) at 1.5-Tesla. RESULTS: Compared with controls, patients had similar morphology/function. As expected, MPRI was significantly reduced in patients compared to controls (1.78 ± 0.39 vs. 2.49 ± 0.41, p < 0.0001). Native T1 was significantly elevated in patients (1040.1 ± 29.3 ms vs. 1003.8 ± 18.5 ms, p < 0.001) and the increased T1 showed a significant inverse correlation with MPRI (r = -0.481, p = 0.004), but was not correlated with reduced diastolic strain rate. CONCLUSIONS: Symptomatic women with INOCA have elevated native T1 compared to matched reference controls and there is a significant association between elevated native T1 and impaired MPRI, considered a surrogate measure of ischemia severity in this cohort. Future studies in a larger cohort are needed to elucidate the mechanism underlying this inverse relationship.

5 Article Maladaptive left ventricular remodeling in women: An analysis from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction study. 2018

Elboudwarej, Omeed / Wei, Janet / Darouian, Navid / Cook-Wiens, Galen / Li, Quanlin / Thomson, Louise E J / Petersen, John W / Anderson, R David / Mehta, Puja / Shufelt, Chrisandra / Berman, Daniel / Azarbal, Babak / Samuels, Bruce / Handberg, Eileen / Sopko, George / Pepine, Carl J / Bairey Merz, C Noel. ·Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States. · University of Florida College of Medicine, Gainesville, FL, United States. · Emory University School of Medicine, Atlanta, GA, United States. · NHLBI, Bethesda, MD, United States. · Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States. Electronic address: merz@cshs.org. ·Int J Cardiol · Pubmed #30041793.

ABSTRACT: BACKGROUND: Women represent approximately half of heart failure hospitalizations and are disproportionately affected by heart failure with preserved ejection fraction (HFpEF). Women with signs and symptoms of ischemia, preserved left ventricular ejection fraction (LVEF), and no obstructive coronary artery disease (CAD) often have elevated left ventricular end-diastolic pressure (LVEDP). However, isolated elevated LVEDP in the absence of coronary microvascular dysfunction (CMD) is not understood. METHODS: Among 244 women with signs and symptoms of ischemia, no obstructive CAD, and preserved LVEF who underwent invasive coronary reactivity testing (CRT), 43 (18%) women had no evidence of CMD. LVEDP was measured at time of CRT, and left ventricular (LV) volumes and mass were assessed by cardiac magnetic resonance (CMR) imaging. RESULTS: Of the 43 women without CMD, 24 (56%) had elevated LVEDP [mean 18 mm Hg (SD = 3)] compared to 19 (44%) with normal LVEDP [11 mm Hg (SD = 3)]. The elevated LVEDP group had a comparatively higher systolic and diastolic blood pressure, lower LV end-diastolic volume index (EDVI), and higher mass-to-volume ratio. Other functional parameters were not significantly different. CONCLUSIONS: Among women with signs and symptoms of ischemia without obstructive CAD, absence of CMD, and preserved LVEF, isolated elevated LVEDP is associated with a significantly higher systolic and diastolic blood pressure, higher LV mass-to-volume ratio and lower LV EDVI. These results suggest these women have maladaptive remodeling to blood pressure. Given the relatively high prevalence of HFpEF in women, these hypothesis-generating results suggest that further study of ventricular remodeling is warranted.

6 Article Impact of Exercise on the Relationship Between CAC Scores and All-Cause Mortality. 2017

Arnson, Yoav / Rozanski, Alan / Gransar, Heidi / Hayes, Sean W / Friedman, John D / Thomson, Louise E J / Berman, Daniel S. ·Department of Imaging, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California. · Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York. · Department of Imaging, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: bermand@cshs.org. ·JACC Cardiovasc Imaging · Pubmed #28528154.

ABSTRACT: OBJECTIVES: This study aims to assess the correlations among coronary artery calcium (CAC), self-reported exercise, and mortality in asymptomatic patients. BACKGROUND: The interaction between reported exercise habits and CAC scores for predicting clinical risk is not yet well known. METHODS: We followed 10,690 asymptomatic patients who underwent CAC scanning. Patients were divided into 4 groups based on a single-item self-reported exercise. Mean follow-up was 8.9 ± 3.5 years for the occurrence of all-cause mortality (ACM). RESULTS: Annualized ACM progressively increased with increasing CAC score (p < 0.001) and decreasing exercise (p < 0.001). Among patients with CAC scores of 0, ACM was low regardless of the amount of exercise. Among patients with CAC scores from 1 to 399, there was a stepwise increase in ACM for each reported decrement in exercise, and this difference was markedly more pronounced among patients with CAC scores ≥400. Compared with highly active patients with a CAC score of 0, highly sedentary patients with CAC scores ≥400 had a 3.1-fold increase (95% confidence interval: 1.35 to 7.11) in adjusted ACM risk. Our single-item physical activity questionnaire was also predictive of risk factors and clinical and lipid profile measurements. CONCLUSIONS: In asymptomatic patients, self-reported exercise is a significant predictor of long-term outcomes. Prognostic value of the reported exercise is additive to the increasing degree of underlying atherosclerosis. Among patients with high CAC scores, exercise may play a protective role, whereas reported minimal or no exercise substantially increases clinical risk. Our results suggest there is clinical utility for the use of a simple single-item exercise questionnaire for such assessments.

7 Article Myocardial tissue deformation is reduced in subjects with coronary microvascular dysfunction but not rescued by treatment with ranolazine. 2017

Nelson, Michael D / Sharif, Behzad / Shaw, Jaime L / Cook-Wiens, Galen / Wei, Janet / Shufelt, Chrisandra / Mehta, Puja K / Thomson, Louise E J / Berman, Daniel S / Thompson, Richard B / Handberg, Eileen M / Pepine, Carl J / Li, Debiao / Bairey Merz, C Noel. ·Applied Physiology and Advanced Imaging Laboratory, University of Texas at Arlington, Arlington, Texas. · Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California. · Barbra Streisand Women's Heart Center, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. · Biostatistics Core, Cedars-Sinai Medical Center, Los Angeles, California. · Emory Women's Heart Center, Emory University School of Medicine, Atlanta, Georgia. · Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, California. · Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada. · Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida. ·Clin Cardiol · Pubmed #28004395.

ABSTRACT: BACKGROUND: Patients with coronary microvascular dysfunction (CMD) often have diastolic dysfunction, representing an important therapeutic target. Ranolazine-a late sodium current inhibitor-improves diastolic function in animal models and subjects with obstructive coronary artery disease (CAD). HYPOTHESIS: We hypothesized that ranolazine would beneficially alter diastolic function in CMD. METHODS: To test this hypothesis, we performed retrospective tissue tracking analysis to evaluate systolic/diastolic strain, using cardiac magnetic resonance imaging cine images acquired in a recently completed, randomized, double-blind, placebo-controlled, crossover trial of short-term ranolazine in subjects with CMD and from 43 healthy reference controls. RESULTS: Diastolic strain rate was impaired in CMD vs controls (circumferential diastolic strain rate: 99.9% ± 2.5%/s vs 120.1% ± 4.0%/s, P = 0.0003; radial diastolic strain rate: -199.5% ± 5.5%/s vs -243.1% ± 9.6%/s, P = 0.0008, case vs control). Moreover, peak systolic circumferential strain (CS) and radial strain (RS) were also impaired in cases vs controls (CS: -18.8% ± 0.3% vs -20.7% ± 0.3%; RS: 35.8% ± 0.7% vs 41.4% ± 0.9%; respectively; both P < 0.0001), despite similar and preserved ejection fraction. In contrast to our hypothesis, however, we observed no significant changes in left ventricular diastolic function in CMD cases after 2 weeks of ranolazine vs placebo. CONCLUSIONS: The case-control comparison both confirms and extends our prior observations of diastolic dysfunction in CMD. That CMD cases were also found to have subclinical systolic dysfunction is a novel finding, highlighting the utility of this retrospective approach. In contrast to previous studies in obstructive CAD, ranolazine did not improve diastolic function in CMD.

8 Article Dyspnea predicts mortality among patients undergoing coronary computed tomographic angiography. 2016

Nakanishi, Rine / Gransar, Heidi / Rozanski, Alan / Rana, Jamal S / Cheng, Victor Y / Thomson, Louise E J / Miranda-Peats, Romalisa / Dey, Damini / Hayes, Sean W / Friedman, John D / Min, James K / Berman, Daniel S. ·Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA. · Division of Cardiology, St. Luke's Roosevelt Hospital, New York, NY, USA. · Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. · Department of Public Health, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA. · Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA. Daniel.Berman@cshs.org. · Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. Daniel.Berman@cshs.org. ·Int J Cardiovasc Imaging · Pubmed #26467171.

ABSTRACT: The prognostic implications of dyspnea and typical angina in patients referred for coronary CT angiography have not been examined. We examined features associated with incident mortality risk among individuals undergoing coronary computed tomographic angiography (CCTA) presenting with dyspnea, typical angina, and neither of these symptoms. 1147 consecutive individuals without known CAD (mean 61 years, 61.6 %men) undergoing CCTA comprised the study population 132 with dyspnea, 218 with typical angina, and 797 without dyspnea or typical angina (reference group). Mortality risk in relation to dyspnea or typical angina was evaluated with multivariable Cox proportional hazards models compared to reference. In addition, the prognosis associated with dyspnea or typical angina was assessed among age matched subgroups. Patients with dyspnea had a greater prevalence of C70 % stenosis (p\0.001) and coronary segments with plaque (p = 0.02) compared to the other two groups. During a follow-up of 3.1 years, 52 individuals died. By multivariable Cox models, compared to patients in reference group, dyspnea patients experienced higher mortality (HR 2.0, 95 % CI 1.0–4.0, p = 0.049) while typical angina patients did not (HR 1.1, 95 % CI 0.6–2.3, p = 0.76). In the matched group, the patients with dyspnea (HR 2.2, 95 % CI 1.1–4.3, p = 0.03) still had significantly reduced survival compared to the other two groups, while those with typical angina did not (HR 1.2, 95 % CI 0.6–2.6,p = 0.62). Dyspnea is associated with increased mortality ate compared to patients with typical angina and those with neither of these symptoms among patients undergoing CCTA.

9 Article Combined Quantitative Assessment of Myocardial Perfusion and Coronary Artery Calcium Score by Hybrid 82Rb PET/CT Improves Detection of Coronary Artery Disease. 2015

Brodov, Yafim / Gransar, Heidi / Dey, Damini / Shalev, Aryeh / Germano, Guido / Friedman, John D / Hayes, Sean W / Thomson, Louise E J / Rogatko, André / Berman, Daniel S / Slomka, Piotr J. ·Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California. · Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and. · Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California. · Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and piotr.slomka@cshs.org. ·J Nucl Med · Pubmed #26159582.

ABSTRACT: METHODS: Consecutive patients (n = 152; mean age ± SD, 69 ± 12 y) without prior CAD, referred to (82)Rb PET MPI followed by invasive coronary angiography performed within 14 days, were studied. Myocardial perfusion was quantified automatically for left anterior descending, left circumflex, and right coronary artery territories as an ischemic total perfusion deficit (ITPD) for 456 vessels. Global and per-vessel CAC Agatston scores were calculated. Obstructive CAD was defined as 50% or greater stenosis of the left main and 70% or greater stenosis in the left anterior descending, left circumflex, and right coronary arteries. Logistic regression and 10-fold cross validation were used to derive and validate the combined ITPD/logCAC (logarithm of coronary calcium) scores. RESULTS: In the prediction of per-vessel obstructive CAD, the receiver-operating-characteristic area under the curve for combined per-vessel ITPD/logCAC score was higher, 0.85 (95% confidence interval [CI], 0.81-0.89), than standalone ITPD area under the curve, 0.81 (95% CI: 0.76-0.85), and logCAC score, 0.73 (95% CI, 0.68-0.78; P < 0.05). The integrated discrimination improvement of combined per-vessel ITPD/logCAC analysis was 0.07 (95% CI, 0.04-0.09; P < 0.0001), as compared with ITPD alone. CONCLUSION: Combined automatically derived per-vessel ITPD and logCAC score improves accuracy of (82)Rb PET MPI for detection of obstructive CAD.

10 Article Relationship of epicardial fat volume from noncontrast CT with impaired myocardial flow reserve by positron emission tomography. 2015

Otaki, Yuka / Hell, Michaela / Slomka, Piotr J / Schuhbaeck, Annika / Gransar, Heidi / Huber, Brandi / Nakazato, Ryo / Germano, Guido / Hayes, Sean W / Thomson, Louise E J / Friedman, John D / Achenbach, Stephan / Berman, Daniel S / Dey, Damini. ·Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Department of Cardiology, University of Erlangen, Erlangen, Germany. · Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA. Electronic address: Damini.Dey@cshs.org. ·J Cardiovasc Comput Tomogr · Pubmed #25977114.

ABSTRACT: BACKGROUND: Impaired myocardial flow reserve (MFR) is a marker of coronary vascular dysfunction with prognostic significance. OBJECTIVES: We aimed to investigate the relationship between epicardial fat volume (EFV) measured from noncontrast CT and impaired MFR derived from rest-stress Rb-82 positron emission tomography (PET). METHODS: We retrospectively studied 85 consecutive patients without known coronary artery disease who underwent rest-stress Rb-82 myocardial PET/CT and were subsequently referred for invasive coronary angiography. EFV was computed from noncontrast CT by validated software and indexed to body surface area (EFVi, cm3/m2). Global stress and rest MFR were automatically derived from PET. Patient age, sex, cardiovascular risk factors, coronary calcium score (CCS), and EFVi were combined by boosted ensemble machine learning algorithm into a novel composite risk score, using 10-fold cross-validation, to predict impaired global MFR (MFR ≤2.0) by PET. RESULTS: Patients with impaired MFR (44 of 85; 52%) were older (71 vs. 65 years; P = .03) and had higher frequency of CCS (≥400; P = .02) with significantly higher EFVi (63.1 ± 20.4 vs. 51.3 ± 14.1 cm3/m2; P = .003). On multivariate logistic regression (with age, sex, number of risk factors, CCS, and EFVi), EFVi was the only independent predictor of impaired MFR (odds ratio, 7.39; P = .02). The machine learning composite risk score significantly improved risk reclassification of impaired MFR compared to CCS or EFVi alone (integrated discrimination improvement = 0.19; P = .007 and IDI = 0.22; P = .002, respectively). CONCLUSIONS: Increased EFVi and composite risk score combining EFVi and CCS significantly improve identification of impaired global MFR by PET.

11 Article Extensive thoracic aortic calcification is an independent predictor of development of coronary artery calcium among individuals with coronary artery calcium score of zero. 2015

Brodov, Yafim / Gransar, Heidi / Rozanski, Alan / Hayes, Sean W / Friedman, John D / Thomson, Louise E J / Dey, Damini / Slomka, Piotr J / Min, James K / Shaw, Leslee J / Shah, P K / Germano, Guido / Berman, Daniel S. ·Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: yafim.brodov@gmail.com. · Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Division of Cardiology, St. Lukes Roosevelt Hospital, New York, NY, USA. · Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. · Department of Cardiac Imaging (Division of Nuclear Medicine), The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Biomedical Sciences and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, CA, USA. · Department of Radiology and Medicine Weill Cornell Medical College, New York, NY, USA. · Emory Clinical Cardiovascular Research Institute (ECCRI), Emory University School of Medicine, Atlanta, GA, USA. ·Atherosclerosis · Pubmed #25461732.

ABSTRACT: OBJECTIVES: The predictive value of thoracic aortic calcium (TAC) scores for coronary artery calcium (CAC) conversion (CAC>0) has not been fully evaluated. METHODS: We studied 1648 asymptomatic subjects (mean age 52 ± 9 years, 54% male) with baseline CAC = 0 who underwent repeat CAC scanning 5 years later (range 3-14 years). TAC was assessed in the ascending and descending aorta. CAC and TAC were measured using Agatston scores. The cohort was categorized by baseline TAC scores: TAC = 0 (n = 1381 subjects), TAC 1-9 (n = 54), TAC 10-99 (n = 132) and TAC≥100 (n = 81). Logistic regression was used to examine the predictive value of baseline TAC scores for CAC>0 on repeat scans. RESULTS: On repeat scanning, 380 subjects (23%) developed CAC>0. The frequency of CAC>0 increased progressively across baseline TAC (TAC = 0, TAC 1-9, TAC 10-99 and TAC≥100) 22%, 26%, 26% and 37%, respectively (P for trend = 0.0025). Univariate analysis showed baseline TAC ≥100 was a significant predictor of CAC>0 in repeat scans, while either TAC 1-9 or TAC 10-99 were not, OR 2.10 [CI 1.32-3.36], P = 0.002; OR 1.25 [CI 0.67-2.33], P = 0.5; OR 1.24 [CI 0.82-1.87], P = 0.3, respectively. In multivariable analysis, TAC ≥100 OR 1.90 [CI 1.08-3.33], P = 0.026, was a significant predictor of CAC>0, along with age, male gender, diabetes, hypertension, hypercholesterolemia and time between scans. CONCLUSIONS: The likelihood of conversion to CAC>0 increases with increasing TAC scores. TAC ≥ 100 is an independent predictor of CAC conversion. Subjects with CAC = 0 and extensive TAC (TAC ≥ 100) may merit earlier repeat scanning than those with no TAC or lower TAC scores.

12 Article Quantitative high-efficiency cadmium-zinc-telluride SPECT with dedicated parallel-hole collimation system in obese patients: results of a multi-center study. 2015

Nakazato, Ryo / Slomka, Piotr J / Fish, Mathews / Schwartz, Ronald G / Hayes, Sean W / Thomson, Louise E J / Friedman, John D / Lemley, Mark / Mackin, Maria L / Peterson, Benjamin / Schwartz, Arielle M / Doran, Jesse A / Germano, Guido / Berman, Daniel S. ·Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building Suite 1258, Los Angeles, CA, 90048, USA. ·J Nucl Cardiol · Pubmed #25388380.

ABSTRACT: BACKGROUND: Obesity is a common source of artifact on conventional SPECT myocardial perfusion imaging (MPI). We evaluated image quality and diagnostic performance of high-efficiency (HE) cadmium-zinc-telluride parallel-hole SPECT MPI for coronary artery disease (CAD) in obese patients. METHODS AND RESULTS: 118 consecutive obese patients at three centers (BMI 43.6 ± 8.9 kg·m(-2), range 35-79.7 kg·m(-2)) had upright/supine HE-SPECT and invasive coronary angiography > 6 months (n = 67) or low likelihood of CAD (n = 51). Stress quantitative total perfusion deficit (TPD) for upright (U-TPD), supine (S-TPD), and combined acquisitions (C-TPD) was assessed. Image quality (IQ; 5 = excellent; < 3 nondiagnostic) was compared among BMI 35-39.9 (n = 58), 40-44.9 (n = 24) and ≥45 (n = 36) groups. ROC curve area for CAD detection (≥50% stenosis) for U-TPD, S-TPD, and C-TPD were 0.80, 0.80, and 0.87, respectively. Sensitivity/specificity was 82%/57% for U-TPD, 74%/71% for S-TPD, and 80%/82% for C-TPD. C-TPD had highest specificity (P = .02). C-TPD normalcy rate was higher than U-TPD (88% vs 75%, P = .02). Mean IQ was similar among BMI 35-39.9, 40-44.9 and ≥45 groups [4.6 vs 4.4 vs 4.5, respectively (P = .6)]. No patient had a nondiagnostic stress scan. CONCLUSIONS: In obese patients, HE-SPECT MPI with dedicated parallel-hole collimation demonstrated high image quality, normalcy rate, and diagnostic accuracy for CAD by quantitative analysis of combined upright/supine acquisitions.

13 Article Long-term mortality following normal exercise myocardial perfusion SPECT according to coronary disease risk factors. 2014

Rozanski, Alan / Gransar, Heidi / Min, James K / Hayes, Sean W / Friedman, John D / Thomson, Louise E J / Berman, Daniel S. ·Division of Cardiology, St. Lukes Roosevelt Hospital, New York, NY, USA, ar77@columbia.edu. ·J Nucl Cardiol · Pubmed #24379127.

ABSTRACT: BACKGROUND: While normal exercise myocardial perfusion imaging (SPECT-MPI) is a robust predictor of low short-term clinical risk, there is increasing interest in ascertaining how clinical factors influence long-term risk following SPECT-MPI. METHODS: We evaluated the predictors of outcome from clinical data obtained at the time of testing in 12,232 patients with normal exercise SPECT-MPI studies. All-cause mortality (ACM) was assessed at a mean of 11.2 ± 4.5 years using the Social Security Death Index. RESULTS: The ACM rate was 0.8%/year, but varied markedly according to the presence of CAD risk factors. Hypertension, smoking, diabetes, exercise capacity, dyspnea, obesity, higher resting heart rate, an abnormal ECG, LVH, atrial fibrillation, and LVEF < 45% were all predictors of increased mortality. Risk factors were synergistic in predicting mortality: annualized age and gender-adjusted ACM rates ranged from only 0.2%/year among patients exercising for >9 minutes having none of three significant risk factors (among hypertension, diabetes, and smoking) to 1.6%/year among patients exercising <6 minutes and having ≥ 2 of these three risk factors. The age and gender-adjusted hazard ratio for mortality was increased by 7.3 (95% confidence interval 5.5-9.7) in the latter patients compared to those patients who exercised >9 minutes and had no significant risk factors (P < .001). CONCLUSIONS: Long-term mortality risk varies markedly in accordance with baseline CAD risk factors and functional capacity among patients with normal exercise SPECT-MPI studies. Further study is indicated to determine whether the prospective characterization of both short-term and long-term risks following the performance of stress SPECT-MPI leads to improved clinical management.

14 Article Improved quantification of myocardial blood flow using highly constrained back projection reconstruction. 2014

Chen, David / Sharif, Behzad / Dharmakumar, Rohan / Thomson, Louise E J / Bairey Merz, C Noel / Berman, Daniel S / Li, Debiao. ·Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA; Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA. ·Magn Reson Med · Pubmed #24122950.

ABSTRACT: PURPOSE: To improve quantification of myocardial blood flow using a fast T1 mapping technique using highly constrained back projection reconstruction (HYPR)-accelerated acquisition. METHODS: A major source of error in the measurement of myocardial blood flow (MBF) using MRI is the nonlinear relationship between image signal intensity and contrast agent (CA) concentration. HYPR-accelerated radial acquisition was used to generate pixel-wise T1 maps with a temporal resolution of one heartbeat. HYPR produces images with a temporal footprint of 40 ms and four images within 188 ms. T1 values were converted into CA concentrations by the known linear relationship between CA concentration and T1 . The T1 mapping technique was used to quantify MBF in 10 healthy subjects and compared with MBF found using image signal intensity as well as MBF reported in the literature. RESULTS: The MBF measured using the proposed method was more consistent with that previously reported in the literature and was significantly lower (P = 0.002) than that calculated using image signal intensity (1.11 ± 0.27 mL/min/g versus 1.88 ± 0.45 mL/min/g, respectively). CONCLUSION: We developed a fast T1 mapping method for MBF quantification using radial sampling and HYPR. Further validation is required to determine its clinical value in assessing myocardial perfusion deficit in coronary artery disease.

15 Article Relationship of dyspnea vs. typical angina to coronary artery disease severity, burden, composition and location on coronary CT angiography. 2013

Nakanishi, Rine / Rana, Jamal S / Rozanski, Alan / Cheng, Victor Y / Gransar, Heidi / Thomson, Louise E J / Miranda-Peats, Romalisa / Hayes, Sean W / Friedman, John D / Berman, Daniel S / Min, James K. ·Department of Imaging, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA. ·Atherosclerosis · Pubmed #23958253.

ABSTRACT: OBJECTIVE: Symptom presentations suspicious for coronary artery disease (CAD) vary widely. While dyspnea is associated with worse prognosis than typical angina (TypAng) for patients referred for non-invasive CAD imaging, the relation of dyspnea vs. TypAng to adverse measures of CAD prognosis-including severity, burden, composition, and myocardium at risk-has not been examined. METHODS: We studied 1443 consecutive individuals without known CAD (mean 61 ± 13 years, 61.6% men) undergoing coronary computed tomographic angiography (CCTA) who presented with dyspnea (n = 170), TypAng (n = 249) or no dyspnea or TypAng (n = 1024). Multivariable logistic regression was performed to evaluate the association of dyspnea or TypAng to obstructive CAD (≥70% stenosis), plaque burden (total segments with plaque), composition (noncalcified, partially calcified) and location (proximal, mid, or distal location in a coronary artery). RESULTS: By multivariable logistic regression, both dyspnea (OR1.9, 95% CI 1.1-3.3, p = 0.02) and TypAng (OR1.9, 95% CI 1.2-3.1, p = 0.01) were associated with obstructive CAD as compared to individuals without dyspnea or TypAng, while dyspnea (OR1.8, 95% CI 1.1-3.1, p = 0.02), but not TypAng (OR1.1, 95% CI 0.7-1.6, p = 0.76) was associated with plaque in the proximal portions of coronary arteries. Neither symptom type was associated with differences in plaque burden nor composition. CONCLUSION: Both dyspnea and TypAng are associated with higher rates of obstructive CAD compared to those without dyspnea or TypAng, but only dyspnea is associated with coronary plaque in proximal vessel portions.

16 Article Relationship of epicardial fat volume to coronary plaque, severe coronary stenosis, and high-risk coronary plaque features assessed by coronary CT angiography. 2013

Rajani, Ronak / Shmilovich, Haim / Nakazato, Ryo / Nakanishi, Rine / Otaki, Yuka / Cheng, Victor Y / Hayes, Sean W / Thomson, Louise E J / Friedman, John D / Slomka, Piotr J / Min, James K / Berman, Daniel S / Dey, Damini. ·Department of Imaging, Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. ·J Cardiovasc Comput Tomogr · Pubmed #23622507.

ABSTRACT: BACKGROUND: Associations of epicardial fat volume (EFV) measured on noncontrast cardiac CT (NCT) include coronary plaque, myocardial ischemia, and adverse cardiac events. OBJECTIVES: This study aimed to define the relationship of EFV to coronary plaque type, severe coronary stenosis, and the presence of high-risk plaque features (HRPFs). METHODS: We retrospectively evaluated 402 consecutive patients, with no prior history of coronary artery disease, who underwent same day NCT and coronary CT angiography (CTA). EFV was measured on NCT with the use of validated, semiautomated software. The coronary arteries were evaluated for coronary plaque type (calcified [CP], noncalcified [NCP], or partially calcified [PCP]) and coronary stenosis severity ≥70% with the use of coronary CTA. For patients with NCP and PCP, 2 high-risk plaque features were evaluated: low-attenuation plaque and positive remodeling. RESULTS: There were 402 patients with a median age of 66 years (range, 23-92 years) of whom 226 (56%) were men. The EFV was greater in patients with CP (112 ± 55 cm(3) vs 89 ± 39 cm(3)), PCP (110 ± 57 cm(3) vs 98 ± 45 cm(3)), and NCP (115 ± 44 cm(3) vs EFV 100 ± 52 cm(3)). In the 192 patients with PCP or NCP, on multivariable analysis, after adjusting for conventional cardiovascular risk factors, EFV was an independent predictor of ≥70% coronary artery stenosis (odds ratio [OR], 3.0; 95% CI, 1.3-6.6; P = 0.008), any high-risk plaque features (OR, 1.7; 95% CI, 0.9-3.4; P = 0.04), and low attention plaque (OR, 2.4; 95% CI, 1.1-5.1; P = 0.02) but not of positive remodeling. CONCLUSIONS: EFV is greater in patients with CP, PCP, and NCP. In patients with NCP and PCP, EFV is significantly associated with severe coronary stenosis, high-risk plaque features, and low attenuation plaque.

17 Article Temporal trends in the frequency of inducible myocardial ischemia during cardiac stress testing: 1991 to 2009. 2013

Rozanski, Alan / Gransar, Heidi / Hayes, Sean W / Min, James / Friedman, John D / Thomson, Louise E J / Berman, Daniel S. ·Division of Cardiology and Department of Medicine, St. Luke's Roosevelt Hospital, New York, New York, USA. ·J Am Coll Cardiol · Pubmed #23473411.

ABSTRACT: OBJECTIVES: This study sought to assess whether the frequency of inducible myocardial ischemia during stress-rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has changed over time. BACKGROUND: The prevalence of cardiac death and other clinical cardiac events have declined in recent decades, but heretofore no study has examined if there has been a temporal change in the frequency of inducible myocardial ischemia during cardiac stress testing. METHODS: We assessed 39,515 diagnostic patients undergoing stress-rest MPI between 1991 and 2009. Patients were assessed for change in demographics, clinical symptoms, risk factors, and frequency of abnormal and ischemic SPECT-MPI. RESULTS: There was a marked progressive decline in the prevalence of abnormal SPECT studies, from 40.9% in 1991 to 8.7% in 2009 (p < 0.001). Similarly, the prevalence of ischemic SPECT-MPI declined, from 29.6% to 5.0% (p < 0.001), as did the prevalence of severe ischemia. The decline of SPECT-MPI abnormality occurred among all age and symptom subgroups, falling to only 2.9% among recent exercising patients without typical angina. We also noted a progressive trend toward performing more pharmacological rather than exercise stress in all age and weight groups, and pharmacological stress was more likely than exercise to be associated with SPECT-MPI abnormality (odds ratio: 1.43, 95% confidence interval: 1.3 to 1.5; p < 0.001). CONCLUSIONS: Over the past 2 decades, the frequency and severity of abnormal stress SPECT-MPI studies has progressively decreased. Notably, the frequency of abnormal SPECT-MPI is now very low among exercising patients without typical angina. These findings suggest the need for developing more cost-effective strategies for the initial work-up of patients who are presently at low risk for manifesting inducible myocardial ischemia during cardiac imaging procedures.

18 Article Mortality risk as a function of the ratio of pulmonary trunk to ascending aorta diameter in patients with suspected coronary artery disease. 2013

Nakanishi, Rine / Rana, Jamal S / Shalev, Aryeh / Gransar, Heidi / Hayes, Sean W / Labounty, Troy M / Dey, Damini / Miranda-Peats, Romalisa / Thomson, Louise E J / Friedman, John D / Abidov, Aiden / Min, James K / Berman, Daniel S. ·Department of Imaging, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA. ·Am J Cardiol · Pubmed #23415638.

ABSTRACT: Although an increased pulmonary trunk (PT) diameter to ascending aorta (AA) diameter ratio (PT/AA ratio) is associated with pulmonary hypertension, the prognostic utility of this metric remains unexamined. We investigated whether an increase in the PT/AA ratio, as measured using coronary computed tomographic angiography, is associated with the risk of all-cause death. We identified 1,326 consecutive patients (mean age 61 ± 13 years; 60% men) without known coronary artery disease who underwent coronary computed tomographic angiography. Patients with a history of congenital or valvular heart disease or aortic enlargement (≥4 cm) were excluded. The PT and AA diameters were measured at the PT bifurcation level. The patients were categorized by PT/AA deciles, with the ≥90th percentile (PT/AA ratio 0.9) considered elevated. All-cause death associated with a PT/AA ratio <0.9 versus ≥0.9 was evaluated using multivariate Cox proportional hazard models. During 2.9 ± 1.0 years of follow-up, 58 patients died. Patients with a PT/AA ratio ≥0.9 experienced 2.5-fold greater annualized mortality compared to those with <0.9 (3.1% vs 1.3%, p = 0.004). Adjusting for age, gender, heart rate, dyslipidemia, smoking, and coronary artery disease extent, the patients with a PT/AA ratio ≥0.9 experienced a greater mortality risk compared to patients with PT/AA ratio <0.9 (hazard ratio 3.2, 95% confidence interval 1.6 to 6.6, p = 0.001). In the 1,059 patients with left ventricular ejection fraction measurements, a lower left ventricular ejection fraction was observed in the PT/AA ratio ≥0.9 group (p <0.05). In conclusion, incrementally and independent of the traditional coronary artery disease risk factors, an elevated PT/AA ratio was associated with increased mortality risk in patients without known coronary artery disease undergoing coronary computed tomographic angiography.

19 Article Prognostic value of quantitative high-speed myocardial perfusion imaging. 2012

Nakazato, Ryo / Berman, Daniel S / Gransar, Heidi / Hyun, Mark / Miranda-Peats, Romalisa / Kite, Faith C / Hayes, Sean W / Thomson, Louise E J / Friedman, John D / Rozanski, Alan / Slomka, Piotr J. ·Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building Suite 1258, Los Angeles, CA 90048, USA. ·J Nucl Cardiol · Pubmed #23065414.

ABSTRACT: BACKGROUND: We studied the prognostic value of fully automated quantitative analysis software applied to new solid-state, high-speed (HS) SPECT-myocardial perfusion imaging (MPI). METHODS: 1,613 consecutive patients undergoing exercise or adenosine HS-MPI were followed for 2.6 ± 0.5 years for all-cause mortality (ACM). Automated quantitative software was used to compute stress total perfusion deficit (sTPD) and was compared to semi-quantitative visual analysis. MPI was characterized as 0% (normal), 1%-4% (minimal perfusion defect), 5%-10% (mildly abnormal), and >10% (moderately/severely abnormal). RESULTS: During follow-up, 79 patients died (4.9%). Annualized ACM increased with progressively increasing sTPD; 0% (0.87%), 1%-4% (1.94%), 5%-10% (3.10%), and >10% (5.33%) (log-rank P < .0001). While similar overall findings were observed with visual analysis, only sTPD demonstrated increased risk in patients with minimal perfusion defects. In multivariable analysis, sTPD > 10% was a mortality predictor (HR 3.03, 95% CI 1.30-7.09, P = .01). Adjusted mortality rate was substantial in adenosine MPI, but low in exercise MPI (9.0% vs 1.0%, P < .0001). CONCLUSIONS: By quantitative analysis, ACM increases with increasing perfusion abnormality among patients undergoing stress HS-MPI. These findings confirm previous results obtained with visual analysis using conventional Anger camera imaging systems.

20 Article Low radiation coronary calcium scoring by dual-source CT with tube current optimization based on patient body size. 2012

Dey, Damini / Nakazato, Ryo / Pimentel, Raymond / Paz, William / Hayes, Sean W / Friedman, John D / Cheng, Victor Y / Thomson, Louise E J / Slomka, Piotr J / Berman, Daniel S. ·Department of Biomedical Sciences and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room A238, Taper Building, Los Angeles, CA 90048, USA. damini.dey@cshs.org ·J Cardiovasc Comput Tomogr · Pubmed #22381663.

ABSTRACT: BACKGROUND: Reducing tube voltage from 120 kV to 100 kV during noncontrast CT for the detection of coronary artery calcium reduces patient radiation exposure. OBJECTIVE: We investigated whether coronary calcium scoring by multidetector row CT can be performed at reduced tube current, resulting in lower radiation dose to the patient. METHODS: Sixty-six outpatients were scanned on the same visit by dual-source CT (DSCT) with a standard protocol (120 kVp, 150 mAs), followed by a scan with reduced tube current: 85 mAs for patients with body mass index (BMI) ≤ 30 kg/m(2) and weight ≤ 85 kg, and 120 mAs for patients with BMI > 30 kg/m(2) or weight > 85 kg. Low-dose scans were scored by an experienced reader blinded to the standard scan. RESULTS: Agatston scores (ASs) and calcium volume for standard versus low-dose scans were 236 ± 581 versus 234 ± 586 (P = 0.65, NS), and 189 ± 460 mm(3) versus 184 ± 455 mm(3) with excellent correlation (r = 1.0, P < 0.0001), and no significant difference (P = 0.14, NS). Effective radiation dose for the low-dose protocol (1.0 ± 0.2 mSv) was significantly lower than for the standard protocol (1.7 ± 0.2 mSv; P < 0.0001). Image noise was higher for the low-dose scan (18.8 ± 5.5 HU vs 15.2 ± 4.8 HU; P < 0.0001), but both were within target limits. CONCLUSION: Noncontrast CT for measurement of coronary artery calcium with lower tube current optimized for patient body size is equivalent to standard methods at 40% lower radiation dose, indicating that radiation dose can be lowered for coronary calcium scanning.

21 Article Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography. 2012

Shmilovich, Haim / Cheng, Victor Y / Rajani, Ronak / Dey, Damini / Tamarappoo, Balaji K / Nakazato, Ryo / Smith, Thomas W / Otaki, Yuka / Nakanishi, Rine / Gransar, Heidi / Paz, William / Pimentel, Raymond T / Hayes, Sean W / Friedman, John D / Thomson, Louise E J / Berman, Daniel S. ·Department of Medicine and Imaging, Heart Institute, Cardiac Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA. haim.shmilovich@gmail.com ·Am J Cardiol · Pubmed #22335855.

ABSTRACT: Controversy exists concerning the relation between diagonal ear lobe crease (DELC) and coronary artery disease (CAD). We examined whether DELC is associated with CAD using coronary computed tomography (CT) angiography. We studied 430 consecutive patients without a history of coronary artery intervention who underwent CT angiography on a dual-source scanner. Presence of DELC was agreed by 2 blinded observers. Two blinded readers evaluated CT angiography images for presence of CAD and for significant CAD (≥50% stenosis). Chi-square and t tests were used to assess demographic differences between subgroups with and without DELC and the relation of DELC to 4 measurements of CAD: any CAD, significant CAD, multivessel disease (cutoff ≥2), and number of segments with plaque (cutoff ≥3). Multivariable logistic regression was performed to adjust for CAD confounders: age, gender, symptoms, and CAD risk factors. Mean age was 61 ± 13 and 61% were men. DELC was found in 71%, any CAD in 71%, and significant CAD in 17% of patients. After adjusting for confounders, DELC remained a significant predictor of all 4 measurements of CAD (odds ratio 1.8 to 3.3, p = 0.002 to 0.017). Sensitivity, specificity, and positive and negative predictive values for DELC in detecting any CAD were 78%, 43%, 77%, and 45%. Test accuracy was calculated at 67%. Area under the receiver operator characteristic curve was 61% (p = 0.001). In conclusion, in this study of patients imaged with CT angiography, finding DELC was independently and significantly associated with increased prevalence, extent, and severity of CAD.

22 Article Patient management after noninvasive cardiac imaging results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease). 2012

Hachamovitch, Rory / Nutter, Benjamin / Hlatky, Mark A / Shaw, Leslee J / Ridner, Michael L / Dorbala, Sharmila / Beanlands, Rob S B / Chow, Benjamin J W / Branscomb, Elizabeth / Chareonthaitawee, Panithaya / Weigold, W Guy / Voros, Szilard / Abbara, Suhny / Yasuda, Tsunehiro / Jacobs, Jill E / Lesser, John / Berman, Daniel S / Thomson, Louise E J / Raman, Subha / Heller, Gary V / Schussheim, Adam / Brunken, Richard / Williams, Kim A / Farkas, Susan / Delbeke, Dominique / Schoepf, Uwe J / Reichek, Nathaniel / Rabinowitz, Stuart / Sigman, Steven R / Patterson, Randall / Corn, Carolyn R / White, Richard / Kazerooni, Ella / Corbett, James / Bokhari, Sabahat / Machac, Josef / Guarneri, Erminia / Borges-Neto, Salvador / Millstine, John W / Caldwell, James / Arrighi, James / Hoffmann, Udo / Budoff, Matthew / Lima, Joao / Johnson, James R / Johnson, Barbara / Gaber, Mariya / Williams, Julie A / Foster, Courtney / Hainer, Jon / Di Carli, Marcelo F / Anonymous4230716. ·Cleveland Clinic Foundation, Cleveland, Ohio, USA. ·J Am Coll Cardiol · Pubmed #22281249.

ABSTRACT: OBJECTIVES: This study examined short-term cardiac catheterization rates and medication changes after cardiac imaging. BACKGROUND: Noninvasive cardiac imaging is widely used in coronary artery disease, but its effects on subsequent patient management are unclear. METHODS: We assessed the 90-day post-test rates of catheterization and medication changes in a prospective registry of 1,703 patients without a documented history of coronary artery disease and an intermediate to high likelihood of coronary artery disease undergoing cardiac single-photon emission computed tomography, positron emission tomography, or 64-slice coronary computed tomography angiography. RESULTS: Baseline medication use was relatively infrequent. At 90 days, 9.6% of patients underwent catheterization. The rates of catheterization and medication changes increased in proportion to test abnormality findings. Among patients with the most severe test result findings, 38% to 61% were not referred to catheterization, 20% to 30% were not receiving aspirin, 35% to 44% were not receiving a beta-blocker, and 20% to 25% were not receiving a lipid-lowering agent at 90 days after the index test. Risk-adjusted analyses revealed that compared with stress single-photon emission computed tomography or positron emission tomography, changes in aspirin and lipid-lowering agent use was greater after computed tomography angiography, as was the 90-day catheterization referral rate in the setting of normal/nonobstructive and mildly abnormal test results. CONCLUSIONS: Overall, noninvasive testing had only a modest impact on clinical management of patients referred for clinical testing. Although post-imaging use of cardiac catheterization and medical therapy increased in proportion to the degree of abnormality findings, the frequency of catheterization and medication change suggests possible undertreatment of higher risk patients. Patients were more likely to undergo cardiac catheterization after computed tomography angiography than after single-photon emission computed tomography or positron emission tomography after normal/nonobstructive and mildly abnormal study findings. (Study of Perfusion and Anatomy's Role in Coronary Artery [CAD] [SPARC]; NCT00321399).

23 Article Automated quantitative Rb-82 3D PET/CT myocardial perfusion imaging: normal limits and correlation with invasive coronary angiography. 2012

Nakazato, Ryo / Berman, Daniel S / Dey, Damini / Le Meunier, Ludovic / Hayes, Sean W / Fermin, Jimmy S / Cheng, Victor Y / Thomson, Louise E J / Friedman, John D / Germano, Guido / Slomka, Piotr J. ·Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. ·J Nucl Cardiol · Pubmed #22203445.

ABSTRACT: BACKGROUND: We aimed to characterize normal limits and to determine the diagnostic accuracy for an automated quantification of 3D 82-Rubidium (Rb-82) PET/CT myocardial perfusion imaging (MPI). METHODS: We studied 125 consecutive patients undergoing Rb-82 PET/CT MPI, including patients with suspected coronary artery disease (CAD) and invasive coronary angiography, and 42 patients with a low likelihood (LLk) of CAD. Normal limits for perfusion and function were derived from LLk patients. QPET software was used to quantify perfusion abnormality at rest and stress expressed as total perfusion deficit (TPD). RESULTS: Relative perfusion databases did not differ in any of the 17 segments between males and females. The areas under the receiver operating characteristic curve for detection of CAD were 0.86 for identification of ≥50% and ≥70% stenosis. The sensitivity/specificity was 86%/86% for detecting ≥50% stenosis and 93%/77% for ≥70% stenosis, respectively. In regard to normal limits, mean rest and stress left ventricular ejection fraction (LVEF) were 67% ± 10% and 75% ± 9%, respectively. Mean transient ischemic dilation ratio was 1.06 ± 0.14 and mean increase in LVEF with stress was 7.4% ± 6.1% (95th percentile of 0%). CONCLUSION: Normal limits have been established for 3D Rb-82 PET/CT analysis with QPET software. Fully automated quantification of myocardial perfusion PET data shows high diagnostic accuracy for detecting obstructive CAD.

24 Article Threshold for the upper normal limit of indexed epicardial fat volume: derivation in a healthy population and validation in an outcome-based study. 2011

Shmilovich, Haim / Dey, Damini / Cheng, Victor Y / Rajani, Ronak / Nakazato, Ryo / Otaki, Yuka / Nakanishi, Rine / Slomka, Piotr J / Thomson, Louise E J / Hayes, Sean W / Friedman, John D / Gransar, Heidi / Wong, Nathan D / Shaw, Leslee J / Budoff, Matthew / Rozanski, Alan / Berman, Daniel S. ·Department of Medicine, Heart Institute, Cardiac Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA. ·Am J Cardiol · Pubmed #21880291.

ABSTRACT: Epicardial fat volume (EFV) quantified on noncontrast cardiac computed tomography relates to cardiovascular prognosis. We sought to define the upper normal limit of body surface area (BSA)-indexed EFV (EFVi) in a healthy population and to validate it as a predictor of major adverse cardiovascular events (MACE). We analyzed noncontrast cardiac computed tomography scans of 226 healthy subjects with a low Framingham Risk Score (FRS; ≤6%) performed for coronary calcium scoring (CCS). EFV was quantified using validated software and indexed to BSA. We defined the 95th percentile as the upper normal limit. Subsequently, we reanalyzed a separate cohort of 232 participants from a previously published case-control study with 4-year follow-up and 58 cases of MACE to test the additive value of an abnormally high EFVi for predicting MACE. Of the 226 healthy participants 51% were men (mean age 52 ± 9 years). EFV correlated to BSA (r = 0.373, p <0.0001). Median, range, and 25th and 75th percentiles of the non-normally distributed EFVi were 33.3, 10.8 to 96.6, and 24.5 and 45.5 cm(3)/m(2). The 95th percentile definition of the upper normal limit of EFVi was 68.1 cm(3)/m(2). For prediction of MACE, EFVi values higher than the newly defined threshold emerged as a significant and independent predictor after controlling for confounders (odds ratio 2.8, 95% confidence interval 1.3 to 6.4, p = 0.012) and trended in its additive value to the combination of CCS ≥400 and FRS (area under the receiver operating characteristic curve 0.714 vs 0.675, p = 0.1277). In conclusion, in a healthy population we determined 68.1 cm(3)/m(2) as the 95th percentile threshold for abnormally high EFVi. EFVi exceeding this value independently predicted MACE and trended to add to CCS and FRS in this prediction.

25 Article Increase in epicardial fat volume is associated with greater coronary artery calcification progression in subjects at intermediate risk by coronary calcium score: a serial study using non-contrast cardiac CT. 2011

Nakanishi, Rine / Rajani, Ronak / Cheng, Victor Y / Gransar, Heidi / Nakazato, Ryo / Shmilovich, Haim / Otaki, Yuka / Hayes, Sean W / Thomson, Louise E J / Friedman, John D / Slomka, Piotr J / Berman, Daniel S / Dey, Damini. ·Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. ·Atherosclerosis · Pubmed #21835407.

ABSTRACT: OBJECTIVE: Epicardial fat volume (EFV) is related to calcified coronary plaques. However, it is unknown whether baseline EFV or changes in EFV affect the progression of coronary artery calcification over time. METHODS: We identified 375 consecutive asymptomatic subjects with an intermediate risk of developing coronary artery disease, who underwent serial non-contrast CT at least 3-5 years apart. Subjects were divided into tertiles of CCS progression (% increase) between the 2 scans. Subjects from the upper tertile (High Progressors) were matched by age and gender to 81 subjects from the lower tertile (Low Progressors). All subjects underwent serial measurements of CCS and EFV. Relationships between EFV and CCS progression, and change in plaque number were examined. RESULTS: At baseline, there was no difference in EFV, and EFV indexed to body surface area (EFVi) between the groups. At follow-up, EFV, EFVi and percent increase in EFVi-change were higher in High Progressors than Low Progressors (EFV, 102 ± 38 cm(3) vs. 90 ± 35 cm(3), p=0.03; EFVi, 50 ± 16cm(3)/m(2) vs. 46 ± 15 cm(3)/m(2), p=0.03; percent increase in EFVi-change, 15 ± 22% vs. 7 ± 20%, p=0.02). On multivariate analysis, after adjusting for conventional risk factors, EFVi increase ≥15% [odds ratio (OR) 2.3, p<0.05], log (baseline CCS) [OR 0.3, p<0.0001] and scan interval time [p=0.003, OR 1.0] were predictive of being a High Progressor. EFVi increase ≥ 15% (β=3.0, p=0.02) and hypertension (β=3.1, p=0.01) were independent predictors of number of new calcified plaques on follow-up. CONCLUSION: Increase in EFV is associated with greater progression of coronary artery calcification in intermediate-risk subjects.

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