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Coronary Artery Disease: HELP
Articles by Shreenidhi M. Venuraju
Based on 13 articles published since 2009
(Why 13 articles?)
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Between 2009 and 2019, Shreenidhi Venuraju wrote the following 13 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Editorial Abnormal myocardial perfusion in the absence of anatomically significant coronary artery disease: implications and clinical significance. 2010

Venuraju, Shreenidhi M / Yerramasu, Ajay / Lahiri, Avijit. · ·J Nucl Cardiol · Pubmed #19763729.

ABSTRACT: -- No abstract --

2 Review Evolving role of cardiac CT in the diagnosis of coronary artery disease. 2011

Yerramasu, Ajay / Venuraju, Shreenidhi / Lahiri, Avijit. ·Clinical Imaging and Research Centre, Wellington Hospital, and Middlesex University, London NW8 9LE, UK. dryerramasu@yahoo.com ·Postgrad Med J · Pubmed #20693150.

ABSTRACT: Non-invasive assessment of coronary artery patency has been attempted with different imaging modalities over the last few decades. The continuous motion of the heart, the respiratory movement, together with the small and tortuous nature of the coronary arteries, made this a technically challenging task. Over the last decade, significant advances in computed tomography (CT) technology helped CT coronary angiography (CTCA) to evolve as a non-invasive alternative to conventional catheter based coronary angiography. Clinical experience with CTCA has since grown rapidly and led to its acceptance as a useful diagnostic technique for coronary artery disease in certain patient populations. Recently, there has been exponential growth in the availability and use of CTCA in several centres across the world. In order to appreciate the potential impact of CTCA on current clinical practice, it is important to understand its advantages and limitations and its clinical performance in comparison with established techniques.

3 Review Osteoprotegerin as a predictor of coronary artery disease and cardiovascular mortality and morbidity. 2010

Venuraju, Shreenidhi M / Yerramasu, Ajay / Corder, Roger / Lahiri, Avijit. ·Clinical Imaging and Research Centre, Wellington Hospital, London, UK. shreenidhimv@gmail.com ·J Am Coll Cardiol · Pubmed #20447527.

ABSTRACT: Osteoprotegerin (OPG) is a glycoprotein that acts as a decoy receptor for receptor activator of nuclear factor kappaB ligand (RANKL) and tumor necrosis factor-related apoptosis-inducing ligand. The OPG/RANKL/receptor activator of nuclear factor kappaB axis plays an important regulatory role in the skeletal, immune, and vascular systems. The protective role of OPG, in animal models, against vascular calcification has not been replicated in human trials; moreover, increased OPG levels have been consistently associated with the incidence and prevalence of coronary artery disease. There seems to be some dichotomy in the role of OPG, RANKL, and tumor necrosis factor-related apoptosis-inducing ligand in atherosclerosis and plaque stability. In this review, we integrate the findings from some of the important studies and try to draw conclusions with a view to gaining some insight into the complex interactions of the OPG/RANKL/receptor activator of nuclear factor kappaB axis and tumor necrosis factor-related apoptosis-inducing ligand in the pathophysiology of atherosclerosis.

4 Clinical Trial Cortisol responses to mental stress and the progression of coronary artery calcification in healthy men and women. 2012

Hamer, Mark / Endrighi, Romano / Venuraju, Shreenidhi M / Lahiri, Avijit / Steptoe, Andrew. ·Department of Epidemiology and Public Health, University College London, London, United Kingdom. m.hamer@ucl.ac.uk ·PLoS One · Pubmed #22328931.

ABSTRACT: BACKGROUND: Psychosocial stress is a risk factor for coronary heart disease (CHD). The mechanisms are incompletely understood, although dysfunction of the hypothalamic pituitary adrenal (HPA) axis might be involved. We examined the association between cortisol responses to laboratory-induced mental stress and the progression of coronary artery calcification (CAC). METHODS AND RESULTS: Participants were 466 healthy men and women (mean age = 62.7±5.6 yrs), without history or objective signs of CHD, drawn from the Whitehall II epidemiological cohort. At the baseline assessment salivary cortisol was measured in response to mental stressors, consisting of a 5-min Stroop task and a 5-min mirror tracing task. CAC was measured at baseline and at 3 years follow up using electron beam computed tomography. CAC progression was defined as an increase >10 Agatston units between baseline and follow up. 38.2% of the sample demonstrated CAC progression over the 3 years follow up. There was considerable variation in the cortisol stress response, with approximately 40% of the sample responding to the stress tasks with an increase in cortisol of at least 1 mmol/l. There was an association between cortisol stress reactivity (per SD) and CAC progression (odds ratio = 1.27, 95% CI, 1.02-1.60) after adjustments for age, sex, pre-stress cortisol, employment grade, smoking, resting systolic BP, fibrinogen, body mass index, and use of statins. There was no association between systolic blood pressure reactivity and CAC progression (odds ratio per SD increase = 1.03, 95% CI, 0.85-1.24). Other independent predictors of CAC progression included age, male sex, smoking, resting systolic blood pressure, and fibrinogen. CONCLUSION: Results demonstrate an association between heightened cortisol reactivity to stress and CAC progression. These data support the notion that cortisol reactivity, an index of HPA function, is one of the possible mechanisms through which psychosocial stress may influence the risk of CHD.

5 Article Predicting Severity of Coronary Artery Disease in Patients With Diabetes Using Endothelial Function Measured With Peripheral Arterial Tonometry: PROCEED Study. 2019

Venuraju, Shreenidhi / Jeevarethinam, Anand / Mehta, Vishal Shahil / Ruano, Sherezade / Dumo, Alain / Nair, Devaki / Rosenthal, Miranda / Darko, Daniel / Cohen, Mark / Rakhit, Roby / Lahiri, Avijit. ·1 Bedford Hospital, Bedford, United Kingdom. · 2 Institute of Cardiovascular Science, University College London, London, United Kingdom. · 3 Norfolk and Norwich University Hospital, Norwich, United Kingdom. · 4 Barnet Hospital, London, United Kingdom. · 5 Department of Diabetes and Endocrinology, Royal Free Hospital, London, United Kingdom. · 6 Imperial College School of Medicine, London, United Kingdom. · 7 Healthcare Science, Middlesex University, London, United Kingdom. · 8 Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom. ·Angiology · Pubmed #30813747.

ABSTRACT: Endothelial dysfunction is common in patients with type 2 diabetes mellitus (T2DM) and is associated with atherosclerotic disease. This study aimed to determine prognostic factors for endothelial dysfunction and identify relationships between reactive hyperemia index (RHI) score, clinically relevant coronary artery disease (>50% stenosis), and major adverse cardiovascular events (MACEs) in patients with T2DM. Endothelial function was assessed using peripheral arterial tonometry and correlated with patient characteristics and cardiovascular outcomes during a median follow-up of 22.8 months. Among 235 patients with a median duration of T2DM of 13 years, mean (standard deviation) RHI score was 2.00 (0.76). Serum low- and high-density lipoprotein cholesterol levels positively (

6 Article Relationship between carotid atherosclerosis and coronary artery calcification in asymptomatic diabetic patients: A prospective multicenter study. 2017

Jeevarethinam, Anand / Venuraju, Shreenidhi / Dumo, Alain / Ruano, Sherezade / Mehta, Vishal S / Rosenthal, Miranda / Nair, Devaki / Cohen, Mark / Darko, Daniel / Lahiri, Avijit / Rakhit, Roby. ·Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom. · Institute of Cardiovascular Sciences, University College London, United Kingdom. · British Cardiac Research Trust, Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom. · Royal Free and UCL Medical School, London, United Kingdom. · Department of Diabetes and Endocrinology, Royal Free Hospital, London, United Kingdom. · Department of Clinical Biochemistry, Royal Free Hospital, London, United Kingdom. · Department of Diabetes and Endocrinology, Barnet Hospital, London, United Kingdom. · The Jeffrey Kelson Centre for Diabetes and Endocrinology, Central Middlesex Hospital, London, United Kingdom. · Imperial College of Medicine, Imperial College London, UK. · Healthcare Science, Middlesex University, London, UK. · Department of Cardiology, Royal Free Hospital, London, United Kingdom. ·Clin Cardiol · Pubmed #28543093.

ABSTRACT: BACKGROUND: The value of screening sub-clinical atherosclerosis in asymptomatic patients with type 2 diabetes mellitus (T2DM) remains controversial. HYPOTHESIS: An integrated model incorporating carotid intima-media thickness (CIMT) and carotid plaque with traditional risk factors can be used to predict prevalence and severity of coronary artery calcification in asymptomatic T2DM patients. METHODS: A cohort of 262 asymptomatic T2DM patients were prospectively studied with carotid ultrasound to evaluate CIMT and carotid plaque and also a computed tomography coronary artery calcium (CT-CAC) scan. RESULTS: Carotid plaque was detected in 124 (47%) patients and mean CIMT was 0.75±0.14 mm. Two hundred (76%) patients had a CAC score >0, of whom 57 (22%) had severe coronary atherosclerosis (>400 Au). In this group, carotid plaque was present in 40 (70%) patients (p<0.001). Univariable analysis revealed significant associations between non-zero CAC score and age (p<0.001), hypertension (p=0.01), gender (p=0.003) and duration of diabetes (p=0.004). Carotid plaque and mean CIMT were also significantly associated with non-zero CAC score (odds ratios [95% CI], 3.12 [1.66 -5.85] and 2.98 [0.24 -7.17], respectively). After adjusting for traditional risk factors, carotid plaque continued to be predictive of non-zero CAC score (2.59 [1.17 -5.74]) and CIMT was borderline significant (p=0.05). When analysed with binary logistical regression, the prevalence of carotid plaque significantly predicted severe CAC burden (CAC >400 Au; 3.26 [2.05 -5.19]). Upper CIMT quartiles showed a similar association (2.55 [1.33 -4.87]). CONCLUSION: Carotid plaque is more predictive of underlying silent coronary atherosclerosis prevalence, severity and extent in asymptomatic T2DM patients.

7 Article Carotid intimal thickness and plaque predict prevalence and severity of coronary atherosclerosis: a pilot study. 2015

Jeevarethinam, Anand / Venuraju, Shreenidhi / Weymouth, Michelle / Atwal, Satvir / Lahiri, Avijit. ·Clinical Imaging and Research Centre, Wellington Hospital, Wellington Place, London, United Kingdom Institute of Cardiovascular Science, University College London, London, United Kingdom dr.anand2812@gmail.com. · Clinical Imaging and Research Centre, Wellington Hospital, Wellington Place, London, United Kingdom. · Clinical Imaging and Research Centre, Wellington Hospital, Wellington Place, London, United Kingdom Imperial College, London, United Kingdom Middlesex University, London, United Kingdom. ·Angiology · Pubmed #24576983.

ABSTRACT: We determined whether increased carotid intima-media thickness (cIMT) and prevalence of carotid plaque (CP) are predictive of prevalence and severity of coronary atherosclerosis. Consecutive patients (n = 150) with no history of coronary artery disease (CAD), who underwent both carotid ultrasound and computed tomographic coronary angiography, were included in the analysis. The mean cIMT was higher in patients with CAD than in those without CAD (0.76 vs 0.66 mm, P < .003). In a logistic regression analysis, diabetes (P = .03) and CP (P = .02) were associated with significant coronary plaque. Backward selection analysis (after removing nonsignificant variables) showed higher mean cIMT measurement correlated well with prevalence of any coronary plaque (P = .03) and obstructive coronary plaque disease (P = .05), whereas presence of CP was a good predictor of both obstructive (>50% stenosis P = .003) and any coronary plaque (P = .003). In conclusion, CP and cIMT can be useful predictors of prevalence of CAD and its severity.

8 Article Diagnostic role of coronary calcium scoring in the rapid access chest pain clinic: prospective evaluation of NICE guidance. 2014

Yerramasu, Ajay / Lahiri, Avijit / Venuraju, Shreenidhi / Dumo, Alain / Lipkin, David / Underwood, S Richard / Rakhit, Roby D / Patel, Deven J. ·Clinical Imaging and Research Centre, Wellington Hospital, London, UK. · Clinical Imaging and Research Centre, Wellington Hospital, London, UK University of Middlesex, London, UK. · National Heart and Lung Institute, Imperial College London, London, UK Royal Brompton Hospital, Sydney St, London SW3 6NP, UK srunderwood@imperial.ac.uk. · Royal Free London Foundation Trust, London, UK. · Barnet and Chase Farm Hospitals NHS Trust, London, UK. ·Eur Heart J Cardiovasc Imaging · Pubmed #24513880.

ABSTRACT: BACKGROUND: Coronary artery calcium (CAC) imaging by unenhanced computed X-ray tomography (CT) is recommended as an initial diagnostic test for patients with stable chest pain symptoms but a low likelihood (10-29%) of underlying obstructive coronary artery disease (CAD) after clinical assessment. The recommendation has not previously been tested prospectively in a rapid access chest pain clinic (RACPC). METHODS: We recruited 300 consecutive patients presenting with stable chest pain to the RACPC of three hospitals. All patients underwent CAC imaging, followed by invasive coronary angiography (ICA) in patients with CAC ≥ 1000 Agatston units (Au) and CT coronary angiography (CTCA) in those with CAC <1000. Patients with 50-70% stenosis on CTCA underwent myocardial perfusion scintigraphy (MPS) while those with ≥ 70% stenosis underwent ICA. Obstructive CAD was defined as ≥ 70% stenosis on ICA or the presence of inducible ischaemia on MPS. Patients were followed up clinically for a mean of 17 (SD 6) months. RESULTS: The mean patient age was 60.6 (SD 9.6) years and 48% were males. Obstructive CAD was found in 56 (19%) patients, of whom 42 (14%) underwent revascularization. CAC was zero in 131 (44%) patients, of whom two (1.5%) had obstructive CAD and one (0.8%) underwent revascularization. The sensitivity, specificity, negative predictive value, and positive predictive value of CAC ≥ 1 for detection of obstructive CAD were 96, 53, 32, and 98%, respectively. None of the 57 patients with low pre-test probability of CAD and zero CAC had obstructive CAD or suffered a cardiovascular event during the follow-up. CONCLUSION: Patients with stable chest pain symptoms but a low likelihood of CAD can safely be diagnosed as not having obstructive CAD in the absence of detectable coronary calcification by unenhanced CT. Patients with CAC >400 Au have a high prevalence of obstructive CAD and further investigation with ICA or functional imaging may be warranted rather than CTCA. These findings support NICE guidance for the investigation of stable chest pain. ClinicalTrials gov identifier: NCT01464203.

9 Article Varying accuracy of myocardial perfusion SPECT and perfusion cardiac MRI for the detection of critical LMS coronary disease. 2013

Jeevarethinam, Anand / Venuraju, Shreenidhi / Raval, Usha / Lipkin, David / Lahiri, Avijit. ·Clinical Imaging and Research Centre, Wellington Hospital, Wellington Place, St. Johns Wood, London, NW8 9LE, United Kingdom, dr.anand2812@gmail.com. ·J Nucl Cardiol · Pubmed #23861146.

ABSTRACT: -- No abstract --

10 Article Physical activity, sedentary time, and pericardial fat in healthy older adults. 2012

Hamer, Mark / Venuraju, Shreenidhi M / Urbanova, Livia / Lahiri, Avijit / Steptoe, Andrew. ·Department of Epidemiology and Public Health, University College London, London, UK. m.hamer@ucl.ac.uk ·Obesity (Silver Spring) · Pubmed #22402739.

ABSTRACT: Pericardial fat is emerging as a unique risk factor for coronary disease. We examined the relationship between objectively measured physical activity during free-living and pericardial fat. Participants were 446 healthy men and women (mean age = 66 ± 6 years), without history or objective signs of cardiovascular disease (CVD), drawn from the Whitehall II epidemiological cohort. Physical activity was objectively measured using accelerometers (Actigraph GT3X) worn around the hip during waking hours for 7 consecutive days (average daily wear time = 889 ± 68 min/day), and was classified as sedentary (<200 counts/min (cpm)), light (200-1,998 cpm), or moderate-vigorous physical activity (MVPA; ≥1,999 cpm). Pericardial fat volume was measured in each participant using electron beam computed tomography. Average daily cpm in men was 338.0 ± 145.0 and in women 303.8 ± 130.2. There was an inverse association between average cpm and pericardial fat (B = -0.070, 95% confidence interval (CI), -0.101, -0.040, P < 0.001), and this remained significant after adjusting for age, sex, registered wear time, BMI, lipids, glycemic control, blood pressure, smoking, statins, and social status. Both sedentary time (B = 0.081, 95% CI, 0.022, 0.14) and MVPA (B = -0.362, 95% CI, -0.527, -0.197) were also associated with pericardial fat, although associations for sedentary time did not remain significant after adjustment for MVPA. The inverse association between physical activity and pericardial fat was stronger among overweight and obese adults than in normal weight. Objectively assessed daily activity levels are related to pericardial fat in healthy participants, independently of BMI. This might be an important mechanism in explaining the association between physical activity and CVD prevention.

11 Article Objectively assessed physical activity, sedentary time, and coronary artery calcification in healthy older adults. 2012

Hamer, Mark / Venuraju, Shreenidhi M / Lahiri, Avijit / Rossi, Amanda / Steptoe, Andrew. ·Department of Epidemiology and Public Health, 1-19 Torrington Pl, University College London, London, WC1E 6BT, United Kingdom. m.hamer@ucl.ac.uk ·Arterioscler Thromb Vasc Biol · Pubmed #22075247.

ABSTRACT: OBJECTIVE: Physical activity is related to lower risk of cardiovascular disease, but data relating to coronary lesions have been conflicting. These inconsistencies may in part be due to unreliable assessment of physical activity and limitations imposed by self-reported data. The purpose of this study was to determine the relationship between objectively measured physical activity and coronary artery calcium (CAC). METHODS AND RESULTS: Participants were 443 healthy men and women (mean age=66±6 years), without history or objective signs of coronary heart disease, drawn from the Whitehall II epidemiological cohort. Physical activity was objectively measured using accelerometers worn during waking hours for 7 consecutive days (average daily wear time=889±68 minutes/day). CAC was measured in each participant using electron beam computed tomography and was quantified according to the Agatston scoring system. On average, 54.4% of the sample recorded at least 30 minutes/day of moderate to vigorous physical activity (MVPA). There was no association between MVPA and presence of detectable CAC. For the participants with detectable CAC (n=283) a weak inverse relationship between MVPA (minutes/day) and log Agatston score was observed (B=-0.008, 95% CI: -0.16 to 0.00, P=0.05), although the association was no longer present after adjustments for age, sex, and conventional risk factors. No associations were seen for light activity or sedentary time. CONCLUSIONS: Our results confirm no association between objectively assessed physical activity and CAC. Because CAC measures cannot identify more vulnerable lesions, additional studies are required to examine whether physical activity can promote plaque stability.

12 Article Increased volume of epicardial fat is an independent risk factor for accelerated progression of sub-clinical coronary atherosclerosis. 2012

Yerramasu, Ajay / Dey, Damini / Venuraju, Shreenidhi / Anand, Dhakshinamurthy Vijay / Atwal, Satvir / Corder, Roger / Berman, Daniel S / Lahiri, Avijit. ·Clinical Imaging and Research Centre, Wellington Hospital, London NW8 9LE, United Kingdom. dryerramasu@yahoo.com ·Atherosclerosis · Pubmed #22015177.

ABSTRACT: BACKGROUND: Epicardial adipose tissue (EAT), a metabolically active visceral fat depot surrounding the heart, has been implicated in the pathogenesis of coronary artery disease (CAD) through possible paracrine interaction with the coronary arteries. We examined the association of EAT with metabolic syndrome and the prevalence and progression of coronary artery calcium (CAC) burden. METHODS: CAC scan was performed in 333 asymptomatic diabetic patients without prior history of CAD (median age 54 years, 62% males), followed by a repeat scan after 2.7±0.3 years. CAC progression was defined as >2.5mm(3) increase in square root transformed volumetric CAC scores. EAT and intra-thoracic fat volumes were quantified using a dedicated software (QFAT), and were examined in relation to the metabolic syndrome, baseline CAC scores and CAC progression. RESULTS: Both epicardial and intra-thoracic fat were associated with metabolic syndrome after adjustment for conventional cardiovascular risk factors, but the association was attenuated after additional adjustment for body mass index. EAT, but not intra-thoracic fat, showed significant association with baseline CAC scores (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.04-1.22, p=0.04) and CAC progression (OR 1.12, 95% CI 1.05-1.19, p<0.001) after adjustment for conventional measures of obesity and risk factors. CONCLUSION: EAT volume measured on non-contrast CT is an independent marker for the presence and severity of coronary calcium burden and also identifies individuals at increased risk of CAC progression. EAT quantification may thus add to the prognostic value of CAC imaging.

13 Article Radiation dose of CT coronary angiography in clinical practice: objective evaluation of strategies for dose optimization. 2012

Yerramasu, Ajay / Venuraju, Shreenidhi / Atwal, Satvir / Goodman, Dennis / Lipkin, David / Lahiri, Avijit. ·Clinical Imaging and Research Centre, Wellington Hospital, London NW8 9LE, UK. dryerramasu@yahoo.com ·Eur J Radiol · Pubmed #21382680.

ABSTRACT: BACKGROUND: CT coronary angiography (CTCA) is an evolving modality for the diagnosis of coronary artery disease. Radiation burden associated with CTCA has been a major concern in the wider application of this technique. It is important to reduce the radiation dose without compromising the image quality. OBJECTIVES: To estimate the radiation dose of CTCA in clinical practice and evaluate the effect of dose-saving algorithms on radiation dose and image quality. METHODS: Effective radiation dose was measured from the dose-length product in 616 consecutive patients (mean age 58 ± 12 years; 70% males) who underwent clinically indicated CTCA at our institution over 1 year. Image quality was assessed subjectively using a 4-point scale and objectively by measuring the signal- and contrast-to-noise ratios in the coronary arteries. Multivariate linear regression analysis was used to identify factors independently associated with radiation dose. RESULTS: Mean effective radiation dose of CTCA was 6.6 ± 3.3 mSv. Radiation dose was significantly reduced by dose saving algorithms such as 100 kV imaging (-47%; 95% CI, -44% to -50%), prospective gating (-35%; 95% CI, -29% to -40%) and ECG controlled tube current modulation (-23%; 95% CI, -9% to -34%). None of the dose saving algorithms were associated with a significant reduction in mean image quality or the frequency of diagnostic scans (P = non-significant for all comparisons). CONCLUSION: Careful application of radiation-dose saving algorithms in appropriately selected patients can reduce the radiation burden of CTCA significantly, without compromising the image quality.