Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Coronary Artery Disease: HELP
Articles from National Institutes of Health
Based on 476 articles published since 2009
||||

These are the 476 published articles about Coronary Artery Disease that originated from National Institutes of Health during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Editorial Bridging the Sex Gap in Early Myocardial Infarction Mortality: Why It Matters. 2017

Cook, Nakela L. ·From the Immediate Office of the Director, National Heart, Lung, and Blood Institute, Bethesda, MD. nakela.cook@nih.gov. ·Circ Cardiovasc Qual Outcomes · Pubmed #29246885.

ABSTRACT: -- No abstract --

2 Editorial Positron Emission Tomography Assessment of Left Main Coronary Arterial Inflammation With Coronary Computed Tomographic Angiography Validation Before and After Statin Therapy: More Promise for Fluorodeoxyglucose Vascular Uptake? 2016

Mehta, Nehal N. ·From the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. nehal.mehta@nih.gov. ·Circ Cardiovasc Imaging · Pubmed #27956410.

ABSTRACT: -- No abstract --

3 Editorial Cholesterol Lowering in 2015: Still Answering Questions About How and in Whom. 2015

Greenland, Philip / Lauer, Michael S. ·Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois2Senior Editor, JAMA. · Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland. ·JAMA · Pubmed #26172891.

ABSTRACT: -- No abstract --

4 Editorial Dietary fatty acids and coronary heart disease. 2014

Reis, Jared P. ·From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD. reisjp@mail.nih.gov. ·Arterioscler Thromb Vasc Biol · Pubmed #25411104.

ABSTRACT: -- No abstract --

5 Editorial Coronary computed tomographic angiography and incidental pulmonary nodules. 2014

Bluemke, David A. ·From the National Institutes of Health, Bethesda, MD. bluemked@nih.gov. ·Circulation · Pubmed #25015341.

ABSTRACT: -- No abstract --

6 Editorial HDL cholesterol in cardiovascular diseases: the good, the bad, and the ugly? 2013

Xu, Suowen / Liu, Zhiping / Liu, Peiqing. ·Department of Pharmacology and Toxicology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, PR China. Electronic address: suo-wen.xu@nih.gov. ·Int J Cardiol · Pubmed #23962777.

ABSTRACT: Atherosclerotic cardiovascular diseases are the leading cause of death in developed and developing countries. HDL-raising therapeutic modalities (such as cholesterol ester transferase protein (CETP) inhibitors) are being developed to combat these diseases. However, recent setback of two CETP inhibitors (Torcetrapib and Dalcetrapib) has highlighted the importance of measuring qualitative functionality of HDL particles, rather than focusing quantitatively on HDL cholesterol serum concentrations. It has been known that, HDL from patients with coronary artery disease (CAD) (i.e., HDL(CAD)) limits the anti-inflammatory and endothelial repair properties of normal HDL, due to the activation of lectin-like oxidized LDL receptor-1 (LOX-1), thereby causing failure in endothelial nitric oxide (NO) production. A more recent study (Immunity 2013; 38: 754-768) also demonstrates that HDL from patients with chronic kidney dysfunction (CKD) (i.e., HDL(CKD)), unlike its healthy counterpart (i.e., HDL(Healthy)), promotes superoxide production, reduces NO bioavailability and raises blood pressure via toll-like receptor-2 (TLR-2) activation. This study provides novel insights into understanding why HDL-raising agents failed to demonstrate beneficial effects on cardiovascular mortality in large clinical trials and why CKD accelerates the development of atherosclerosis in CAD patients. Further research is warranted to elucidate whether HDL(CKD) and HDL(CAD) participate in other cellular processes in atherosclerosis, such as foam cell formation, the proliferation and migration of smooth muscle cells, and most importantly, plaque destabilization.

7 Editorial Computed tomography perfusion to assess physiological significance of coronary stenosis in the post-FAME era (Fractional Flow Reserve versus Angiography for Multivessel Evaluation). 2013

Arai, Andrew E. ·Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland. Electronic address: araia@nih.gov. ·J Am Coll Cardiol · Pubmed #23773869.

ABSTRACT: -- No abstract --

8 Review The Role of Neutrophils and Neutrophil Extracellular Traps in Vascular Damage in Systemic Lupus Erythematosus. 2019

O'Neil, Liam J / Kaplan, Mariana J / Carmona-Rivera, Carmelo. ·Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA. · Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA. carmelo.carmona-rivera@nih.gov. ·J Clin Med · Pubmed #31466329.

ABSTRACT: Systemic lupus erythematosus (SLE) is an autoimmune syndrome of unknown etiology, characterized by multi-organ inflammation and clinical heterogeneity. SLE affects mostly women and is associated with a high risk of cardiovascular disease. As the therapeutic management of SLE improved, a pattern of early atherosclerotic disease became one of the hallmarks of late disease morbidity and mortality. Neutrophils emerged as important players in SLE pathogenesis and they are associated with increased risk of developing atherosclerotic disease and vascular damage. Enhanced neutrophil extracellular trap (NET) formation was linked to vasculopathy in both SLE and non-SLE subjects and may promote enhanced coronary plaque formation and lipoprotein dysregulation. Foundational work provided insight into the complex relationship between NETs and immune and tissue resident cells within the diseased artery. In this review, we highlight the mechanistic link between neutrophils, NETs, and atherosclerosis within the context of both SLE and non-SLE subjects. We aim to identify actionable pathways that will drive future research toward translational therapeutics, with the ultimate goal of preventing early morbidity and mortality in SLE.

9 Review Subclinical Atherosclerosis Imaging in People Living with HIV. 2019

Schoepf, Isabella C / Buechel, Ronny R / Kovari, Helen / Hammoud, Dima A / Tarr, Philip E. ·University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland. · Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland. · Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, 8091 Zurich, Switzerland. · Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD 20892, USA. · University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland. philip.tarr@unibas.ch. ·J Clin Med · Pubmed #31362391.

ABSTRACT: In many, but not all studies, people living with HIV (PLWH) have an increased risk of coronary artery disease (CAD) events compared to the general population. This has generated considerable interest in the early, non-invasive detection of asymptomatic (subclinical) atherosclerosis in PLWH. Ultrasound studies assessing carotid artery intima-media thickness (CIMT) have tended to show a somewhat greater thickness in HIV+ compared to HIV-, likely due to an increased prevalence of cardiovascular (CV) risk factors in PLWH. Coronary artery calcification (CAC) determination by non-contrast computed tomography (CT) seems promising to predict CV events but is limited to the detection of calcified plaque. Coronary CT angiography (CCTA) detects calcified and non-calcified plaque and predicts CAD better than either CAC or CIMT. A normal CCTA predicts survival free of CV events over a very long time-span. Research imaging techniques, including black-blood magnetic resonance imaging of the vessel wall and 18F-fluorodeoxyglucose positron emission tomography for the assessment of arterial inflammation have provided insights into the prevalence of HIV-vasculopathy and associated risk factors, but their clinical applicability remains limited. Therefore, CCTA currently appears as the most promising cardiac imaging modality in PLWH for the evaluation of suspected CAD, particularly in patients <50 years, in whom most atherosclerotic coronary lesions are non-calcified.

10 Review Genetic and Nongenetic Implications of Racial Variation in Response to Antiplatelet Therapy. 2019

Iantorno, Micaela / Weintraub, William S / Garcia-Garcia, Hector M / Attaran, Saina / Gajanana, Deepakraj / Buchanan, Kyle D / Rogers, Toby / Torguson, Rebecca / Waksman, Ron. ·Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address: ron.waksman@medstar.net. ·Am J Cardiol · Pubmed #30967284.

ABSTRACT: Race has been identified as an independent risk factor for poor prognosis and an independent predictor of survival in coronary artery disease. Race-related dissimilarities have been identified in cardiovascular patients in terms of age of presentation, co-morbidities, socioeconomic status, and treatment approach as well as genetically driven race-related disparities in responsiveness to medications. Antiplatelet therapy represents a fundamental component of therapy in cardiovascular patients, especially in patients presenting with acute coronary syndromes. It has been argued that the different level of platelet reactivity and varying response to antiplatelet therapy among races may account in part for worse outcomes in certain populations. The purpose of this review is to describe genotypic and phenotypic race-related differences in platelet reactivity and responsiveness to cardiovascular treatment, focusing on antiplatelet therapy to highlight the need establish a more effective and targeted antithrombotic strategy.

11 Review Emergence of omega-3 fatty acids in biomedical research. 2019

Spector, Arthur A / Kim, Hee-Yong. ·Laboratory of Molecular Signaling, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, 5625 Fishers Lane, Room 3N07, Bethesda, MD 20892-9410, United States. Electronic address: spectora@nih.gov. · Laboratory of Molecular Signaling, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, 5625 Fishers Lane, Room 3N07, Bethesda, MD 20892-9410, United States. ·Prostaglandins Leukot Essent Fatty Acids · Pubmed #30553403.

ABSTRACT: Shortly after the discovery that linoleic acid was an essential fatty acid in 1930, α-linolenic acid also was reported to prevent the fatty acid deficiency syndrome in animals. However, several prominent laboratories could not confirm the findings with α-linolenic acid, and as a result there was a loss of interest in omega-3 fatty acids in lipid research. Even the findings that a prostaglandin can be synthesized from eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) is necessary for optimum retinal function generated only limited interest in omega-3 fatty acids. The breakthrough came in the 1970s when Dyerberg and Bang reported that the low incidence of atherosclerotic coronary disease in Greenland Eskimos was due to the high marine lipid content of their diet. They subsequently found that EPA, which was increased in Eskimo plasma, inhibited platelet aggregation, and they concluded that the low incidence of coronary artery disease was due to the anti-thrombotic effect of EPA. This stimulated widespread interest and research in EPA and DHA, leading to the present view that, like their omega-6 counterparts, omega-3 fatty acids have important physiological functions and are essential fatty acids.

12 Review Association of Hepatic Steatosis With Subclinical Atherosclerosis: Systematic Review and Meta-Analysis. 2018

Kapuria, Devika / Takyar, Varun K / Etzion, Ohad / Surana, Pallavi / O'Keefe, James H / Koh, Christopher. ·Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD. · Department of Cardiology Saint Luke's Mid-America Heart Institute Kansas City MO. ·Hepatol Commun · Pubmed #30094399.

ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is becoming common in the United States and throughout the world and can progress to cirrhosis, hepatocellular carcinoma, and death. There is a strong association between coronary artery disease and NAFLD due to common risk factors, such as metabolic syndrome, obesity, and diabetes mellitus. Subclinical atherosclerosis, defined as coronary artery calcification in asymptomatic patients, has been shown to have a higher incidence in patients with NAFLD. We performed a meta-analysis to examine the association of NAFLD with subclinical atherosclerosis measured by coronary artery calcium (CAC) scoring. Data were extracted from 12 studies selected using a predefined search strategy. NAFLD was diagnosed by abdominal ultrasound or computed tomography scans. The rate of coronary artery calcification was analyzed using random effects models, and publication bias was assessed using Egger's regression test. A total of 42,410 subjects were assessed, including 16,883 patients with NAFLD. Mean CAC score was significantly higher in subjects with NAFLD compared to those without NAFLD (odds ratio with random effects model, 1.64; 95% confidence inteval, 1.42-1.89). This association remained significant through subgroup analyses for studies with >1,000 subjects and a higher CAC score cutoff of >100. Higher aspartate aminotransferase levels were also associated with increased subclinical atherosclerosis (mean difference 1.77; 95% confidence interval, 1.19-2.34).

13 Review International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial: Rationale and design. 2018

Anonymous521280 / Maron, David J / Hochman, Judith S / O'Brien, Sean M / Reynolds, Harmony R / Boden, William E / Stone, Gregg W / Bangalore, Sripal / Spertus, John A / Mark, Daniel B / Alexander, Karen P / Shaw, Leslee / Berger, Jeffrey S / Ferguson, T Bruce / Williams, David O / Harrington, Robert A / Rosenberg, Yves. ·Department of Medicine, Stanford University School of Medicine, Stanford, CA. Electronic address: david.maron@stanford.edu. · New York University School of Medicine, New York, New York. · Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. · VA New England Healthcare System and Boston University School of Medicine, Boston, MA. · Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY. · Saint Luke's Mid America Heart. · Emory University School of Medicine, Atlanta, GA. · Brody School of Medicine, East Carolina University, Greenville, NC. · Department of Medicine, Stanford University School of Medicine, Stanford, CA. · National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. ·Am Heart J · Pubmed #29778671.

ABSTRACT: BACKGROUND: Prior trials comparing a strategy of optimal medical therapy with or without revascularization have not shown that revascularization reduces cardiovascular events in patients with stable ischemic heart disease (SIHD). However, those trials only included participants in whom coronary anatomy was known prior to randomization and did not include sufficient numbers of participants with significant ischemia. It remains unknown whether a routine invasive approach offers incremental value over a conservative approach with catheterization reserved for failure of medical therapy in patients with moderate or severe ischemia. METHODS: The ISCHEMIA trial is a National Heart, Lung, and Blood Institute supported trial, designed to compare an initial invasive or conservative treatment strategy for managing SIHD patients with moderate or severe ischemia on stress testing. Five thousand one-hundred seventy-nine participants have been randomized. Key exclusion criteria included estimated glomerular filtration rate (eGFR) <30 mL/min, recent myocardial infarction (MI), left ventricular ejection fraction <35%, left main stenosis >50%, or unacceptable angina at baseline. Most enrolled participants with normal renal function first underwent blinded coronary computed tomography angiography (CCTA) to exclude those with left main coronary artery disease (CAD) and without obstructive CAD. All randomized participants receive secondary prevention that includes lifestyle advice and pharmacologic interventions referred to as optimal medical therapy (OMT). Participants randomized to the invasive strategy underwent routine cardiac catheterization followed by revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery, when feasible, as selected by the local Heart Team to achieve optimal revascularization. Participants randomized to the conservative strategy undergo cardiac catheterization only for failure of OMT. The primary endpoint is a composite of cardiovascular (CV) death, nonfatal myocardial infarction (MI), hospitalization for unstable angina, hospitalization for heart failure, or resuscitated cardiac arrest. Assuming the primary endpoint will occur in 16% of the conservative group within 4 years, estimated power exceeds 80% to detect an 18.5% reduction in the primary endpoint. Major secondary endpoints include the composite of CV death and nonfatal MI, net clinical benefit (primary and secondary endpoints combined with stroke), angina-related symptoms and disease-specific quality of life, as well as a cost-effectiveness assessment in North American participants. Ancillary studies of patients with advanced chronic kidney disease and those with documented ischemia and non-obstructive coronary artery disease are being conducted concurrently. CONCLUSIONS: ISCHEMIA will provide new scientific evidence regarding whether an invasive management strategy improves clinical outcomes when added to optimal medical therapy in patients with SIHD and moderate or severe ischemia.

14 Review A Review of the Literature Regarding Sleep and Cardiometabolic Disease in African Descent Populations. 2018

Whitesell, Peter L / Obi, Jennifer / Tamanna, Nuri S / Sumner, Anne E. ·Howard University Hospital Sleep Disorders Center, Washington, DC, United States. · Department of Internal Medicine, Howard University Hospital, Washington, DC, United States. · Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases and National Institute of Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD, United States. ·Front Endocrinol (Lausanne) · Pubmed #29695999.

ABSTRACT: In the twenty-first century, African descent populations on both the continent of Africa and throughout the world are experiencing a high rate of both sleep disturbances and cardiometabolic diseases. The most common sleep disturbances are reduced sleep duration, insomnia, disordered circadian rhythm, and obstructive sleep apnea. Cardiometabolic diseases include hypertension, coronary artery disease, diabetes, hyperlipidemia, and the metabolic syndrome. This review seeks to call attention to new insights regarding the impact of sleep disturbance on cardiometabolic risk factors and outcomes and then apply these concepts to African descent populations, a relatively understudied population. Initial data suggest disparities in sleep quality may have an important role in current and emerging patterns of cardiometabolic disease for African descent populations both in the United States and abroad. ClinicalTrialsgov Identifier: Not applicable.

15 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.

16 Review Dynamic stress computed tomography myocardial perfusion for detecting myocardial ischemia: A systematic review and meta-analysis. 2018

Lu, Minjie / Wang, Shuli / Sirajuddin, Arlene / Arai, Andrew E / Zhao, Shihua. ·Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China; Department of Health and Human Services, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD, 20892-1061, USA. Electronic address: coolkan@163.com. · Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China. · Department of Health and Human Services, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD, 20892-1061, USA. · Department of Health and Human Services, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD, 20892-1061, USA. Electronic address: araia@nhlbi.nih.gov. · Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China. Electronic address: cjr.zhaoshihua@vip.163.com. ·Int J Cardiol · Pubmed #29433968.

ABSTRACT: BACKGROUND: Comparing to SPECT and MRI, with higher temporal and spatial resolution and development of radiation dose reduction, myocardial computed tomography perfusion has emerged as a potential method for evaluation of hemodynamic myocardial ischemia. This meta-analysis systematically analyzed the performance of dynamic CT myocardial perfusion (DCTMP) to diagnose myocardial ischemia (MI) with clinically established reference methods [MR/SPECT/PET perfusion and fractional flow reserve (FFR)] as the reference standard. METHODS: We searched PubMed, Embase and web of science databases for all published studies that evaluated the accuracy of DCTMP to diagnose MI met our inclusion criteria. An exact binomial rendition of the bivariate mixed-effects regression model with test type as a random-effects covariate was performed to synthesize the available data. RESULTS: The search revealed 13 eligible studies including 482 patients. The pooled sensitivity and specificity of myocardial blood flow (MBF) were 0.83 (95% CI: 0.80 to 0.86) and 0.90 (95% CI: 0.88 to 0.91) at the segment level, 0.85 (95% CI: 0.80 to 0.88) and 0.81 (95% CI: 0.78 to 0.84) at the artery level, and 0.93 (95% CI: 0.82 to 0.98) and 0.82 (95% CI: 0.70 to 0.91), at the patient level, respectively. The high area under the sROC curves of MBF were 0.944 at segment level, 0.911 at vessel level and 0.949 at patient level, respectively. CONCLUSIONS: DCTMP has a high diagnostic accuracy in detecting myocardial ischemia and it may increase significantly at segment level in combined use of coronary CTA.

17 Review Bridging the gap for lipid lowering therapy: plaque regression, coronary computed tomographic angiography, and imaging-guided personalized medicine. 2017

Kwan, Alan C / Aronis, Konstantinos N / Sandfort, Veit / Blumenthal, Roger S / Bluemke, David A. ·a Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MA , USA. · b Radiology and Imaging Sciences, Department of the National Institutes of Health , Bethesda , MD , USA. · c Department of Cardiology , Johns Hopkins University School of Medicine , Baltimore , MA , USA. ·Expert Rev Cardiovasc Ther · Pubmed #28657444.

ABSTRACT: INTRODUCTION: Lipid-lowering therapy effectively decreases cardiovascular risk on a population level, but it remains difficult to identify an individual patient's personal risk reduction while following guideline directed medical therapy, leading to overtreatment in some patients and cardiovascular events in others. Recent improvements in cardiac CT technology provide the ability to directly assess an individual's atherosclerotic disease burden, which has the potential to personalize risk assessment for lipid-lowering therapy. Areas covered: We review the current unmet need in identifying patients at elevated residual risk despite guideline directed medical therapy, the evidence behind plaque regression as a potential marker of therapeutic response, and highlight state-of-the-art advances in coronary computed tomographic angiography (CCTA) for measurement of quantitative and qualitative changes in coronary atherosclerosis over time. Literature search was performed using PubMed and Google Scholar for literature relevant to statin therapy and residual risk, coronary plaque regression measurement, and CCTA assessment of quantitative and qualitative change in coronary atherosclerosis. Expert commentary: We discuss the potential ability of CCTA to guide lipid-lowering therapy as a bridge between population and personalized medicine in the future, as well as the potential barriers to its use.

18 Review Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis. 2017

Xie, Jing / Ikram, M Kamran / Cotch, Mary Frances / Klein, Barbara / Varma, Rohit / Shaw, Jonathan E / Klein, Ronald / Mitchell, Paul / Lamoureux, Ecosse L / Wong, Tien Yin. ·Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia. · Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore3Duke-NUS Medical School, National University of Singapore, Singapore. · Division of Epidemiology and Clinical Applications, National Eye Institute, Intramural Research Program, National Institutes of Health, Bethesda, Maryland. · Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison. · Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine at Chicago, Chicago. · Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia. · Centre for Vision Research, Westmead Insitute for Medical Research and University of Sydney, Sydney, New South Wales, Australia. ·JAMA Ophthalmol · Pubmed #28472362.

ABSTRACT: Importance: Previous studies on the relationship between diabetic retinopathy (DR) and cardiovascular disease (CVD) focused on the early stages of DR. Understanding whether patients with type 2 diabetes and severe stages of DR (diabetic macular edema [DME] and proliferative diabetic retinopathy [PDR]) have a higher risk of CVD will allow physicians to more effectively counsel patients. Objective: To examine the association of severe stages of DR (DME and PDR) with incident CVD in patients with type 2 diabetes. Data Sources: English-language publications were reviewed for articles evaluating the relationship of DR and CVD in MEDLINE, EMBASE, Current Contents, and the Cochrane Library from inception (January 1, 1950) to December 31, 2014, using the search terms diabetic retinopathy OR macular edema AND stroke OR cerebrovascular disease OR coronary artery disease OR heart failure OR myocardial infarction OR angina pectoris OR acute coronary syndrome OR coronary artery disease OR cardiomyopathy. Study Selection: Among 656 studies screened for eligibility, 7604 individuals were included from 8 prospective population-based studies with data on photographic-based DR grading, follow-up visits, and well-defined incident CVD end point. Data Extraction and Synthesis: Two independent reviewers conducted a systematic search of the 4 databases, and a single pooled database was developed. Incidence rate ratios (IRRs) were estimated for patients with DME, PDR, and vision-threatening DR, compared with persons without these conditions, by using individual participant data followed by a standard inverse-variance meta-analysis (2-step analysis). The review and analyses were performed from January 1, 2009, to January 1, 2017. Main Outcome and Measures: Incident CVD, including coronary heart disease, stroke, or death from cardiovascular causes. Results: Among 7604 patients with type 2 diabetes, the prevalence of DME was 4.6% and PDR, 7.4%. After a mean follow-up of 5.9 years (range, 3.2-10.1 years), 1203 incident CVD events, including 916 coronary heart disease cases, were reported. Persons with DME or PDR were more likely to have incident CVD (IRR, 1.39; 95% CI, 1.16-1.67) and fatal CVD (IRR, 2.33; 95% CI, 1.49-3.67) compared with those without DME or PDR. Conclusions and Relevance: Patients with type 2 diabetes and DME or PDR have an increased risk of incident CVD, which suggests that these persons should be followed up more closely to prevent CVD.

19 Review Cardiac Applications of PET-MR. 2017

Bergquist, Peter J / Chung, Michael S / Jones, Anja / Ahlman, Mark A / White, Charles S / Jeudy, Jean. ·Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. · Department of Radiology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA. · Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. jjeudy@umm.edu. · University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA. jjeudy@umm.edu. ·Curr Cardiol Rep · Pubmed #28401505.

ABSTRACT: PURPOSE OF REVIEW: The purpose of this study was to provide an overview of the clinical applications of PET-MR in the setting of cardiac imaging with emphasis on specific scenarios where both techniques together provided added information. RECENT FINDINGS: Synergy of cardiac PET and MR fusion may hold similar promise eliminating ionizing radiation and improving tissue contrast. Future development of new hybrid scanners, use of new imaging tracers, and clinical applications are significant factors which will influence its use. Both positron emission tomography (PET) and cardiac magnetic resonance imaging (CMR) provide important anatomic and physiologic information with regard to the heart. Being able to combine the data from these two examinations in a hybrid technique allows for a more complete evaluation of cardiac pathology. While hybrid PET-CT has already established the utility of a combined imaging approach, the use of CMR in lieu of CT allows for elimination of ionizing radiation and for improved tissue contrast.

20 Review Ischemia and No Obstructive Coronary Artery Disease (INOCA): Developing Evidence-Based Therapies and Research Agenda for the Next Decade. 2017

Bairey Merz, C Noel / Pepine, Carl J / Walsh, Mary Norine / Fleg, Jerome L. ·From Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.) · Division of Cardiology, University of Florida, Gainesville (C.J.P.) · St. Vincent Heart Transplant, Indianapolis, IN (M.N.W.) · and National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.). ·Circulation · Pubmed #28289007.

ABSTRACT: The Cardiovascular Disease in Women Committee of the American College of Cardiology, in conjunction with interested parties (from the National Heart, Lung, and Blood Institute, American Heart Association, and European Society of Cardiology), convened a working group to develop a consensus on the syndrome of myocardial ischemia with no obstructive coronary arteries. In general, these patients have elevated risk for a cardiovascular event (including acute coronary syndrome, heart failure hospitalization, stroke, and repeat cardiovascular procedures) compared with reference subjects and appear to be at higher risk for development of heart failure with preserved ejection fraction. A subgroup of these patients also has coronary microvascular dysfunction and evidence of inflammation. This document provides a summary of findings and recommendations for the development of an integrated approach for identifying and managing patients with ischemia with no obstructive coronary arteries and outlines knowledge gaps in the area. Working group members critically reviewed available literature and current practices for risk assessment and state-of-the-science techniques in multiple areas, with a focus on next steps needed to develop evidence-based therapies. This report presents highlights of this working group review and a summary of suggested research directions to advance this field in the next decade.

21 Review CT calcium scoring. History, current status and outlook. 2017

Sandfort, V / Bluemke, D A. ·Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA. · Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA. Electronic address: david.bluemke@nih.gov. ·Diagn Interv Imaging · Pubmed #27423708.

ABSTRACT: Cardiovascular risk assessment has assumed a prominent role in the course of preventive care of all adults. Traditionally cardiovascular risk assessment has been performed using risk factors including gender, age, smoking history, lipid status, diabetes status, and family history. Increasingly, imaging has been deployed to directly detect coronary atherosclerotic disease. Quantification of coronary calcium (e.g., Agatston method, calcium mass and volume) is readily detected using helical CT scanners. Large multicenter cohort studies have enabled a better understanding of the relevance of coronary calcium detection. The purpose of this review is to review the methods for quantification of coronary artery calcium, as well as to present current and future perspectives on calcium scoring for cardiovascular risk stratification.

22 Review Salutary effects of high-intensity interval training in persons with elevated cardiovascular risk. 2016

Fleg, Jerome L. ·Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA. ·F1000Res · Pubmed #27635241.

ABSTRACT: Although moderate-intensity continuous training (MICT) has been the traditional model for aerobic exercise training for over four decades, a growing body of literature has demonstrated equal if not greater improvement in aerobic capacity and similar beneficial effects on body composition, glucose metabolism, blood pressure, and quality of life from high-intensity interval training (HIIT). An advantage of HIIT over MICT is the shorter time required to perform the same amount of energy expenditure. The current brief review summarizes the effects of HIIT on peak aerobic capacity and cardiovascular risk factors in healthy adults and those with various cardiovascular diseases, including coronary artery disease, chronic heart failure, and post heart transplantation.

23 Review Coronary Computed Tomography Angiography in the Evaluation of Chest Pain of Suspected Cardiac Origin. 2016

Bittencourt, Marcio Sommer / Hulten, Edward A / Veeranna, Vikas / Blankstein, Ron. ·From Center for Clinical and Epidemiological Research, University Hospital & São Paulo State Cancer Institute, University of São Paulo School of Medicine, Brazil (M.S.B.);Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.);Cardiology Service, Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.) · andCardiovascular Imaging Program, Departments of Medicine and Radiology · Brigham and Women's Hospital · Harvard Medical School, Boston, MA (V.V., R.B.). ·Circulation · Pubmed #27185023.

ABSTRACT: -- No abstract --

24 Review Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73). 2016

Ramsden, Christopher E / Zamora, Daisy / Majchrzak-Hong, Sharon / Faurot, Keturah R / Broste, Steven K / Frantz, Robert P / Davis, John M / Ringel, Amit / Suchindran, Chirayath M / Hibbeln, Joseph R. ·Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA Chris.Ramsden@nih.gov. · Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA. · Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA. · Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA. · Medtronic, Minneapolis, MN, USA. · Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. · Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA Psychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA. · Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA. ·BMJ · Pubmed #27071971.

ABSTRACT: OBJECTIVE: To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and meta-analysis. DESIGN: The MCE (1968-73) is a double blind randomized controlled trial designed to test whether replacement of saturated fat with vegetable oil rich in linoleic acid reduces coronary heart disease and death by lowering serum cholesterol. Recovered MCE unpublished documents and raw data were analyzed according to hypotheses prespecified by original investigators. Further, a systematic review and meta-analyses of randomized controlled trials that lowered serum cholesterol by providing vegetable oil rich in linoleic acid in place of saturated fat without confounding by concomitant interventions was conducted. SETTING: One nursing home and six state mental hospitals in Minnesota, United States. PARTICIPANTS: Unpublished documents with completed analyses for the randomized cohort of 9423 women and men aged 20-97; longitudinal data on serum cholesterol for the 2355 participants exposed to the study diets for a year or more; 149 completed autopsy files. INTERVENTIONS: Serum cholesterol lowering diet that replaced saturated fat with linoleic acid (from corn oil and corn oil polyunsaturated margarine). Control diet was high in saturated fat from animal fats, common margarines, and shortenings. MAIN OUTCOME MEASURES: Death from all causes; association between changes in serum cholesterol and death; and coronary atherosclerosis and myocardial infarcts detected at autopsy. RESULTS: The intervention group had significant reduction in serum cholesterol compared with controls (mean change from baseline -13.8%v-1.0%; P<0.001). Kaplan Meier graphs showed no mortality benefit for the intervention group in the full randomized cohort or for any prespecified subgroup. There was a 22% higher risk of death for each 30 mg/dL (0.78 mmol/L) reduction in serum cholesterol in covariate adjusted Cox regression models (hazard ratio 1.22, 95% confidence interval 1.14 to 1.32; P<0.001). There was no evidence of benefit in the intervention group for coronary atherosclerosis or myocardial infarcts. Systematic review identified five randomized controlled trials for inclusion (n=10,808). In meta-analyses, these cholesterol lowering interventions showed no evidence of benefit on mortality from coronary heart disease (1.13, 0.83 to 1.54) or all cause mortality (1.07, 0.90 to 1.27). CONCLUSIONS: Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes. Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.

25 Review Low Radiation Dose Calcium Scoring: Evidence and Techniques. 2016

Baron, Kaitlin B / Choi, Andrew D / Chen, Marcus Y. ·Division of Cardiology, The George Washington University School of Medicine, Washington, DC USA. · Division of Cardiology, The George Washington University School of Medicine, Washington, DC USA ; Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10, B1D416, Bethesda, MD 20891-1061 USA. · Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10, B1D416, Bethesda, MD 20891-1061 USA. ·Curr Cardiovasc Imaging Rep · Pubmed #27057268.

ABSTRACT: Coronary computed tomography (CT) allows for the acquisition of thin slices of the heart and coronary arteries, which can be used to detect and quantify coronary artery calcium (CAC), a marker of atherosclerotic cardiovascular disease. Despite the proven clinical value in cardiac risk prognostication, there remain concerns regarding radiation exposure from CAC CT scans. There have been several recent technical advancements that allow for significant radiation dose reduction in CAC scoring. This paper reviews the clinical utility and recent literature in low radiation dose CAC scoring.

Next