19 results on '"Bittner, Daniel O."'
Search Results
2. Coronary Atherosclerosis, Cardiac Troponin, and Interleukin-6 in Patients With Chest Pain: The PROMISE Trial Results.
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Ferencik, Maros, Mayrhofer, Thomas, Lu, Michael T., Bittner, Daniel O., Emami, Hamed, Puchner, Stefan B., Meyersohn, Nandini M., Ivanov, Alexander V., Adami, Elizabeth C., Voora, Deepak, Ginsburg, Geoffrey S., Januzzi, James L., Douglas, Pamela S., and Hoffmann, Udo
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Increased inflammation and myocardial injury can be observed in the absence of myocardial infarction or obstructive coronary artery disease (CAD). The authors determined whether biomarkers of inflammation and myocardial injury—interleukin (IL)-6 and high-sensitivity cardiac troponin (hs-cTn)—were associated with the presence and extent of CAD and were independent predictors of major adverse cardiovascular events (MACEs) in stable chest pain. Using participants from the PROMISE trial, the authors measured hs-cTn I and IL-6 concentrations and analyzed computed tomography angiography (CTA) images in the core laboratory for CAD characteristics: significant stenosis (≥70%), high-risk plaque (HRP), Coronary Artery Disease Reporting and Data System (CAD-RADS) categories, segment involvement score (SIS), and coronary artery calcium (CAC) score. The primary endpoint was a composite MACE (death, myocardial infarction, or unstable angina). The authors included 1,796 participants (age 60.2 ± 8.0 years; 47.5% men, median follow-up 25 months). In multivariable linear regression adjusted for atherosclerotic cardiovascular disease (ASCVD) risk, hs-cTn was associated with HRP, stenosis, CAD-RADS, and SIS. IL-6 was only associated with stenosis and CAD-RADS. hs-cTn above median (1.5 ng/L) was associated with MACEs in univariable analysis (HR: 2.1 [95% CI: 1.3-3.6]; P = 0.006), but not in multivariable analysis adjusted for ASCVD and CAD. IL-6 above median (1.8 ng/L) was associated with MACEs in multivariable analysis adjusted for ASCVD and HRP (HR: 1.9 [95% CI: 1.1-3.3]; P = 0.03), CAC (HR: 1.9 [95% CI: 1.0-3.4]; P = 0.04), and SIS (HR: 1.8 [95% CI: 1.0-3.2]; P = 0.04), but not for stenosis or CAD-RADS. In participants with nonobstructive CAD (stenosis 1%-69%), the presence of both hs-cTn and IL-6 above median was strongly associated with MACEs (HR: 2.5-2.7 after adjustment for CAD characteristics). Concentrations of hs-cTn and IL-6 were associated with CAD characteristics and MACEs, indicating that myocardial injury and inflammation may each contribute to pathways in CAD pathophysiology. This association was most pronounced among participants with nonobstructive CAD representing an opportunity to tailor treatment in this at-risk group. (PROspective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550) [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2022
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3. Risk Stratification With the Use of Coronary Computed Tomographic Angiography in Patients With Nonobstructive Coronary Artery Disease.
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Taron, Jana, Foldyna, Borek, Mayrhofer, Thomas, Osborne, Michael T., Meyersohn, Nandini, Bittner, Daniel O., Puchner, Stefan B., Emami, Hamed, Lu, Michael T., Ferencik, Maros, Pagidipati, Neha J., Douglas, Pamela S., and Hoffmann, Udo
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The purpose of this study was to develop a risk prediction model for patients with nonobstructive CAD. Among stable chest pain patients, most cardiovascular (CV) events occur in those with nonobstructive coronary artery disease (CAD). Thus, developing tailored risk prediction approaches in this group of patients, including CV risk factors and CAD characteristics, is needed. In PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) computed tomographic angiography patients, a core laboratory assessed prevalence of CAD (nonobstructive 1% to 49% left main or 1% to 69% stenosis any coronary artery), degree of stenosis (minimal: 1% to 29%; mild: 30% to 49%; or moderate: 50% to 69%), high-risk plaque (HRP) features (positive remodeling, low-attenuation plaque, and napkin-ring sign), segment involvement score (SIS), and coronary artery calcium (CAC). The primary end point was an adjudicated composite of unstable angina pectoris, nonfatal myocardial infarction, and death. Cox regression analysis determined independent predictors in nonobstructive CAD. Of 2,890 patients (age 61.7 years, 46% women) with any CAD, 90.4% (n = 2,614) had nonobstructive CAD (mean age 61.6 yrs, 46% women, atherosclerotic cardiovascular disease [ASCVD] risk 16.2%). Composite events were independently predicted by ASCVD risk (hazard ratio [HR]: 1.03; p = 0.001), degree of stenosis (30% to 69%; HR: 1.91; p = 0.011), and presence of ≥2 HRP features (HR: 2.40; p = 0.008). Addition of ≥2 HRP features to: 1) ASCVD and CAC; 2) ASCVD and SIS; or 3) ASCVD and degree of stenosis resulted in a statistically significant improvement in model fit (p = 0.0036; p = 0.0176; and p = 0.0318; respectively). Patients with ASCVD ≥7.5%, any HRP, and mild/moderate stenosis had significantly higher event rates than those who did not meet those criteria (3.0% vs. 6.2%; p = 0.007). Advanced coronary plaque features have incremental value over total plaque burden for the discrimination of clinical events in low-risk stable chest pain patients with nonobstructive CAD. This may be a first step to improve prevention in this cohort with the highest absolute risk for CV events. [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2021
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4. Pericoronary adipose tissue CT attenuation and its association with serum levels of atherosclerosis-relevant inflammatory mediators, coronary calcification and major adverse cardiac events.
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Goeller, Markus, Achenbach, Stephan, Herrmann, Nicolai, Bittner, Daniel O., Kilian, Tobias, Dey, Damini, Raaz-Schrauder, Dorette, and Marwan, Mohamed
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Increased attenuation of pericoronary adipose tissue (PCAT) around the right coronary artery (RCA) derived from coronary CTA might detect coronary inflammation. We investigated a potential association between RCA PCAT attenuation and serum levels of atherosclerosis-relevant cytokines and MACE (coronary revascularization, myocardial infarction and/or cardiac death). Blood samples of 293 clinically stable individuals (59.0 ± 9.8 years, 69% males) were analyzed for atherosclerosis-relevant cytokines including interleukin (IL)-2, IL- 4, IL-6, IL-7, IL-8, IL-10, IL-13, IL-15, IL-17, TNF-a, IP-10, CRP, MCP-1, MIP-1a, Eotaxin and GM-CSF. Subjects also underwent coronary calcium scoring (CCS) followed by CTA. PCAT CT attenuation was measured around the RCA using semi-automated software. Increased RCA PCAT attenuation was defined as PCAT attenuation above the 75th percentile (>−73.5 HU). To assess MACE, 232 individuals were followed for a mean duration of 9.6 ± 2.1 years. In patients with increased RCA PCAT attenuation the serum levels of MCP-1 were increased (p < 0.01), whereas levels of anti-inflammatory mediators IL-4 and -13 were significantly reduced (each p < 0.05). Adipocytokine MCP-1 (r = 0.23, p < 0.01) and pro-inflammatory mediator IL-7 (r = 0.12, p = 0.04) showed a mild positive correlation with RCA PCAT attenuation, whereas anti-inflammatory mediators Il-4, -10 and -13 correlated inversely (each r < −0.12, each p < 0.05). 40/232 patients experienced MACE during follow-up. In multivariable Cox regression analysis increased RCA PCAT attenuation was shown to be an independent predictor of MACE (HR 2.01, p = 0.044). Increased RCA PCAT CT attenuation shows a weak association with serum levels of selected atherosclerosis-relevant inflammatory biomarkers. Increased RCA PCAT attenuation is an independent predictor of MACE and may potentially guide future prevention strategies in stable patients. [ABSTRACT FROM AUTHOR]
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- 2021
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5. Differences in Cardiovascular Risk, Coronary Artery Disease, and Cardiac Events Between Black and White Individuals Enrolled in the PROMISE Trial
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Zhang, Lili, Olalere, Devvora, Mayrhofer, Thomas, Bittner, Daniel O., Emami, Hamed, Meyersohn, Nina M., Puchner, Stefan B., Abidov, Aiden, Moloo, Jamaluddin, Dolor, Rowena J., Mark, Daniel B., Ferencik, Maros, Hoffmann, Udo, Douglas, Pamela S., and Lu, Michael T.
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IMPORTANCE: Race and ethnicity have been studied as risk factors in cardiovascular disease. How risk factors, epicardial coronary artery disease, and cardiac events differ between Black and White individuals undergoing noninvasive testing for coronary artery disease is not known. OBJECTIVE: To assess differences in cardiovascular risk burden, coronary plaque, and major adverse cardiac events between Black and White individuals assigned to receive coronary computed tomography angiography (CCTA) or functional testing for stable chest pain. DESIGN, SETTING, AND PARTICIPANTS: A nested observational cohort study within the PROMISE trial was conducted at 193 outpatient sites in North America. A total of 1071 non-Hispanic Black (hereafter Black) and 7693 non-Hispanic White (hereafter White) participants with stable chest pain undergoing noninvasive cardiovascular testing were included. This analysis was conducted from February 13, 2015, to November 2, 2021. MAIN OUTCOMES AND MEASURES: The primary end point was the composite of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 24.4 months. RESULTS: Among 1071 Black individuals (12.2%) (women, 646 [60.3%]; mean [SD] age, 59 [8] years) and 7693 White individuals (87.8%) (women, 4029 [52.4%]; mean [SD] age, 61.1 [8.4] years), Black participants had a higher cardiovascular risk burden (more hypertension and diabetes), yet there was a similarly low major adverse cardiovascular events rate over a median 2-year follow-up (32 [3.0%] vs 243 [3.2%]; P = .84). Sensitivity analyses restricted to the 79.8% (6993 of 8764) individuals with a normal or mildly abnormal noninvasive testing result and the 54.3% (4559 of 8396) not receiving statin therapy yielded similar findings. In comparison of Black and White individuals in the CCTA group (n = 3323), significant coronary stenosis (hazard ratio [HR], 7.21; 95% CI, 1.94-26.76 vs HR, 4.30; 95% CI, 2.62-7.04) and high-risk plaque (HR, 3.47; 95% CI, 1.00-12.06 vs HR, 2.21; 95% CI, 1.37-3.57) were associated with major adverse cardiovascular events in both Black and White patients. However, with respect to epicardial coronary artery disease burden, Black individuals had a less-prevalent coronary artery calcium score greater than 0 (45.1% vs 63.2%; P < .001), coronary stenosis greater than or equal to 50% (32 [8.7%] vs 430 [14.6%]; P = .001), and high-risk plaque (139 [37.6%] vs 1547 [52.4%]; P < .001). CONCLUSIONS AND RELEVANCE: The findings of this study suggest that, despite a greater cardiovascular risk burden in Black persons, rates of coronary artery calcium, stenosis, and high-risk plaque observed via CCTA were lower in Black persons than White persons. This result suggests differences in cardiovascular risk burden and coronary plaque in Black and White individuals with stable chest pain.
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- 2022
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6. Lipoprotein subclasses are associated with Hepatic steatosis: insights from the prospective multicenter imaging study for the evaluation of chest pain (PROMISE) clinical trial
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Karady, Julia, McGarrah, Robert W, Nguyen, Maggie, Giamberardino, Stephanie N, Meyersohn, Nandini, Lu, Michael T, Staziaki, Pedro V, Puchner, Stefan B, Bittner, Daniel O, Foldyna, Borek, Mayrhofer, Thomas, Connelly, Margery A, Tchernof, Andre, White, Phillip J, Nasir, Khurram, Corey, Kathleen, Voora, Deepak, Pagidipati, Neha, Ginsburg, Geoffrey S, Kraus, William E, Hoffmann, Udo, Douglas, Pamela S, Shah, Svati H, and Ferencik, Maros
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•The nr1 cause of morbidity and mortality in hepatic steatosis (HS) is CV disease.•Clinically, HS is associated with dyslipidemia and coronary artery disease (CAD).•Lipoprotein particle number/size are associated with CAD and CV events.•We analyzed the association lipoprotein particle size/number and HS on CT/biopsy.•Large TRL, mean sizes of TRL-, and HDL were associated with HS on CT/biopsy.•The use of lipoprotein subclasses may improve CV risk assessment in patients with HS.
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- 2024
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7. Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE.
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Bittner, Daniel O., Mayrhofer, Thomas, Budoff, Matt, Szilveszter, Balint, Foldyna, Borek, Hallett, Travis R., Ivanov, Alexander, Janjua, Sumbal, Meyersohn, Nandini M., Staziaki, Pedro V., Achenbach, Stephan, Ferencik, Maros, Douglas, Pamela S., Hoffmann, Udo, and Lu, Michael T.
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The purpose of this study was to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) to traditional stenosis categories and the coronary artery calcium score (CACS) for predicting cardiovascular events in patients with stable chest pain and suspected coronary artery disease (CAD). The 2016 CAD-RADS has been established to standardize the reporting of CAD on coronary CT angiography (CTA). PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial participants' CTAs were assessed by a central CT core laboratory for CACS, traditional stenosis-based categories, and modified CAD-RADS grade including high-risk coronary plaque (HRP) features. Traditional stenosis categories and CAD-RADS grade were compared for the prediction of the composite endpoint of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 25 months. Incremental prognostic value over traditional risk factors and CACS was assessed. In 3,840 eligible patients (mean age: 60.4 ± 8.2 years; 49% men), 3.0% (115) experienced events. CAD-RADS (concordance statistic [C-statistic] 0.747) had significantly higher discriminatory value than traditional stenosis-based assessments (C-statistic 0.698 to 0.717; all p for comparison ≤0.001). With no plaque (CAD-RADS 0) as the baseline, the hazard ratio (HR) for an event increased from 2.43 (95% confidence interval [CI]: 1.16 to 5.08) for CAD-RADS 1 to 21.84 (95% CI: 8.63 to 55.26) for CAD-RADS 4b and 5. In stepwise nested models, CAD-RADS added incremental prognostic value beyond ASCVD risk score and CACS (C-statistic 0.776 vs. 0.682; p < 0.001), and added incremental value persisted in all CACS strata. These data from a large representative contemporary cohort of patients undergoing coronary CTA for stable chest pain support the prognostic value of CAD-RADS as a standard reporting system for coronary CTA. [ABSTRACT FROM AUTHOR]
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- 2020
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8. Epicardial Adipose Tissue in Patients With Stable Chest Pain: Insights From the PROMISE Trial.
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Foldyna, Borek, Zeleznik, Roman, Eslami, Parastou, Mayrhofer, Thomas, Ferencik, Maros, Bittner, Daniel O., Meyersohn, Nandini M., Puchner, Stefan B., Emami, Hamed, Aerts, Hugo J.W.L., Douglas, Pamela S., Lu, Michael T., and Hoffmann, Udo
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- 2020
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9. Left Ventricular Intramyocardial Fat Detected on Cardiac Computed Tomography in Patients With Stable Chest Pain.
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Karády, Júlia, Mayrhofer, Thomas, Foldyna, Borek, Ivanov, Alexander, Kikuchi, Yasuka, Ferencik, Maros, Lu, Michael T., Puchner, Stefan B., Emami, Hamed, Meyersohn, Nandini M., Bittner, Daniel O., Maurovich-Horvat, Pál, Douglas, Pamela S., and Hoffmann, Udo
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- 2020
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10. Influence of Cardiovascular Risk Factors on the Prevalence of Coronary Atherosclerosis in Patients with Angiographically Normal Coronary Arteries.
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Bittner, Daniel O., Klinghammer, Lutz, Marwan, Mohamed, Schmid, Jasmin, Layritz, Christian, Hoffmann, Udo, Achenbach, Stephan, and Pflederer, Tobias
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Rationale and Objectives: Cardiovascular (CV) disease is predominately influenced by CV risk factors and coronary computed tomography angiography (CTA) is capable of detecting early-stage coronary artery disease. We sought to determine the influence of CV risk factors on the prevalence of nonobstructive atherosclerosis in patients with normal-appearing coronary arteries in invasive coronary angiography (ICA).Materials and Methods: In this retrospective analysis, we included 60 consecutive symptomatic patients, having undergone ICA and coronary CTA. Coronary dual source CTA was performed using electrocardiogram-triggered retrospective gated image acquisition at 40%-70% of RR interval (tube voltage 100-120 kV, tube current time product 320-440 mAs, 60 mL contrast, and flow rate 6 mL/s).Results: Out of 60 patients (32 men, mean age 61 ± 11 years) with a normal coronary artery appearance in ICA, 45 (75%) patients showed atherosclerotic plaque in CTA. Plaque was present in 14 of 60 (23%) left main, 41 of 60 (68%) left anterior descending, 21 of 60 (35%) circumflex coronary arteries, and 24 of 60 (40%) right coronary arteries. More than 15% of all coronary artery segments showed detectable plaques. Interobserver agreement ranged from good to very good on a per-patient, per-vessel, and per-segment level. Patients with presence of plaque were significantly older (P = 0.005) and showed higher incidence of arterial hypertension (P = 0.019) as compared to individuals without coronary plaque in dual source computed tomography.Conclusions: The prevalence of coronary atherosclerosis by CTA is substantial in symptomatic patients with normal invasive coronary angiogram. Hypertension and older age significantly influence the prevalence of atherosclerotic plaque and highlight the importance of risk-modifying therapy. [ABSTRACT FROM AUTHOR]- Published
- 2017
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11. Impact of Coronary Calcification on Clinical Management in Patients With Acute Chest Pain.
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Bittner, Daniel O., Mayrhofer, Thomas, Bamberg, Fabian, Hallett, Travis R., Janjua, Sumbal, Addison, Daniel, Nagurney, John T., Udelson, James E., Lu, Michael T., Truong, Quynh A., Woodard, Pamela K., Hollander, Judd E., Miller, Chadwick, Chang, Anna Marie, Singh, Harjit, Litt, Harold, Hoffmann, Udo, and Ferencik, Maros
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Background—Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS).Methods and Results—This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network–Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients. In the CTA arms, we investigated appropriateness of downstream testing, cost, and diagnostic yield to identify patients with obstructive coronary artery disease on subsequent invasive coronary angiography across CAC score strata (Agatston score: 0, >0–10, >10–100, >100–400, >400). Out of 1234 patients (mean age 51±8.8 years), 80 (6.5%) had obstructive coronary artery disease (≥70% stenosis) and 68 (5.5%) had ACS. Prevalence of obstructive coronary artery disease (1%–64%), ACS (1%–44%), downstream testing (4%–72%), and total (2337–8484 US$) and diagnostic cost (2310–6678 US$) increased across CAC strata (P<0.001). As the increase in testing and cost were lower than the increase of ACS rate in patients with CAC>400, cost to diagnose one ACS was lowest in this group (19 283 US$ versus 464 399 US$) as compared with patients without CAC. The diagnostic yield of invasive coronary angiography was highest in patients with CAC>400 (87% versus 38%).Conclusions—Downstream testing, total, and diagnostic cost increased with increasing CAC, but were found to be appropriate because obstructive coronary artery disease and ACS were more prevalent in patients with high CAC. In patients with acute chest pain undergoing coronary CTA, cost-efficient testing and excellent diagnostic yield can be achieved even with high CAC burden. [ABSTRACT FROM AUTHOR]
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- 2017
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12. Perivascular Epicardial Fat Stranding at Coronary CT Angiography: A Marker of Acute Plaque Rupture and Spontaneous Coronary Artery Dissection
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Hedgire, Sandeep, Baliyan, Vinit, Zucker, Evan J., Bittner, Daniel O., Staziaki, Pedro V., Takx, Richard A. P., Scholtz, Jan-Erik, Meyersohn, Nandini, Hoffmann, Udo, and Ghoshhajra, Brian
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Our study describes perivascular epicardial fat stranding, which has the potential to improve the detection of higher-risk patients with coronary atherosclerosis or can act as a marker of a non-atherosclerotic cause of stenosis (ie, spontaneous coronary artery dissection [SCAD]). Perivascular fat stranding was seen in 5% of low-to-intermediate pretest risk patients found to have moderate or higher degrees of stenosis (Coronary Artery Disease Reporting and Data System [CAD-RADS] 3–5) and was seen less commonly along with the classic high-risk plaque features (vulnerable plaque, CAD-RADS modifier V). Recognition of perivascular fat stranding may be helpful in identifying culprit lesion, SCAD, and patients at elevated risk for acute coronary syndrome.
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- 2018
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13. Central Core Laboratory versus Site Interpretation of Coronary CT Angiography: Agreement and Association with Cardiovascular Events in the PROMISE Trial
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Lu, Michael T., Meyersohn, Nandini M., Mayrhofer, Thomas, Bittner, Daniel O., Emami, Hamed, Puchner, Stefan B., Foldyna, Borek, Mueller, Martin E., Hearne, Steven, Yang, Clifford, Achenbach, Stephan, Truong, Quynh A., Ghoshhajra, Brian B., Patel, Manesh R., Ferencik, Maros, Douglas, Pamela S., and Hoffmann, Udo
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Core laboratory interpretation classified 41% fewer patients as having significant coronary artery disease compared with site interpretation.
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- 2018
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14. Use of High-Risk Coronary Atherosclerotic Plaque Detection for Risk Stratification of Patients With Stable Chest Pain: A Secondary Analysis of the PROMISE Randomized Clinical Trial
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Ferencik, Maros, Mayrhofer, Thomas, Bittner, Daniel O., Emami, Hamed, Puchner, Stefan B., Lu, Michael T., Meyersohn, Nandini M., Ivanov, Alexander V., Adami, Elizabeth C., Patel, Manesh R., Mark, Daniel B., Udelson, James E., Lee, Kerry L., Douglas, Pamela S., and Hoffmann, Udo
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IMPORTANCE: Coronary computed tomographic angiography (coronary CTA) can characterize coronary artery disease, including high-risk plaque. A noninvasive method of identifying high-risk plaque before major adverse cardiovascular events (MACE) could provide practice-changing optimizations in coronary artery disease care. OBJECTIVE: To determine whether high-risk plaque detected by coronary CTA was associated with incident MACE independently of significant stenosis (SS) and cardiovascular risk factors. DESIGN, SETTING, AND PARTICIPANTS: This prespecified nested observational cohort study was part of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial. All stable, symptomatic outpatients in this trial who required noninvasive cardiovascular testing and received coronary CTA were included and followed up for a median of 25 months. EXPOSURES: Core laboratory assessment of coronary CTA for SS and high-risk plaque (eg, positive remodeling, low computed tomographic attenuation, or napkin-ring sign). MAIN OUTCOMES AND MEASURES: The primary end point was an adjudicated composite of MACE (defined as death, myocardial infarction, or unstable angina). RESULTS: The study included 4415 patients, of whom 2296 (52%) were women, with a mean age of 60.5 years, a median atherosclerotic cardiovascular disease (ASCVD) risk score of 11, and a MACE rate of 3% (131 events). A total of 676 patients (15.3%) had high-risk plaques, and 276 (6.3%) had SS. The presence of high-risk plaque was associated with a higher MACE rate (6.4% vs 2.4%; hazard ratio, 2.73; 95% CI, 1.89-3.93). This association persisted after adjustment for ASCVD risk score and SS (adjusted hazard ratio [aHR], 1.72; 95% CI, 1.13-2.62). Adding high-risk plaque to the ASCVD risk score and SS assessment led to a significant continuous net reclassification improvement (0.34; 95% CI, 0.02-0.51). Presence of high-risk plaque increased MACE risk among patients with nonobstructive coronary artery disease relative to patients without high-risk plaque (aHR, 4.31 vs 2.64; 95% CI, 2.25-8.26 vs 1.49-4.69). There were no significant differences in MACE in patients with SS and high-risk plaque as opposed to those with SS but not high-risk plaque (aHR, 8.68 vs. 9.31; 95% CI, 4.25-17.73 vs 4.21-20.61). High-risk plaque was a stronger predictor of MACE in women (aHR, 2.41; 95% CI, 1.25-4.64) vs men (aHR, 1.40; 95% CI, 0.81-2.39) and younger patients (aHR, 2.33; 95% CI, 1.20-4.51) vs older ones (aHR, 1.36; 95% CI, 0.77-2.39). CONCLUSIONS AND RELEVANCE: High-risk plaque found by coronary CTA was associated with a future MACE in a large US population of outpatients with stable chest pain. High-risk plaque may be an additional risk stratification tool, especially in patients with nonobstructive coronary artery disease, younger patients, and women. The importance of findings is limited by low absolute MACE rates and low positive predictive value of high-risk plaque. TRIAL REGISTRATION: clinicaltrials.gov Indentifier: NCT01174550
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- 2018
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15. Diagnostic Performance of Coronary CTA in Intermediate-to-High-Risk Patients for Suspected Acute Coronary Syndrome: Results From an Emergency Department Registry.
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Scholtz, Jan-Erik, Addison, Daniel, Bittner, Daniel O., Janjua, Sumbal, Foldyna, Borek, Hedgire, Sandeep, Staziaki, Pedro V., Januzzi, James L., Nagurney, John T., Meyersohn, Nina, Lu, Michael T., Neilan, Tomas G., Hoffmann, Udo, and Ghoshhajra, Brian B.
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- 2018
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16. Association of Hepatic Steatosis With Major Adverse Cardiovascular Events, Independent of Coronary Artery Disease.
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Meyersohn, Nandini M., Mayrhofer, Thomas, Corey, Kathleen E., Bittner, Daniel O., Staziaki, Pedro V., Szilveszter, Balint, Hallett, Travis, Lu, Michael T., Puchner, Stefan B., Simon, Tracey G., Foldyna, Borek, Voora, Deepak, Ginsburg, Geoffrey S., Douglas, Pamela S., Hoffmann, Udo, and Ferencik, Maros
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Hepatic steatosis has been associated with increased risk of major adverse cardiovascular events (MACE) but it is not clear whether steatosis is independently associated with risk of MACE. We investigated whether steatosis is associated with risk of MACE independently of the presence and extent of baseline coronary artery disease, assessed by comprehensive contrast-enhanced computed tomography angiography (CTA). We conducted a nested cohort study of 3756 subjects (mean age, 60.6 years; 48.4% men) who underwent coronary CTA at 193 sites in North America, from July 2010 through September 2013, as part of the PROMISE study, which included noninvasive cardiovascular analyses of symptomatic outpatients without coronary artery disease. Independent core laboratory readers measured hepatic and splenic attenuation, using non-contrast computed tomography images to identify steatosis, and evaluated coronary plaques and stenosis in coronary CTA images. We collected data on participants' cardiovascular risk factors, presence of metabolic syndrome, and body mass index. The primary endpoint was an adjudicated composite of MACE (death, myocardial infarction, or unstable angina) during a median follow-up time of 25 months. Among the 959 subjects who had steatosis (25.5% of the cohort), 42 had MACE (4.4%), whereas among the 2797 subjects without steatosis, 73 had MACE (2.6%) (hazard ratio [HR] for MACE in subjects with steatosis, 1.69; 95% CI, 1.16–2.48; P =.006 for MACE in subjects with vs without steatosis). This association remained after adjustment for atherosclerotic cardiovascular disease risk scores, significant stenosis, and metabolic syndrome (adjusted HR, 1.72; 95% CI, 1.16–2.54; P =.007) or obesity (adjusted HR, 1.75; 95% CI, 1.19–2.59; P =.005). Steatosis remained independently associated with MACE after adjustment for all CTA measures of plaques and stenosis. Hepatic steatosis is associated with MACE independently of other cardiovascular risk factors or extent of coronary artery disease. Strategies to reduce steatosis might reduce risk of MACE. ClinicalTrials.gov no: NCT01174550 [ABSTRACT FROM AUTHOR]
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- 2021
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17. Coronary Computed Tomography Angiography–Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome: Results From the ROMICAT II Trial.
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Bittner, Daniel O., Mayrhofer, Thomas, Puchner, Stefan B., Lu, Michael T., Maurovich-Horvat, Pal, Ghemigian, Khristine, Kitslaar, Pieter H., Broersen, Alexander, Bamberg, Fabian, Truong, Quynh A., Schlett, Christopher L., Hoffmann, Udo, and Ferencik, Maros
- Abstract
Supplemental Digital Content is available in the text. Background: High-risk plaque (HRP) features as detected by coronary computed tomography angiography (CTA) predict acute coronary syndrome (ACS). We sought to determine whether coronary CTA-specific definitions of HRP improve discrimination of patients with ACS as compared with definitions from intravascular ultrasound (IVUS). Methods and Results: In patients with suspected ACS, randomized to coronary CTA in the ROMICAT II (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography II) trial, we retrospectively performed semiautomated quantitative analysis of HRP (including remodeling index, plaque burden as derived by plaque area, low computed tomography attenuation plaque volume) and degree of luminal stenosis and analyzed the performance of traditional IVUS thresholds to detect ACS. Furthermore, we derived CTA-specific thresholds in patients with ACS to detect culprit lesions and applied those to all patients to calculate the discriminatory ability to detect ACS in comparison to IVUS thresholds. Of 472 patients, 255 patients (56±7.8 years; 63% men) had coronary plaque. In 32 patients (6.8%) with ACS, culprit plaques (n=35) differed from nonculprit plaques (n=172) with significantly greater values for all HRP features except minimal luminal area (significantly lower; all P <0.01). IVUS definitions showed good performance while minimal luminal area (odds ratio: 6.82; P =0.014) and plaque burden (odds ratio: 5.71; P =0.008) were independently associated with ACS but not remodeling index (odds ratio: 0.78; P =0.673). Optimized CTA-specific thresholds for plaque burden (area under the curve: 0.832 versus 0.676) and degree of stenosis (area under the curve: 0.826 versus 0.721) showed significantly higher diagnostic performance for ACS as compared with IVUS-based thresholds (all P <0.05) with borderline significance for minimal luminal area (area under the curve: 0.817 versus 0.742; P =0.066). Conclusions: CTA-specific definitions of HRP features may improve the discrimination of patients with ACS as compared with IVUS-based definitions. CLINICAL TRIAL REGISTRATION: URL:
https://www.clinicaltrials.gov . Unique identifier: NCT01084239 [ABSTRACT FROM AUTHOR]- Published
- 2018
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18. Coronary Computed Tomography Angiography–Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome
- Author
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Bittner, Daniel O., Mayrhofer, Thomas, Puchner, Stefan B., Lu, Michael T., Maurovich-Horvat, Pal, Ghemigian, Khristine, Kitslaar, Pieter H., Broersen, Alexander, Bamberg, Fabian, Truong, Quynh A., Schlett, Christopher L., Hoffmann, Udo, and Ferencik, Maros
- Abstract
Supplemental Digital Content is available in the text.
- Published
- 2018
- Full Text
- View/download PDF
19. Impact of Coronary Calcification on Clinical Management in Patients With Acute Chest Pain
- Author
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Bittner, Daniel O., Mayrhofer, Thomas, Bamberg, Fabian, Hallett, Travis R., Janjua, Sumbal, Addison, Daniel, Nagurney, John T., Udelson, James E., Lu, Michael T., Truong, Quynh A., Woodard, Pamela K., Hollander, Judd E., Miller, Chadwick, Chang, Anna Marie, Singh, Harjit, Litt, Harold, Hoffmann, Udo, and Ferencik, Maros
- Abstract
Supplemental Digital Content is available in the text.
- Published
- 2017
- Full Text
- View/download PDF
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