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3. Efficacy and safety of aldosterone synthase inhibition with and without empagliflozin for chronic kidney disease: a randomised, controlled, phase 2 trial

Author

Tuttle, Katherine R, Hauske, Sibylle J, Canziani, Maria Eugenia, Caramori, Maria Luiza, Cherney, David, Cronin, Lisa, Heerspink, Hiddo J L, Hugo, Christian, Nangaku, Masaomi, Rotter, Ricardo Correa, Silva, Arnold, Shah, Shimoli V, Sun, Zhichao, Urbach, Dorothea, de Zeeuw, Dick, Rossing, Peter, Tuttle, Katherine R, Hauske, Sibylle J, Canziani, Maria Eugenia, Caramori, Maria Luiza, Cherney, David, Cronin, Lisa, Heerspink, Hiddo J L, Hugo, Christian, Nangaku, Masaomi, Rotter, Ricardo Correa, Silva, Arnold, Shah, Shimoli V, Sun, Zhichao, Urbach, Dorothea, de Zeeuw, Dick, Rossing, Peter, SZETO, Cheuk Chun, Echeverri, Diego, Martin, Edouard, Yee, Ming Li, Wah, William, Wang, Ray, Chacko, Bobby, Swaminathan, Shriram, MacIsaac, Richard, Hashimura, Hikaru, Ward, Glenn, De Vusser, Katrien, Claes, Kathleen, Kuypers, Dirk, Meijers, Björn, Van Craenenbroeck, Amaryllis, Hilbrands, Robert, Debroye, Corinne, Wissing, Karl Martin, Jadoul, Michel, Demoulin, Nathalie, Treille De Grandsaigne, Serge, Beklevic, Ishak, Marcoux, Diane, Liénart, Fabienne, Daper, Claude, De Brouckere, Véronique, Heureux, Mercédès, Felicio, Joao, Felicio, Karem Mileo, Leite, Daniella, Melo, Franciane, Queiroz, Natercia, Souza, Ana Carolina, Vieira, Jocyelle, Franco, Roberto, Mendes, Adriana, Picolli, Giovana, Canani, Luis Henrique, Sartori, Carla, Valenti, Adriana, Eliaschewitz, Freddy, Bona, Renata, Franco, Denise, Ludovico Costa de Castro, Denise, Magalhaes, Vanessa, Oliveira, Marcelo, Sampaio, Célia Regina, Visconti, Guilherme, Halpern, Bruno, Nihei, Camila, Pessoa, Bruna, Seraphim, Carlos, Santos, Daniel, Brito, Claudia, Douverny, Joao, Colella, Marina, Gazeta, Cristina, Vercia, Monique, Watanabe, Renato, Temelkova, Theodora, Kjurkchiev, Dimo, Statkova, Silviya, Popov, Iliya, Radeva, Radosveta, Arabadzhiev, Lachezar, Binova, Mariya, Bosilkov, Aleksandar, Koleva-Stoicheva, Neli, Ivanov, Ivaylo, Ivanova, Zornitsa, Kotseva, Viktoria, Spasov, Petar, Tsvetkov, Ivaylo, Jolly, Shivinder, Bailey, Gordon, Ye, Zhiming, Niu, Jianying, Li, Hongmei, Wu, Qing, Liao, Bing, Hao, Chuanming, Lai, Lingyun, Xu, Yunyu, Zhang, Min, Li, Yiwen, Liu, Bo, Shao, Lina, Chen, Wei, Wu, Haishan, Pirchala, Marian, Skarpova, Iva, Hraskova, Marketa, Soukupova, Simoneta, Veberova, Lucie, Drasnar, Tomas, Falc, Matej, Racz, Blazej, Votocek, Stepan, Weissova, Danica, Syc-Krivanova, Lenka, Slezak, Dagmar, Kantola, Ilkka, Nieminen, Sakari, Anttonen, Milla, Taurio, Jyrki, Lahtela, Jorma, Tsimihodimos, Vasileios, Balafa, Olga, Dounousi, Evangelia, Sakkou, Sissy, Tentolouris, Nikolaos, Siafarikas, Christos, Siami, Evangelia, Doupis, Ioannis, Angelopoulos, Theodoros, Georgoulias, Christodoulos, Pall, Denes, Esze, Regina, Kobling, Tamas, Varadi, Zita, Zsiros, Noemi, Vass, Viktor, Balo, Timea, Csanyi, Erika, Ory, Ivan, Pall, Istvan, Patai, Valentina, Zeak, Zsuzsanna, Takacs, Istvan, Petho, Akos, Szili, Balazs, Koranyi, Laszlo, Bezzegh, Katalin, Pauer, Jozsef, Peterfai, Eva, Konyves, Laszlo, Szoke, Brigitta, Hajdu, Csaba, Kalman, Krisztina, Yadav, Raj, Saxena, Navneet, Bhattacharya, Meenakshi, Sharma, Bal, Thomas, Nihal, K, Felix Jebasingh, Kapoor, Nitin, Kurian, Mathews E., Paul, Jinson, Ramesh, Priyadharshini, Varghese, Sheeba, Shibusawa, Nobuyuki, Nishi, Hiroshi, Noritake, Nobuyasu, Oda, Takashi, Okamoto, Hideki, Kasuga, Hirotake, Hori, Hiroshi, Ito, Yukiko, Mizukoshi, Toshihiro, Ishii, Hideto, Han, Seung Hyeok, Kim, Hyung Woo, Oh, Kook-Hwan, Han, Seung Seok, Han, Sang Youb, Cha, Dae Ryong, Cha, Jin Joo, Kwon, Soon-Kil, Cho, Hyunjeong, Kim, Hye-Young, Kim, Sun Moon, Lee, Jung Pyo, Lee, Jeonghwan, Lee, Li Yuan, Chang, Meng Lee, Laang, Shian Tuck, Tan, Zhao Zhi, Ahmad Rosdi, Hajar, Mohammad Ismail, Siti Hafizah, Simatherai, Devamalar, Tay, Ju Fan, Eddie, Wong, Fook Sem, Yakob, Suryati, Abdul Sukur, Noorhafini, Anuar, Amalina, Md. Rasid, Syaliza, Mushaddik, Irma Liyana, Mustafar, Ruslinda, Abu Shamsi, Muhammad Yusuf, Fong, Voon Ken, Kamaruzaman, Lydia, Mohd, Rozita, Wan Daud, Wan Rohaslizan, Wan Hassan, Wan Hasnul Halimi, Ab Hamid, Suhaidarwani, Abdullah, Muhammad Nabil, Yusoff, Mohd Yusran, Ramanathan, G R Letchuman, Lee, Kim Yen, Wan Ismail, Wan Fadhilah, Morales Villegas, Enrique, Ramirez Baez, Rubria, Vital Lopez, Jorge, Arias Delgadillo, Cristhian, Herrera Marmolejo, Marisol, Parra Perez, Rosa, Alpizar Salazar, Melchor, Flores Montealegre, Ana, Galvan Magaña, Jose, Gutierrez Tlapale, Minerva, Reyes Munguia, Daniela, Witczak, Bartlomiej, Gøransson, Lasse, Strand Thorsen, Inga, Caringal, Clodoaido, Villardo, Mario, Toledo, Ronaldo, Dijamco, Emerlinda Fausto, De Asis, Norman Cornelio, Kuizon, Angelica, Catindig, Elizabeth Ann, Perez, Ronald, Aquitania, Grace, Pableo, Jimrie David, Sanchez, Jay Karlou, Czernecka, Ewa, Cegiel, Aleksandra, Knychas, Dorota, Ochnio, Malgorzata, Kuligowska-Jakubowska, Monika, Cesarz, Marek, Kowalewska-Celejewska, Milena, Masajtis-Zagajewska, Anna, Jankowski, Lukasz, Ojrzanowski, Marcin, Olszewska-Jander, Magdalena, Skokowska, Ewa, Giermakowska-Samek, Malgorzata, Luchowska, Elzbieta, Patkowska, Renata, Sekulska, Marzenna, Marczuk-Krynicka, Dorota, Marciniak, Andrzej, Barwijuk, Michal, Myslicki, Marcin, Siek, Michal, Wronska, Danuta, Tomsia-Goncerz, Jadwiga, Wronski, Krzysztof, Junik, Roman, Dzialak, Szymon, Kurlapska, Ewelina, Malecha, Wieslaw, Suwala, Szymon, Branco, Patrícia, Birne, Rita, Raposo, João, Ferreira, Marta, Alexandrino, Henrique, Alves, Helena, Correia, Sara, Oliveira, Maria João, Ramalho, Diogo, Tavares, Patricia, Coetzee, Kathleen, Blignaut, Sue, Viljoen, Winifred, Potgieter, Elsje, Malherbe, Elmien, Ortiz Arduán, Alberto, Goma Garcés, Elena, Pérez, María, Santamaría, Rafael, López López, Isabel, Pendón de Mier, Victoria, Rodelo Haad, Cristian, Marques, María, Domènech, Esther, Portoles, Josep Maria, Soler, María José, Agraz, Irene, Azancot, María Antonieta, Bermejo, Sheila, Bolufer, Mónica, López, Marina, Ramos, Natalia, Toapanta, Néstor, Cigarrán Guldris, Secundino, Primo, Juan Carlos, Pérez, Luis Enrique, Rebollido Fernández, María, Holmer, Helene, Bruchfeld, Annette, Rofors, Justus, Tengmark, Bengt-Olov, Wuerzner, Gregoire, Leanizbarrutia, Garazi, Ozturk, Savas, Guler, Nurana, Safak, Seda, Lee, Keung, Campbell, Stephen, Siddiqui, Imran, Abbasi, Nadia, Tahir, Faiza, Azizad, Masoud, Jackson, Timothy, Everhart, Brian, Oliver, Michael, Rust, William, Sniezek, Matthew, Arif, Ahmed, Syed, Mohammed, Bhasin, Nitin, Bien, Michael, Gallego, Claudio, Jamal, Aamir, Moghadam, Mojtaba, Rizvi, Abid, Rizvi, Amna, Rizvi, Syed, Wong, Christopher, Lucas, Kathryn, Buery, Andrea, Chang, Ku-Lang, Presswood, Claire, Smith, Justin, Doshi, Ankur, Parikh, Manish, Wallace, Jeannine, Krishna, Arvind, Daugherty, Heidi, Fearday, Aaron, Keller, Christopher, Meng, Jerry, Nielsen, Alexandra, Rovner, Sergio, Almeida, Javier, Marranzini, Benito, Selby, Lisa, Yablon, Zachary, Jean-Louis, Daphne, Kotzker, Wayne, Perez, Chabely, Richards, Marc, Rosario, Reinaldo, Marcus, Roy, Okechukwu, Chike, Ross, Dennis, Gromala, Rachel, Reed, Matthew, Weber, Lisa, Nazeer, Imran, Kumar, Prashant, Mir, Muhammad, Shea, Heidi, Hart, Amanda, Wiebel, Jaime, Kooienga, Laura, Newsome, Britt, Suyumova, Irina, Alvarez, German, Bireddy, Venkata, Lansang, Maria, Mandry, Jose, Freire, Maria, Herrera Albornoz, Oscarina, Desai, Anant, Gandhi, Dayan, Rajan, Sibu, Raymond, Louis, Posada, Jorge, Garcia-Mayol, Luis, Gutierrez-Alsina, Rodolfo, Fernandez, Juan, Bruce, Kendaling, Cuellar, Juan, Ranz y Alvarez, Maria, Bartolacci, Ines, Pautasso, Mauro, Stoppa, Daniela, Riella, Miguel, Barbosa, Maria, Harcsa, Eleonora, Gulati, Yuvraj, Savalia, Denish, Khetan, Prakash, Sinha, Dhananjay, R, Niranjan, K, Srinivas, Pazos, Fabiola, Gacutan-Liwag, Aretha, Duszynska, Malgorzata, Antkowiak-Piatyszek, Karolina, Konieczny, Grzegorz, Sidorowicz-Bialynicka, Anna, Ciesiolkiewicz-Wojcik, Agnieszka, Dwojak, Marek, Szymkowiak, Katarzyna, Gorczyca-Siudak, Daria, Janik-Palazzolo, Marzena, Siudak, Lukasz, Opiela, Jaroslaw, Iwanow, Dariusz, Solkiewicz, Monika, Sipinska-Surzynska, Malgorzata, Olszanecka - Glinianowicz, Magdalena, Rozmilowska, Izabela, Trokis, Julian, Prozesky, Hans, Burgess, Lesley, Cyster, Henry, Jordaan, Jurie, Mohamed, Hawa, Naude, Christina, Sitsila, Thembie, Mehta, Arvind, Mocherla, Bharat, Lee, Sungchun, Boren, Kenneth, Rudolph, Lance, Benjamin, Sabrina, Sugimoto, Danny, Hammoud, Jamal, Bakleh, Muhammad, Hashish, Yaseen, Da Costa, Jonathan, Gold, Marina, Majul, Claudio, Buscema, Juan, Gatto, Maria, Lombardi, Facundo, Paez, Olga, Puleio, Pablo, Alvarisqueta, Andrés, Pajon, Vanessa, Suarez, Gabriel, Hernandez Gauna, Adrian, Pereyra, Alejandro, Reig, Moira, Gelersztein, Elizabeth, Campestri, Gina, Gonzalez Santos, Maria, Sambresqui, Julieta, Catalano, Gustavo, Igarzabal, Cecilia, Vallejos, Augusto, Escobari, Claudio, Marchetto, Rocio, Chahin, Mariano, Aguilera, Andrea, Comes, Ana, Rodriguez Segade, Silvia, Baccaro, Claudia, Larrieu Lacoste, María Verónica, Saurral, Ruben, Cristino, Alberto, Dran, Dario, Koretzky, Martin, Ponti, Juan, Porto, Alejandro, Tenaglia, Yasmin, Maldonado, Natacha, Bertollo, Natalia, Van Perdeck, Verónica, Lopau, Kai, Wanner, Christoph, Berfelo, Florieke, Contzen, Christel, Arbi, Abdulwahab, Lee-Barkey, Young Hee, Maciejewska, Aleksandra, Arelin, Katrin, Haller, Hermann, Kaufeld, Jessica, Schmidt-Ott, Kai, Heinrichs, Sven, Krüger, Thilo, Gebauer, Chris, Paliege, Alexander, Henkel, Elena, Axthelm, Christoph, Derwahl, Karl-Michael, Trevisan, Roberto, Bellante, Rosalia, Borrella, Nicolò, Corsi, Anna, Gesualdo, Loreto, Ardillo, Teodora, Ficarella, Maria, Fikry, Sameh, Mazza, Giuseppe, Poirier, Lysane, Bajaj, Harpreet, Hatziagelaki, Erifili, Katopodis, Sokratis, Katsoudas, Spiros, Yamaura, Shuichi, Shikano, Tsutomu, Tosaki, Takahiro, Miho, Otoya, Tachibana, Naoki, Yumita, Wataru, Kado, Hiroshi, Villarreal Martinez, Jesus, Soto Miranda, Ernesto, Gonzalez Rodriguez, David, Panelo, Araceli, Santos, Telma, Birne, Rita, Branco, Patrícia, Martins, Ana, Mateus, Catarina, Teixeira e Costa, Fernando, Barreto, Sara, Silva Costa, Joana, Ferrer, Francisco, Silva, Joana, Awad, Ahmed, Khaleel, Shatha, Lustig, Ryan, Maharjan, Gajendra, Moya, Jaynier, Johnsingh, Amit, Acosta, Idalia, Newman, George, Buckle, Anita, and Hendon, Kendra

Abstract

Excess aldosterone accelerates chronic kidney disease progression. This phase 2 clinical trial assessed BI 690517, an aldosterone synthase inhibitor, for efficacy, safety, and dose selection.

Published
2024
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6. Dynamic computed tomographic assessment of the mitral annulus in patients with and without mitral prolapse.

Author

Rizvi, Asim, Marcus, Roy P., Guo, Yugene, Carter, Rickey, Mark, Ian T., Foley, Thomas A., Weber, Nikkole M., Sheedy, Emily N., Leng, Shuai, and Williamson, Eric E.

Abstract

To obtain 3D CT measurements of mitral annulus throughout cardiac cycle using prototype mitral modeling software, assess interobserver agreement, and compare among patients with mitral prolapse (MP) and control group. Pre-procedural imaging is critical for planning of transcatheter mitral valve (MV) replacement. However, there is limited data regarding reliable CT-based measurements to accurately characterize the dynamic geometry of the mitral annulus in patients with MV disease. Patients with MP and control subjects without any MV disease who underwent ECG-gated cardiac CT were retrospectively identified. Multiphasic CT data was loaded into a prototype mitral modeling software. Multiple anatomical parameters in 3D space were recorded throughout the cardiac cycle (0–95%): annular circumference, planar-surface-area (PSA), anterior-posterior (A-P) distance, and anterolateral-posteromedial (AL-PM) distance. Comparisons were made among the two groups, with p < 0.05 considered statistically significant. Interobserver agreement was assessed on ten patients using intraclass correlation coefficient (ICC) among 4 experienced readers. A total of 100 subjects were included: 50 with MP and 50 control. Annular dimensions were significantly higher in the MP group than control group, with circumference (144 ± 11 vs. 117±8 mm), PSA (1533 ± 247 vs. 1005 ± 142 mm2), A-P distance (38 ± 4 vs. 32±2 mm), and AL-PM distance (47 ± 4 vs. 39±3 mm) (all p < 0.001). Substantial size changes were observed throughout the cardiac cycle, but with maximal and minimal sizes at different cardiac phases for the two groups. The interobserver agreement was excellent (ICC≥0.75) for annular circumference, PSA, A-P- and AL-PM distance. A significant variation in the mitral annular measures between different cardiac phases and two groups was observed with excellent interobserver agreement. [ABSTRACT FROM AUTHOR]

Published
2020
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9. Recent Scientific Evidence and Technical Developments in Cardiovascular Computed Tomography.

Author

Marcus, Roy, Ruff, Christer, Burgstahler, Christof, Notohamiprodjo, Mike, Nikolaou, Konstantin, Geisler, Tobias, Schroeder, Stephen, and Bamberg, Fabian

Abstract

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2016
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11. Evidencia científica reciente y avances técnicos en la tomografía computarizada cardiovascular

Author

Marcus, Roy, Ruff, Christer, Burgstahler, Christof, Notohamiprodjo, Mike, Nikolaou, Konstantin, Geisler, Tobias, Schroeder, Stephen, and Bamberg, Fabian

Abstract

En los últimos años, la coronariografía (o angiografía coronaria) por tomografía computarizada se ha asentado cada vez más como una modalidad diagnóstica segura y no invasiva para la evaluación de la antomía del árbol arterial coronario, que aporta ventajas diagnósticas, en especial para pacientes con probabilidad pretest baja o intermedia de la enfermedad. Actualmente hay cada vez más evidencia de grandes ensayos aleatorizados sobre la influencia diagnóstica de la angiotomografía computarizada en el manejo de los pacientes con síndromes de dolor torácico agudo y crónico. Al mismo tiempo, los avances técnicos han reducido sustancialmente los efectos adversos y los factores limitantes, como la exposición a la radiación, la cantidad de medio de contraste yodado que se aplica y el tiempo de exploración, lo cual la hace apropiada para aplicaciones clínicas más amplias. En este trabajo se revisan los avances más recientes en la tecnología de la tomografía computarizada y se describe la evidencia científica existente sobre el uso de la angiotomografía computarizada cardiaca en la evaluación de los pacientes con síndromes de dolor torácico agudo y crónico.

Published
2016
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12. Dynamic Myocardial CT Perfusion Imaging for Evaluation of Myocardial Ischemia as Determined by MR Imaging.

Author

Bamberg, Fabian, Marcus, Roy P., Becker, Alexander, Hildebrandt, Kristof, Bauner, Kerstin, Schwarz, Florian, Greif, Martin, von Ziegler, Franz, Bischoff, Bernhard, Becker, Hans-Christoph, Johnson, Thorsten R., Reiser, Maximilian F., Nikolaou, Konstantin, and Theisen, Daniel

Abstract

Objectives: The aim of this study was to determine the feasibility of computed tomography (CT)-based dynamic myocardial perfusion imaging for the assessment of myocardial ischemia and infarction compared with cardiac magnetic resonance (CMR). Background: Sequential myocardial CT perfusion imaging has emerged as a novel imaging technique for the assessment of myocardial hypoperfusion. Methods: We prospectively enrolled subjects with known coronary artery disease who underwent adenosine-mediated stress dynamic dual-source CT (100 kV, 320 mAs/rot) and CMR (3-T). Estimated myocardial blood flow (eMBF) and estimated myocardial blood volume (eMBV) were derived from CT images, using a model-based parametric deconvolution technique. The values were independently related to perfusion defects (ischemic and/or infarcted myocardial segments) as visually assessed during rest/stress and late gadolinium enhancement CMR. Conventional measures of diagnostic accuracy and differences in eMBF/eMBV were determined. Results: Of 38 enrolled subjects, 31 (mean age 70.4 ± 9.3 years; 77% men) completed both CT and CMR protocols. The prevalence of ischemic and infarcted myocardial segments detected by CMR was moderate (11.6%, n = 56 and 12.6%, n = 61, respectively, of 484 analyzed segments, with 8.4% being transmural). The diagnostic accuracy of CT for the detection of any perfusion defect was good (eMBF threshold, 88 ml/mg/min; sensitivity, 77.8% [95% confidence interval (CI): 69% to 85%]; negative predictive value, 91.3% [95% CI: 86% to 94%]) with moderate positive predictive value (50.6% [95% CI: 43% to 58%] and specificity (75.41% [95% CI: 70% to 79%]). Higher diagnostic accuracy was observed for transmural perfusion defects (sensitivity 87.8%; 95% CI: 74% to 96%) and infarcted segments (sensitivity 85.3%; 95% CI: 74% to 93%). Although eMBF in high-quality examinations was lower but not different between ischemic and infarcted segments (72.3 ± 18.7 ml/100 ml/min vs. 73.1 ± 31.9 ml/100 ml/min, respectively, p > 0.05), eMBV was significantly lower in infarcted segments compared with ischemic segments (11.3 ± 3.3 ml/100 ml vs. 18.4 ± 2.8 ml/100 ml, respectively; p < 0.01). Conclusions: Compared with CMR, dynamic stress CT provides good diagnostic accuracy for the detection of myocardial perfusion defects and may differentiate ischemic and infarcted myocardium. [Copyright &y& Elsevier]

Published
2014
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13. Myocardial CT Perfusion Imaging in a Large Animal Model: Comparison of Dynamic Versus Single-Phase Acquisitions.

Author

Schwarz, Florian, Hinkel, Rabea, Baloch, Elisabeth, Marcus, Roy P., Hildebrandt, Kristof, Sandner, Torleif A., Kupatt, Christian, Hoffmann, Verena, Wintersperger, Bernd J., Reiser, Maximilian F., Theisen, Daniel, Nikolaou, Konstantin, and Bamberg, Fabian

Abstract

Objectives: This study sought to compare dynamic versus single-phase high-pitch computed tomography (CT) acquisitions for the assessment of myocardial perfusion in a porcine model with adjustable degrees of coronary stenosis. Background: The incremental value of the 2 different approaches to CT-based myocardial perfusion imaging remains unclear. Methods: Country pigs received stent implantation in the left anterior descending coronary artery, in which an adjustable narrowing (50% and 75% stenoses) was created using a balloon catheter. All animals underwent CT-based rest and adenosine-stress myocardial perfusion imaging using dynamic and single-phase high-pitch acquisitions at both degrees of stenosis. Fluorescent microspheres served as a reference standard for myocardial blood flow. Segmental CT-based myocardial blood flow (MBFCT) was derived from dynamic acquisitions. Segmental single-phase enhancement (SPE) was recorded from high-pitch, single-phase examinations. MBFCT and SPE were compared between post-stenotic and reference segments, and receiver-operating characteristic curve analysis was performed. Results: Among 6 animals (28 ± 2 kg), there were significant differences of MBFCT and SPE between post-stenotic and reference segments for all acquisitions at 75% stenosis. By contrast, although for 50% stenosis at rest, MBFCT was lower in post-stenotic than in reference segments (0.65 ± 0.10 ml/g/min vs. 0.75 ± 0.16 ml/g/min, p < 0.05), there was no difference for SPE (128 ± 27 Hounsfield units vs. 137 ± 35 Hounsfield units, p = 0.17), which also did not significantly change under adenosine stress. In receiver-operating characteristic curve analyses, segmental MBFCT showed significantly better performance for ischemia prediction at 75% stenosis and stress (area under the curve: 0.99 vs. 0.89, p < 0.05) as well as for 50% stenosis, regardless of adenosine administration (area under the curve: 0.74 vs. 0.57 and 0.88 vs. 0.61, respectively, both p < 0.05). Conclusions: At higher degrees of coronary stenosis, both MBFCT and SPE permit an accurate prediction of segmental myocardial hypoperfusion. However, accuracy of MBFCT is higher than that of SPE at 50% stenosis and can be increased by adenosine stress at both degrees of stenosis. [Copyright &y& Elsevier]

Published
2013
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14. The Use of Coronary CT Angiography for the Evaluation of Chest Pain

Author

Schlett, Christopher L., Pursnani, Amit, Marcus, Roy P., Truong, Quynh A., and Hoffmann, Udo

Abstract

Coronary computed tomography angiography (CCTA) may improve the diagnosis and management of acute and stable chest pain syndromes. The key for caregivers of patients presenting with acute chest pain is the early identification and management of life-threatening conditions, such as acute coronary syndromes, pulmonary embolism, and acute aortic dissection. The main goal in stable chest pain syndromes is to determine the extent and severity of coronary artery disease. This review article will critically evaluate the current literature supporting the evidence for the clinical use of CCTA in acute and stable chest pain syndromes, considering the latest innovations in CCTA technology and their potential impact on patient care.

Published
2014
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15. Imaging Evaluation of Acute Chest Pain

Author

Bamberg, Fabian, Marcus, Roy P., Schlett, Christopher L., Schoepf, U. Joseph, Johnson, Thorsten R., Nance, John W., Hoffmann, Udo, Reiser, Maximilian F., and Nikolaou, Konstantin

Abstract

Given the often inconclusive initial evaluation of patients presenting with acute chest pain in the Emergency Department, advanced imaging techniques have been evaluated in the quest for improving the current standard of care. In this article, we systematically compare and evaluate the available evidence and cost-effectiveness of radionucleotide myocardial perfusion imaging, cardiac computed tomography angiography, and cardiac magnetic resonance imaging using data from PubMed and EMBASE through January 2012. The obtained data were summarized and categorized according to the reached level of evidence and its impact on the decision-making process.

Published
2012
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16. Accuracy of Dynamic Computed Tomography Adenosine Stress Myocardial Perfusion Imaging in Estimating Myocardial Blood Flow at Various Degrees of Coronary Artery Stenosis Using a Porcine Animal Model

Author

Bamberg, Fabian, Hinkel, Rabea, Schwarz, Florian, Sandner, Torleif A., Baloch, Elisabeth, Marcus, Roy, Becker, Alexander, Kupatt, Christian, Wintersperger, Bernd J., Johnson, Thorsten R., Theisen, Daniel, Klotz, Ernst, Reiser, Maximilian F., and Nikolaou, Konstantin

Abstract

To determine the accuracy of computed tomography (CT) dynamic stress myocardial perfusion imaging to estimate myocardial blood flow (MBF) in a porcine animal model with variable degrees of induced coronary artery stenosis in comparison with microsphere-derived MBF.

Published
2012
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17. Protein Intake Seems to Respond to Increases in Kt/V despite Baseline Kt/V Greater than 1.2

Author

Marcus, Roy G., Cohl, Edith, and Uribarri, Jaime

Abstract

The nutritional status is a strong predictor of outcome in hemodialysis patients. Adequate delivery of dialysis is necessary for hemodialysis patients to maintain their protein nutrition. In general, a single-pool Kt/V of 1.2 has been considered adequate dialysis. We recently decided to maximize the blood flow during hemodialysis in all of our patients; this enabled us to increase the dose of delivered dialysis in those patients who were not initially utilizing their maximum blood flow. There were 18 patients who already received a Kt/V greater than 1.2. We were able to increase Kt/V even further in 10 of them, resulting in a significant increase in nPCR and a trend to increase serum albumin over the next 6 months of follow-up. The mean normalized protein catabolic rate (nPCR) and serum albumin remained unchanged in the remaining 8 patients whose Kt/V could not be increased. Our data provide evidence that protein intake in hemodialysis patients will increase with an increase in delivered dialysis above the level generally considered to be adequate.

Published
1999
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18. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data

Author

Haase, Robert, Schlattmann, Peter, Gueret, Pascal, Andreini, Daniele, Pontone, Gianluca, Alkadhi, Hatem, Hausleiter, Jo¨rg, Garcia, Mario J, Leschka, Sebastian, Meijboom, Willem B, Zimmermann, Elke, Gerber, Bernhard, Schoepf, U Joseph, Shabestari, Abbas A, Nørgaard, Bjarne L, Meijs, Matthijs F L, Sato, Akira, Ovrehus, Kristian A, Diederichsen, Axel C P, Jenkins, Shona M M, Knuuti, Juhani, Hamdan, Ashraf, Halvorsen, Bjørn A, Mendoza-Rodriguez, Vladimir, Rochitte, Carlos E, Rixe, Johannes, Wan, Yung Liang, Langer, Christoph, Bettencourt, Nuno, Martuscelli, Eugenio, Ghostine, Said, Buechel, Ronny R, Nikolaou, Konstantin, Mickley, Hans, Yang, Lin, Zhang, Zhaqoi, Chen, Marcus Y, Halon, David A, Rief, Matthias, Sun, Kai, Hirt-Moch, Beatrice, Niinuma, Hiroyuki, Marcus, Roy P, Muraglia, Simone, Jakamy, Réda, Chow, Benjamin J, Kaufmann, Philipp A, Tardif, Jean-Claude, Nomura, Cesar, Kofoed, Klaus F, Laissy, Jean-Pierre, Arbab-Zadeh, Armin, Kitagawa, Kakuya, Laham, Roger, Jinzaki, Masahiro, Hoe, John, Rybicki, Frank J, Scholte, Arthur, Paul, Narinder, Tan, Swee Y, Yoshioka, Kunihiro, Ro¨hle, Robert, Schuetz, Georg M, Schueler, Sabine, Coenen, Maria H, Wieske, Viktoria, Achenbach, Stephan, Budoff, Matthew J, Laule, Michael, Newby, David E, and Dewey, Marc

Abstract

ObjectiveTo determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients.DesignProspectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies.Data sourcesMedline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators.Eligibility criteria for selecting studiesProspective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups.ResultsIndividual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v86.5%, P=0.002) and specificity (84.4% v72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 vall other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)).ConclusionsIn a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients.Systematic review registrationPROSPERO CRD42012002780.

Published
2019
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