4 results on '"Nandini, M."'
Search Results
2. Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome
- Author
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Ghoshhajra, Brian B., Takx, Richard A. P., Staziaki, Pedro V., Vadvala, Harshna, Kim, Phillip, Neilan, Tomas G., Meyersohn, Nandini M., Bittner, Daniel, Janjua, Sumbal A., Mayrhofer, Thomas, Greenwald, Jeffrey L., Truong, Quyhn A., Abbara, Suhny, Brown, David F. M., Januzzi, James L., Francis, Sanjeev, Nagurney, John T., Hoffmann, Udo, Chan, Andy, Choy, Garry, Gupta, Rajiv, Kalra, Mannudeep, Karaosmanoglu, Ali, Levesque, Marie-Helene, Lu, Michael T., Oliveira, George R., Prabhakar, Anand M., Kulkarni, Naveen, Peterson, Paul Gabriel, Scheske, Jonathan, Singh, Parmanand, Pursnani, Amit, Panagia, Marcello, Sayegh, Karl, Sharma, Umesh, Walker, Christopher, Verzosa, Stacey, and on behalf of MGH Emergency Cardiac CTA Program Contributors
- Published
- 2017
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3. Small whole heart volume predicts cardiovascular events in patients with stable chest pain: insights from the PROMISE trial
- Author
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Michael T. Lu, Pamela S. Douglas, Roman Zeleznik, Nandini M. Meyersohn, Hamed Emami, Borek Foldyna, Maros Ferencik, Patricia A. Pellikka, Jan-Erik Scholtz, Thomas Mayrhofer, Daniel O. Bittner, Stefan Puchner, Hugo J.W.L. Aerts, Udo Hoffmann, Parastou Eslami, Beeldvorming, MUMC+: DA BV Research (9), and RS: Carim - B06 Imaging
- Subjects
Male ,Chest Pain ,medicine.medical_specialty ,Computed Tomography Angiography ,Cardiac Volume ,heart failure ,Coronary Artery Disease ,Coronary Angiography ,Chest pain ,Risk Assessment ,Article ,030218 nuclear medicine & medical imaging ,Multidetector computed tomography ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,cardiovascular diseases ,Myocardial infarction ,Coronary disease ,Framingham Risk Score ,Unstable angina ,business.industry ,General Medicine ,Prognosis ,medicine.disease ,030220 oncology & carcinogenesis ,Heart failure ,Cardiology ,Female ,Radiology ,medicine.symptom ,Metabolic syndrome ,business ,Mace - Abstract
The size of the heart may predict major cardiovascular events (MACE) in patients with stable chest pain. We aimed to evaluate the prognostic value of 3D whole heart volume (WHV) derived from non-contrast cardiac computed tomography (CT). Among participants randomized to the CT arm of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE), we used deep learning to extract WHV, defined as the volume of the pericardial sac. We compared the WHV across categories of cardiovascular risk factors and coronary artery disease (CAD) characteristics and determined the association of WHV with MACE (all-cause death, myocardial infarction, unstable angina; median follow-up: 26 months). In the 3798 included patients (60.5 ± 8.2 years; 51.5% women), the WHV was 351.9 ± 57.6 cm3/m2. We found smaller WHV in no- or non-obstructive CAD, women, people with diabetes, sedentary lifestyle, and metabolic syndrome. Larger WHV was found in obstructive CAD, men, and increased atherosclerosis cardiovascular disease (ASCVD) risk score (p < 0.05). In a time-to-event analysis, small WHV was associated with over 4.4-fold risk of MACE (HR (per one standard deviation) = 0.221; 95% CI: 0.068–0.721; p = 0.012) independent of ASCVD risk score and CT-derived CAD characteristics. In patients with non-obstructive CAD, but not in those with no- or obstructive CAD, WHV increased the discriminatory capacity of ASCVD and CT-derived CAD characteristics significantly. Small WHV may represent a novel imaging marker of MACE in stable chest pain. In particular, WHV may improve risk stratification in patients with non-obstructive CAD, a cohort with an unmet need for better risk stratification. • Heart volume is easily assessable from non-contrast cardiac computed tomography. • Small heart volume may be an imaging marker of major adverse cardiac events independent and incremental to traditional cardiovascular risk factors and established CT measures of CAD. • Heart volume may improve cardiovascular risk stratification in patients with non-obstructive CAD.
- Published
- 2021
4. Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome
- Author
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Suhny Abbara, Sanjeev A. Francis, Richard A.P. Takx, Quyhn A. Truong, Brian B. Ghoshhajra, Pedro V. Staziaki, Daniel O. Bittner, Sumbal Janjua, Thomas Mayrhofer, Udo Hoffmann, Phillip Kim, John T. Nagurney, Jeffrey L. Greenwald, Tomas G. Neilan, David F.M. Brown, James L. Januzzi, Nandini M. Meyersohn, and Harshna V. Vadvala
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,Computed Tomography Angiography ,030204 cardiovascular system & hematology ,Coronary Angiography ,Article ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Acute Coronary Syndrome ,Neuroradiology ,medicine.diagnostic_test ,business.industry ,musculoskeletal, neural, and ocular physiology ,Coronary Care Units ,Reproducibility of Results ,Interventional radiology ,General Medicine ,Emergency department ,Middle Aged ,medicine.disease ,Coronary Vessels ,Triage ,Clinical trial ,Cardiology ,Female ,Radiology ,business ,psychological phenomena and processes ,Mace - Abstract
To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience. Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure. One thousand twenty two consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7-24.1) hours. Patient disposition was 42.7 % direct discharge from the ED, 43.2 % discharge from emergency unit, and 14.1 % hospital admission. ACS rate during index hospitalization was 9.1 %. One hundred ninety two patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9 % (95 %-CI 68.1-87.5 %). Median CT radiation exposure was 4.0 (2.5-5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2 %. Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS. • ED Coronary CTA using advanced systems is associated with low radiation exposure. • Negative coronary CTA is associated with low rates of MACE. • CTA in ED patients enables short median time to discharge home. • CTA strategy is characterized by few downstream tests including unnecessary ICA.
- Published
- 2016
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