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Chimeric Antigen Receptor (CAR)-T cells have emerged as a promising immune effector cell-based therapy. With promising results and approval for the treatment of hematological malignancies, we discuss the scope of this novel therapeutic modality in systemic autoimmune diseases and immune-mediated inflammatory disorders refractory to conventional and biological disease-modifying agents.

Background: There is a paucity of data regarding the optimum timing of PCI in relation to TAVR., Objective: We compared the major adverse cardiovascular and cerebrovascular events (MACCE) rates among patients who underwent percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR) with those who received PCI with/after TAVR., Methods: In this multicenter study, we pooled all consecutive patients who underwent TAVR at three high volume centers., Results: Among 3,982 patients who underwent TAVR, 327 (8%) patients underwent PCI within 1 year before TAVR, 38 (1%) had PCI the same day as TAVR and 15 (0.5%) had PCI within 2 months after TAVR. Overall, among patients who received both PCI and TAVR (n = 380), history of previous CABG (HR:0.501; p = .001), higher BMI at TAVR (HR:0.970; p = .038), and statin therapy after TAVR (HR:0.660, p = .037) were independently associated with lower MACCE while warfarin therapy after TAVR was associated with a higher risk of MACCE (HR:1.779, p = .017). Patients who received PCI within 1 year before TAVR had similar baseline demographics, STS scores, clinical risk factors when compared to patients receiving PCI with/after TAVR. Both groups were similar in PCI (Syntax Score, ACC/AHA lesion class) and TAVR (valve types, access) related variables. There were no significant differences in terms of MACCE (log rank p = .550), all-cause mortality (log rank p = .433), strokes (log rank p = .153), and repeat PCI (log rank p = .054) in patients who underwent PCI with/after TAVR when compared to patients who received PCI before TAVR., Conclusion: Among patients who underwent both PCI and TAVR, history of CABG, higher BMI, and statin therapy had lower, while those discharged on warfarin, had higher adverse event rates. Adverse events rates were similar regardless of timing of PCI., (© 2020 Wiley Periodicals LLC.)

Purpose: To measure the inter- and intraobserver variability among operators of varying expertise in conducting CT-derived fractional flow reserve (CT FFR) measurements on-site by using structural and fluid analysis and to evaluate differences in reproducibility between two different training methods for end users., Materials and Methods: This retrospective analysis of the prospectively enrolled cohort included 22 symptomatic patients who underwent both 320-detector row coronary CT angiography and catheter-derived fractional flow reserve (FFR) within 90 days. Thirteen operators of varying expertise were assigned to one of two training arms: arm 1, on-site training by a specialist in CT FFR technology; arm 2, self-training through use of written materials. After the training, all 13 operators reviewed the CT data and measured CT FFR in 24 vessels in 22 patients. Inter- and intraoperator variability and agreements between CT FFR and catheter-derived FFR measurements were evaluated., Results: The overall intraclass correlation coefficient (ICC) among operators was 0.71 (95% confidence interval: 0.58, 0.83) with a mean absolute difference (± standard deviation) of 0.027 ± 0.022. The operators in arm 2 showed greater interoperator differences than those in arm 1 (0.031 ± 0.024 vs 0.023 ± 0.018; P = .024). Among operators who recalculated CT FFR, the mean CT FFR value did not significantly differ between the first and second calculations (ICC, 0.66; 95% confidence interval: 0.46, 0.87), with the medical specialists producing the lowest intraoperator variability (0.053 ± 0.060). The overall correlation coefficient between CT FFR and catheter FFR was r = 0.61, with a mean absolute difference of 0.096 ± 0.089., Conclusion: Good reproducibility of CT FFR values calculated on-site on the basis of structural and fluid analysis was observed among operators of varying expertise. Face-to-face training sessions may cause less variability.© RSNA, 2019 Supplemental material is available for this article., Competing Interests: Disclosures of Conflicts of Interest: K.K.K. disclosed no relevant relationships. E.A. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: employed by Canon Medical Systems USA. Other relationships: disclosed no relevant relationships. K.N.S. disclosed no relevant relationships. V.I. disclosed no relevant relationships. M.F.W. Activities related to the present article: institution receives grant from Jacobs Institute. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. N.A. disclosed no relevant relationships. A.B. Activities related to the present article: institution receives grant from Jacobs Institute. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. S.B.K. disclosed no relevant relationships. S.K. Activities related to the present article: institution receives grant from Jacobs Institute. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. S.M. disclosed no relevant relationships. C.M. Activities related to the present article: author did not receive payment or services from a third party for any aspect of the submitted work; author is uncertain if his institution received payment or services from a third party for any aspect of the submitted work (defers to lead author). Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. K.P. disclosed no relevant relationships. T.R. Activities related to the present article: author received payment from the University of Buffalo for participation in review activities. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. A.C.S. disclosed no relevant relationships. M.M.S. Activities related to the present article: institution receives grant from Jacobs Institute. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. S.W. Activities related to the present article: author paid by Toshiba for participating in the data collection of this study. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. S.F. disclosed no relevant relationships. U.C.S. Activities related to the present article: author received consulting fee from Jacobs Neurological Research Institute for interpretation of CT FFT and was fully blinded and not influenced by any means regarding the outcome. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. F.J.R. Activities related to the present article: institution received grant from Canon Medical Systems. Activities not related to the present article: medical director of Imagia (there is no overlap between this work and any company activity). Other relationships: disclosed no relevant relationships. C.N.I. Activities related to the present article: University of Buffalo received grant from Canon Medical Systems; institution receives travel funds for graduate and undergraduates for international conferences. Activities not related to the present article: author paid consultant fee for studies on vascular device evaluation from Jacobs Institute; institution receives NIH grants, Cumming Foundation grant, Canon Medical Systems grant, author paid for lecture on 3D printing advances from Canon Medical Systems; paid for patent for x-ray system design (University of Buffalo); University of Buffalo gives travel grants to conferences. Other relationships: disclosed no relevant relationships., (2019 by the Radiological Society of North America, Inc.)