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101. Impact of a Genetic Risk Score for Coronary Artery Disease on Reducing Cardiovascular Risk: A Pilot Randomized Controlled Study

Author

Knowles, Joshua W., primary, Zarafshar, Shirin, additional, Pavlovic, Aleksandra, additional, Goldstein, Benjamin A., additional, Tsai, Sandra, additional, Li, Jin, additional, McConnell, Michael V., additional, Absher, Devin, additional, Ashley, Euan A., additional, Kiernan, Michaela, additional, Ioannidis, John P. A., additional, and Assimes, Themistocles L., additional

Published
2017
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102. Right Heart End-Systolic Remodeling Index Strongly Predicts Outcomes in Pulmonary Arterial Hypertension

Author

Amsallem, Myriam, primary, Sweatt, Andrew J., additional, Aymami, Marie C., additional, Kuznetsova, Tatiana, additional, Selej, Mona, additional, Lu, HongQuan, additional, Mercier, Olaf, additional, Fadel, Elie, additional, Schnittger, Ingela, additional, McConnell, Michael V., additional, Rabinovitch, Marlene, additional, Zamanian, Roham T., additional, and Haddad, Francois, additional

Published
2017
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103. Informed Consent

Author

Grady, Christine, primary, Cummings, Steven R., additional, Rowbotham, Michael C., additional, McConnell, Michael V., additional, Ashley, Euan A., additional, and Kang, Gagandeep, additional

Published
2017
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104. Feasibility of Obtaining Measures of Lifestyle From a Smartphone App

Author

McConnell, Michael V., primary, Shcherbina, Anna, additional, Pavlovic, Aleksandra, additional, Homburger, Julian R., additional, Goldfeder, Rachel L., additional, Waggot, Daryl, additional, Cho, Mildred K., additional, Rosenberger, Mary E., additional, Haskell, William L., additional, Myers, Jonathan, additional, Champagne, Mary Ann, additional, Mignot, Emmanuel, additional, Landray, Martin, additional, Tarassenko, Lionel, additional, Harrington, Robert A., additional, Yeung, Alan C., additional, and Ashley, Euan A., additional

Published
2017
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105. Acquisition, Analysis, and Sharing of Data in 2015 and Beyond: A Survey of the Landscape

Author

Antman, Elliott M., Benjamin, Emelia J., Harrington, Robert A., Houser, Steven R., Peterson, Eric D., Bauman, Mary Ann, Brown, Nancy, Bufalino, Vincent, Califf, Robert M., Creager, Mark A., Daugherty, Alan, Demets, David L., Dennis, Bernard P., Ebadollahi, Shahram, Jessup, Mariell, Lauer, Michael S., Lo, Bernard, MacRae, Calum A., McConnell, Michael V., McCray, Alexa T., Mello, Michelle M., Mueller, Eric, Newburger, Jane W., Okun, Sally, Packer, Milton, Philippakis, Anthony, Ping, Peipei, Prasoon, Prad, Roger, Véronique L., Singer, Steve, Temple, Robert, Turner, Melanie B., Vigilante, Kevin, Warner, John, and Wayte, Patrick

Subjects
AHA Scientific Statements, clinical trials, data, AHA Conference Proceedings, preclinical, epidemiology, ethics, mobile health
Abstract

Background A 1.5‐day interactive forum was convened to discuss critical issues in the acquisition, analysis, and sharing of data in the field of cardiovascular and stroke science. The discussion will serve as the foundation for the American Heart Association's (AHA's) near‐term and future strategies in the Big Data area. The concepts evolving from this forum may also inform other fields of medicine and science. Methods and Results A total of 47 participants representing stakeholders from 7 domains (patients, basic scientists, clinical investigators, population researchers, clinicians and healthcare system administrators, industry, and regulatory authorities) participated in the conference. Presentation topics included updates on data as viewed from conventional medical and nonmedical sources, building and using Big Data repositories, articulation of the goals of data sharing, and principles of responsible data sharing. Facilitated breakout sessions were conducted to examine what each of the 7 stakeholder domains wants from Big Data under ideal circumstances and the possible roles that the AHA might play in meeting their needs. Important areas that are high priorities for further study regarding Big Data include a description of the methodology of how to acquire and analyze findings, validation of the veracity of discoveries from such research, and integration into investigative and clinical care aspects of future cardiovascular and stroke medicine. Potential roles that the AHA might consider include facilitating a standards discussion (eg, tools, methodology, and appropriate data use), providing education (eg, healthcare providers, patients, investigators), and helping build an interoperable digital ecosystem in cardiovascular and stroke science. Conclusion There was a consensus across stakeholder domains that Big Data holds great promise for revolutionizing the way cardiovascular and stroke research is conducted and clinical care is delivered; however, there is a clear need for the creation of a vision of how to use it to achieve the desired goals. Potential roles for the AHA center around facilitating a discussion of standards, providing education, and helping establish a cardiovascular digital ecosystem. This ecosystem should be interoperable and needs to interface with the rapidly growing digital object environment of the modern‐day healthcare system.

Published
2015

106. Clinician Innovator: A Novel Career Path in Academic Medicine

Author

Majmudar, Maulik D., Harrington, Robert A., Brown, Nancy J., Graham, Garth, and McConnell, Michael V.

Subjects
Biomedical Research, information technology, Career Choice, Cardiovascular Diseases, Education, Medical, Graduate, Cardiology, academic medicine, clinician innovator, Humans, healthcare innovation, Special Report, disruption
Published
2015

107. Self-Gated Fat-Suppressed Cardiac Cine MRI

Author

Ingle, R. Reeve, Santos, Juan M., Overall, William R., McConnell, Michael V., Hu, Bob S., and Nishimura, Dwight G.

Subjects
Male, Cardiac-Gated Imaging Techniques, Magnetic Resonance Imaging, Cine, Image Enhancement, Myocardial Contraction, Sensitivity and Specificity, Article, Meglumine, Reference Values, Image Processing, Computer-Assisted, Organometallic Compounds, Humans, Female, Algorithms
Abstract

To develop a self-gated alternating repetition time balanced steady-state free precession (ATR-SSFP) pulse sequence for fat-suppressed cardiac cine imaging.Cardiac gating is computed retrospectively using acquired magnetic resonance self-gating data, enabling cine imaging without the need for electrocardiogram (ECG) gating. Modification of the slice-select rephasing gradients of an ATR-SSFP sequence enables the acquisition of a one-dimensional self-gating readout during the unused short repetition time (TR). Self-gating readouts are acquired during every TR of segmented, breath-held cardiac scans. A template-matching algorithm is designed to compute cardiac trigger points from the self-gating signals, and these trigger points are used for retrospective cine reconstruction. The proposed approach is compared with ECG-gated ATR-SSFP and balanced steady-state free precession in 10 volunteers and five patients.The difference of ECG and self-gating trigger times has a variability of 13 ± 11 ms (mean ± SD). Qualitative reviewer scoring and ranking indicate no statistically significant differences (P 0.05) between self-gated and ECG-gated ATR-SSFP images. Quantitative blood-myocardial border sharpness is not significantly different among self-gated ATR-SSFP ( 0.61±0.15 mm -1), ECG-gated ATR-SSFP ( 0.61±0.15 mm -1), or conventional ECG-gated balanced steady-state free precession cine MRI ( 0.59±0.15 mm -1).The proposed self-gated ATR-SSFP sequence enables fat-suppressed cardiac cine imaging at 1.5 T without the need for ECG gating and without decreasing the imaging efficiency of ATR-SSFP.

Published
2014

109. Multimodality Molecular Imaging of Cardiac Cell Transplantation: Part II. In Vivo Imaging of Bone Marrow Stromal Cells in Swine with PET/CT and MR Imaging

Author

Parashurama, Natesh, primary, Ahn, Byeong-Cheol, additional, Ziv, Keren, additional, Ito, Ken, additional, Paulmurugan, Ramasamy, additional, Willmann, Jürgen K., additional, Chung, Jaehoon, additional, Ikeno, Fumiaki, additional, Swanson, Julia C., additional, Merk, Denis R., additional, Lyons, Jennifer K., additional, Yerushalmi, David, additional, Teramoto, Tomohiko, additional, Kosuge, Hisanori, additional, Dao, Catherine N., additional, Ray, Pritha, additional, Patel, Manishkumar, additional, Chang, Ya-fang, additional, Mahmoudi, Morteza, additional, Cohen, Jeff Eric, additional, Goldstone, Andrew Brooks, additional, Habte, Frezghi, additional, Bhaumik, Srabani, additional, Yaghoubi, Shahriar, additional, Robbins, Robert C., additional, Dash, Rajesh, additional, Yang, Phillip C., additional, Brinton, Todd J., additional, Yock, Paul G., additional, McConnell, Michael V., additional, and Gambhir, Sanjiv S., additional

Published
2016
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110. Multimodality Molecular Imaging of Cardiac Cell Transplantation: Part I. Reporter Gene Design, Characterization, and Optical in Vivo Imaging of Bone Marrow Stromal Cells after Myocardial Infarction

Author

Parashurama, Natesh, primary, Ahn, Byeong-Cheol, additional, Ziv, Keren, additional, Ito, Ken, additional, Paulmurugan, Ramasamy, additional, Willmann, Jürgen K., additional, Chung, Jaehoon, additional, Ikeno, Fumiaki, additional, Swanson, Julia C., additional, Merk, Denis R., additional, Lyons, Jennifer K., additional, Yerushalmi, David, additional, Teramoto, Tomohiko, additional, Kosuge, Hisanori, additional, Dao, Catherine N., additional, Ray, Pritha, additional, Patel, Manishkumar, additional, Chang, Ya-fang, additional, Mahmoudi, Morteza, additional, Cohen, Jeff Eric, additional, Goldstone, Andrew Brooks, additional, Habte, Frezghi, additional, Bhaumik, Srabani, additional, Yaghoubi, Shahriar, additional, Robbins, Robert C., additional, Dash, Rajesh, additional, Yang, Phillip C., additional, Brinton, Todd J., additional, Yock, Paul G., additional, McConnell, Michael V., additional, and Gambhir, Sanjiv S., additional

Published
2016
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114. Dual-Modality Activity-Based Probes as Molecular Imaging Agents for Vascular Inflammation

Author

Withana, Nimali P., primary, Saito, Toshinobu, additional, Ma, Xiaowei, additional, Garland, Megan, additional, Liu, Changhao, additional, Kosuge, Hisanori, additional, Amsallem, Myriam, additional, Verdoes, Martijn, additional, Ofori, Leslie O., additional, Fischbein, Michael, additional, Arakawa, Mamoru, additional, Cheng, Zhen, additional, McConnell, Michael V., additional, and Bogyo, Matthew, additional

Published
2016
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116. 0038: Addressing the controversy of estimating right ventricular systolic pressure by echocardiography: insights from 307 patients with advanced lung disease or pulmonary arterial hypertension

Author

Amsallem, Myriam, primary, Sternbach, Joshua, additional, Adigopula, Sasikanth, additional, Kobayashi, Yukari, additional, Vu, Thu, additional, Zamanian, Roham, additional, Liang, David, additional, Dhillon, Gundeep, additional, Schnittger, Ingela, additional, Mcconnell, Michael V., additional, and Haddad, François, additional

Published
2016
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118. Imaging cellular pharmacokinetics of 18F-FDG and 6-NBDG uptake by inflammatory and stem cells.

Author

Zaman, Raiyan T., Tuerkcan, Silvan, Mahmoudi, Morteza, Saito, Toshinobu, Yang, Phillip C., Chin, Frederick T., McConnell, Michael V., and Xing, Lei

Subjects
FLUORODEOXYGLUCOSE F18, PHARMACOKINETICS, NITROBENZENE, INFLAMMATION, STEM cells
Abstract

Objectives: Myocardial infarction (MI) causes significant loss of cardiomyocytes, myocardial tissue damage, and impairment of myocardial function. The inability of cardiomyocytes to proliferate prevents the heart from self-regeneration. The treatment for advanced heart failure following an MI is heart transplantation despite the limited availability of the organs. Thus, stem-cell-based cardiac therapies could ultimately prevent heart failure by repairing injured myocardium that reverses cardiomyocyte loss. However, stem-cell-based therapies lack understanding of the mechanisms behind a successful therapy, including difficulty tracking stem cells to provide information on cell migration, proliferation and differentiation. In this study, we have investigated the interaction between different types of stem and inflammatory cells and cell-targeted imaging molecules, 18F-FDG and 6-NBDG, to identify uptake patterns and pharmacokinetics in vitro. Methods: Macrophages (both M1 and M2), human induced pluripotent stem cells (hiPSCs), and human amniotic mesenchymal stem cells (hAMSCs) were incubated with either 18F-FDG or 6-NBDG. Excess radiotracer and fluorescence were removed and a 100 μm-thin CdWO4 scintillator plate was placed on top of the cells for radioluminescence microscopy imaging of 18F-FDG uptake, while no scintillator was needed for fluorescence imaging of 6-NBDG uptake. Light produced following beta decay was imaged with a highly sensitive inverted microscope (LV200, Olympus) and an Electron Multiplying Charge-Couple Device (EM-CCD) camera. Custom-written software was developed in MATLAB for image processing. Results: The average cellular activity of 18F-FDG in a single cell of hAMSCs (0.670±0.028 fCi/μm2, P = 0.001) was 20% and 36% higher compared to uptake in hiPSCs (0.540±0.026 fCi/μm2, P = 0.003) and macrophages (0.430±0.023 fCi/μm2, P = 0.002), respectively. hAMSCs exhibited the slowest influx (0.210 min-1) but the fastest efflux (0.327 min-1) rate compared to the other tested cell lines for 18F-FDG. This cell line also has the highest phosphorylation but exhibited the lowest rate of de-phosphorylation. The uptake pattern for 6-NBDG was very different in these three cell lines. The average cellular activity of 6-NBDG in a single cell of macrophages (0.570±0.230 fM/μm2, P = 0.004) was 38% and 14% higher compared to hiPSCs (0.350±0.160 fM/μm2, P = 0.001) and hAMSCs (0.490±0.028 fM/μm2, P = 0.006), respectively. The influx (0.276 min-1), efflux (0.612 min-1), phosphorylation (0.269 min-1), and de-phosphorylation (0.049 min-1) rates were also highest for macrophages compared to the other two tested cell lines. Conclusion: hAMSCs were found to be 2–3× more sensitive to 18F-FDG molecule compared to hiPSCs/macrophages. However, macrophages exhibited the most sensitivity towards 6-NBDG. Based on this result, hAMSCs targeted with 18F-FDG could be more suitable for understanding the mechanisms behind successful therapy for treating MI patients by gathering information on cell migration, proliferation and differentiation. [ABSTRACT FROM AUTHOR]

Published
2018
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119. Three-dimensional first-pass myocardial perfusion MRI using a stack-of-spirals acquisition

Author

Shin, Taehoon, Nayak, Krishna S., Santos, Juan M., Nishimura, Dwight G., Hu, Bob S., and McConnell, Michael V.

Subjects
Imaging, Three-Dimensional, Image Interpretation, Computer-Assisted, Myocardial Perfusion Imaging, Humans, Reproducibility of Results, Image Enhancement, Sensitivity and Specificity, Article, Algorithms, Magnetic Resonance Angiography
Abstract

Three-dimensional cardiac magnetic resonance perfusion imaging is promising for the precise sizing of defects and for providing high perfusion contrast, but remains an experimental approach primarily due to the need for large-dimensional encoding, which, for traditional 3DFT imaging, requires either impractical acceleration factors or sacrifices in spatial resolution. We demonstrated the feasibility of rapid three-dimensional cardiac magnetic resonance perfusion imaging using a stack-of-spirals acquisition accelerated by non-Cartesian k-t SENSE, which enables entire myocardial coverage with an in-plane resolution of 2.4 mm. The optimal undersampling pattern was used to achieve the largest separation between true and aliased signals, which is a prerequisite for k-t SENSE reconstruction. Flip angle and saturation recovery time were chosen to ensure negligible magnetization variation during the transient data acquisition. We compared the proposed three-dimensional perfusion method with the standard 2DFT approach by consecutively acquiring both data during each R-R interval in cardiac patients. The mean and standard deviation of the correlation coefficients between time intensity curves of three-dimensional versus 2DFT were 0.94 and 0.06 across seven subjects. The linear correlation between the two sets of upslope values was significant (r = 0.78, P0.05).

Published
2012

120. Regional right ventricular dysfunction in acute pulmonary embolism: relationship with clot burden and biomarker profile

Author

Tuzovic, Mirela, primary, Adigopula, Sasikanth, additional, Amsallem, Myriam, additional, Kobayashi, Yukari, additional, Kadoch, Michael, additional, Boulate, David, additional, Krishnan, Gomathi, additional, Liang, David, additional, Schnittger, Ingela, additional, Fleischmann, Dominik, additional, McConnell, Michael V., additional, and Haddad, François, additional

Published
2015
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121. Manganese‐Enhanced Magnetic Resonance Imaging Enables In Vivo Confirmation of Peri‐Infarct Restoration Following Stem Cell Therapy in a Porcine Ischemia–Reperfusion Model

Author

Dash, Rajesh, primary, Kim, Paul J., additional, Matsuura, Yuka, additional, Ikeno, Fumiaki, additional, Metzler, Scott, additional, Huang, Ngan F., additional, Lyons, Jennifer K., additional, Nguyen, Patricia K., additional, Ge, Xiaohu, additional, Wong Po Foo, Cheryl, additional, McConnell, Michael V., additional, Wu, Joseph C., additional, Yeung, Alan C., additional, Harnish, Phillip, additional, and Yang, Phillip C., additional

Published
2015
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124. Direct Evaluation of Myocardial Viability and Stem Cell Engraftment Demonstrates Salvage of the Injured Myocardium

Author

Kim, Paul J., primary, Mahmoudi, Morteza, additional, Ge, Xiaohu, additional, Matsuura, Yuka, additional, Toma, Ildiko, additional, Metzler, Scott, additional, Kooreman, Nigel G., additional, Ramunas, John, additional, Holbrook, Colin, additional, McConnell, Michael V., additional, Blau, Helen, additional, Harnish, Phillip, additional, Rulifson, Eric, additional, and Yang, Phillip C., additional

Published
2015
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125. Erratum: miR-24 limits aortic vascular inflammation and murine abdominal aneurysm development

Author

Maegdefessel, Lars, primary, Spin, Joshua M., additional, Raaz, Uwe, additional, Eken, Suzanne M., additional, Toh, Ryuji, additional, Azuma, Junya, additional, Adam, Matti, additional, Nakagami, Futoshi, additional, Heymann, Helen M., additional, Chernogubova, Ekaterina, additional, Jin, Hong, additional, Roy, Joy, additional, Hultgren, Rebecka, additional, Caidahl, Kenneth, additional, Schrepfer, Sonja, additional, Hamsten, Anders, additional, Eriksson, Per, additional, McConnell, Michael V., additional, Dalman, Ronald L., additional, and Tsao, Philip S., additional

Published
2015
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127. RGD targeting of human ferritin iron oxide nanoparticles enhances in vivo MRI of vascular inflammation and angiogenesis in experimental carotid disease and abdominal aortic aneurysm.

Author

Kitagawa, Toshiro, Kosuge, Hisanori, Uchida, Masaki, Iida, Yasunori, Dalman, Ronald L., Douglas, Trevor, and McConnell, Michael V.

Abstract

Purpose: To evaluate Arg-Gly-Asp (RGD)-conjugated human ferritin (HFn) iron oxide nanoparticles for in vivo magnetic resonance imaging (MRI) of vascular inflammation and angiogenesis in experimental carotid disease and abdominal aortic aneurysm (AAA).Materials and Methods: HFn was genetically engineered to express the RGD peptide and Fe3 O4 nanoparticles were chemically synthesized inside the engineered HFn (RGD-HFn). Macrophage-rich left carotid lesions were induced by ligation in FVB mice made hyperlipidemic and diabetic (n = 14), with the contralateral right carotid serving as control. Murine AAAs were created by continuous angiotensin II infusion in ApoE-deficient mice (n = 12), while control mice underwent saline infusion (n = 8). All mice were imaged before and after intravenous injection with either RGD-HFn-Fe3 O4 or HFn-Fe3 O4 using a gradient-echo sequence on a whole-body 3T clinical scanner, followed by histological analysis. The nanoparticle accumulation was assessed by the extent of T2*-induced carotid lumen reduction (% lumen loss) or aortic T2*-weighted signal intensity reduction (% SI [signal intensity] loss).Results: RGD-HFn-Fe3 O4 was taken up more than HFn-Fe3 O4 in both the ligated left carotid arteries (% lumen loss; 69 ± 9% vs. 36 ± 7%, P = 0.01) and AAAs (% SI loss; 47 ± 6% vs. 20 ± 5%, P = 0.01). The AAA % SI loss correlated positively with AAA size (r = 0.89, P < 0.001). Histology confirmed the greater accumulation and colocalization of RGD-HFn-Fe3 O4 to both vascular macrophages and endothelial cells.Conclusion: RGD-HFn-Fe3 O4 enhances in vivo MRI by targeting both vascular inflammation and angiogenesis, and provides a promising translatable MRI approach to detect high-risk atherosclerotic and aneurysmal vascular diseases.Level Of Evidence: 1 J. Magn. Reson. Imaging 2017;45:1144-1153. [ABSTRACT FROM AUTHOR]

Published
2017
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128. CANDI: an R package and Shiny app for annotating radiographs and evaluating computer-aided diagnosis.

Author

Badgeley, Marcus A, Liu, Manway, Snyder, Thomas M, Glicksberg, Benjamin S, Shervey, Mark, Dudley, Joel T, Zech, John, Shameer, Khader, Lehar, Joseph, Oermann, Eric K, and McConnell, Michael V

Subjects
COMPUTER-aided diagnosis, MEDICAL radiography, MACHINE learning, DATA analysis, BIOINFORMATICS
Abstract

Motivation Radiologists have used algorithms for Computer-Aided Diagnosis (CAD) for decades. These algorithms use machine learning with engineered features, and there have been mixed findings on whether they improve radiologists' interpretations. Deep learning offers superior performance but requires more training data and has not been evaluated in joint algorithm-radiologist decision systems. Results We developed the Computer-Aided Note and Diagnosis Interface (CANDI) for collaboratively annotating radiographs and evaluating how algorithms alter human interpretation. The annotation app collects classification, segmentation, and image captioning training data, and the evaluation app randomizes the availability of CAD tools to facilitate clinical trials on radiologist enhancement. Availability and implementation Demonstrations and source code are hosted at (https://candi.nextgenhealthcare.org), and (https://github.com/mbadge/candi), respectively, under GPL-3 license. Supplementary information Supplementary material is available at Bioinformatics online. [ABSTRACT FROM AUTHOR]

Published
2019
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132. Assessment of Elastin Deficit in a Marfan Mouse Aneurysm Model Using an Elastin-Specific Magnetic Resonance Imaging Contrast Agent

Author

Okamura, Homare, primary, Pisani, Laura J., additional, Dalal, Alex R., additional, Emrich, Fabian, additional, Dake, Benjamin A., additional, Arakawa, Mamoru, additional, Onthank, David C., additional, Cesati, Richard R., additional, Robinson, Simon P., additional, Milanesi, Matteo, additional, Kotek, Gyula, additional, Smit, Henk, additional, Connolly, Andrew J., additional, Adachi, Hideo, additional, McConnell, Michael V., additional, and Fischbein, Michael P., additional

Published
2014
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135. ACC/AHA/ASE/ASNC/HRS/IAC/Mended Hearts/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR/SNMMI 2014 Health Policy Statement on Use of Noninvasive Cardiovascular Imaging

Author

Mark, Daniel B., primary, Anderson, Jeffrey L., additional, Brinker, Jeffrey A., additional, Brophy, James A., additional, Casey, Donald E., additional, Cross, Russell R., additional, Edmundowicz, Daniel, additional, Hachamovitch, Rory, additional, Hlatky, Mark A., additional, Jacobs, Jill E., additional, Jaskie, Suzette, additional, Kett, Kevin G., additional, Malhotra, Vinay, additional, Masoudi, Frederick A., additional, McConnell, Michael V., additional, Rubin, Geoffrey D., additional, Shaw, Leslee J., additional, Sherman, M. Eugene, additional, Stanko, Steve, additional, and Ward, R. Parker, additional

Published
2014
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139. Noninvasive assessment of coronary vasodilation using cardiovascular magnetic resonance in patients at high risk for coronary artery disease

Author

Nguyen, Patricia K., Meyer, Craig, Engvall, Jan, Yang, Phillip, McConnell, Michael V., Nguyen, Patricia K., Meyer, Craig, Engvall, Jan, Yang, Phillip, and McConnell, Michael V.

Abstract

Background: Impaired coronary vasodilation to both endothelial-dependent and endothelial-independent stimuli have been associated with atherosclerosis. Direct measurement of coronary vasodilation using x-ray angiography or intravascular ultrasound is invasive and, thus, not appropriate for asymptomatic patients or for serial follow-up. In this study, high-resolution coronary cardiovascular magnetic resonance (CMR) was used to investigate the vasodilatory response to nitroglycerine (NTG) of asymptomatic patients at high risk for CAD. Methods: A total of 46 asymptomatic subjects were studied: 13 high-risk patients [8 with diabetes mellitus (DM), 5 with end stage renal disease (ESRD)] and 33 age-matched controls. Long-axis and cross-sectional coronary artery images were acquired pre-and 5 minutes post-sublingual NTG using a sub-mm-resolution multi-slice spiral coronary CMR sequence. Coronary cross sectional area (CSA) was measured on pre-and post-NTG images and % coronary vasodilation was calculated. Results: Patients with DM and ESRD had impaired coronary vasodilation to NTG compared to age-matched controls (17.8 +/- 7.3% vs. 25.6 +/- 7.1%, p = 0.002). This remained significant for ESRD patients alone (14.8 +/- 7.7% vs. 25.6 +/- 7.1%, p = 0.003) and for DM patients alone (19.8 +/- 6.3% vs. 25.6 +/- 7.1%, p = 0.049), with a non-significant trend toward greater impairment in the ESRD vs. DM patients (14.8 +/- 7.7% vs. 19.8 +/- 6.3%, p = 0.23). Conclusion: Noninvasive coronary CMR demonstrates impairment of coronary vasodilation to NTG in high-risk patients with DM and ESRD. This may provide a functional indicator of subclinical atherosclerosis and warrants clinical follow up to determine prognostic significance.

Published
2008
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149. The Wild Wild West: A Framework to Integrate mHealth Software Applications and Wearables to Support Physical Activity Assessment, Counseling and Interventions for Cardiovascular Disease Risk Reduction.

Author

Lobelo, Felipe, Kelli, Heval M., Tejedor, Sheri Chernetsky, Pratt, Michael, McConnell, Michael V., Martin, Seth S., and Welk, Gregory J.

Abstract

Physical activity (PA) interventions constitute a critical component of cardiovascular disease (CVD) risk reduction programs. Objective mobile health (mHealth) software applications (apps) and wearable activity monitors (WAMs) can advance both assessment and integration of PA counseling in clinical settings and support community-based PA interventions. The use of mHealth technology for CVD risk reduction is promising, but integration into routine clinical care and population health management has proven challenging. The increasing diversity of available technologies and the lack of a comprehensive guiding framework are key barriers for standardizing data collection and integration. This paper reviews the validity, utility and feasibility of implementing mHealth technology in clinical settings and proposes an organizational framework to support PA assessment, counseling and referrals to community resources for CVD risk reduction interventions. This integration framework can be adapted to different clinical population needs. It should also be refined as technologies and regulations advance under an evolving health care system landscape in the United States and globally. [ABSTRACT FROM AUTHOR]

Published
2016
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