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1. Bidirectional Association Between Frailty and Cardiac Structure and Function: The Atherosclerosis Risk in Communities Study

Author: Diego Ramonfaur, Hicham Skali, Brian Claggett, B. Gwen Windham, Priya Palta, Dalane Kitzman, Chiadi Ndumele, Suma Konety, and Amil M. Shah
Subjects: echocardiography, epidemiology, frailty, LV function, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Frailty and heart failure frequently coexist in late life. Limited data exist regarding the longitudinal associations of frailty and subclinical cardiac dysfunction. We aim to quantify the association of frailty with longitudinal changes in cardiac function and of cardiac function with progression in frailty status in older adults. Methods and Results Participants in the Atherosclerosis Risk in Communities cohort underwent frailty assessments at Visit 5 (V5; 2011–2013), V6 (2016–2017), and V7 (2018–2019), and echocardiographic assessments at V5 and V7. We assessed the association between frailty status at V5 and changes in frailty status from V5 to V7 and changes in cardiac function over 6 years. We then evaluated the association of cardiac function measured at Visit 5 with progression in frailty status over 4 years. Multivariable regression models adjusted for demographics and comorbidities. Among 2574 participants free of heart failure at V5 and V7 (age 74±4 years at V5 and 81±4 years at V7), 3% (n=83) were frail. Frailty at V5 was associated with greater left atrial volume index and E/e' ratio at V5 and 7. Participants who transitioned from robust at V5 to frail at V7 demonstrated greater increases in left ventricular mass index, left atrial volume index, and E/e' over the same period. Among 1648 robust participants at Visit 5, greater left ventricular mass index and mean wall thickness, lower tissue Doppler imaging e', and higher E/e' ratio at Visit 5 were associated with progression in frailty status. Conclusions Among robust, older adults free of heart failure, progression in frailty and subclinical left ventricular remodeling and diastolic dysfunction are interrelated.
Published: 2023
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2. Coronary Artery Disease and Heart Failure With Preserved Ejection Fraction: The ARIC Study

Author: Jenine E. John, Brian Claggett, Hicham Skali, Scott D. Solomon, Jonathan W. Cunningham, Kunihiro Matsushita, Suma H. Konety, Dalane W. Kitzman, Thomas H. Mosley, Donald Clark, Patricia P. Chang, and Amil M. Shah
Subjects: atherosclerosis, coronary artery disease, diastolic function, echocardiography, heart failure with preserved ejection fraction, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Whether coronary artery disease (CAD) is a significant risk factor for heart failure (HF) with preserved ejection fraction (HFpEF) is unclear. Methods and Results Among 9902 participants in the ARIC (Atherosclerosis Risk in Communities) study, we assessed the association of incident CAD with subsequent incident HFpEF (left ventricular ejection fraction [≥50%]) and HF with reduced ejection fraction (HFrEF; left ventricular ejection fraction 1 year post‐CAD event, adjusted incidence of HFrEF and HFpEF were similar (7.2 [95% CI, 5.2–10.0] and 6.7 [4.8–9.2] per 1000 person‐years, respectively) and CAD remained predictive of both (HFrEF: hazard ratio, 2.76 [95% CI, 1.99–3.84]; HFpEF: 1.85 [1.35–2.54]) after adjusting for demographics and common comorbidities. Among 4779 HF‐free participants at Visit 5 (2011–2013), the 490 with prevalent CAD had lower left ventricular ejection fraction and higher left ventricular mass index, E/e’, and left atrial volume index (all P
Published: 2022
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3. Association of Pulmonary Function With Late‐Life Cardiac Function and Heart Failure Risk: The ARIC Study

Author: Sergio H. R. Ramalho, Brian L. Claggett, George R. Washko, Raul San Jose Estepar, Patricia P. Chang, Dalane W. Kitzman, Gerson Cipriano Junior, Scott D. Solomon, Hicham Skali, and Amil M. Shah
Subjects: cardiopulmonary, elderly, heart dysfunction, lung function, respiratory disease, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Pulmonary and cardiac functions decline with age, but the associations of pulmonary dysfunction with cardiac function and heart failure (HF) risk in late life is not known. We aimed to determine the associations of percent predicted forced vital capacity (ppFVC) and the ratio of forced expired volume in 1 second (FEV1) to forced vital capacity (FVC; FEV1/FVC) with cardiac function and incident HF with preserved or reduced ejection fraction in late life. Methods and Results Among 3854 HF‐free participants in the ARIC (Atherosclerosis Risk in Communities) cohort study who underwent echocardiography and spirometry at the fifth study visit (2011–2013), associations of FEV1/FVC and ppFVC with echocardiographic measures, cardiac biomarkers, and risk of HF, HF with preserved ejection fraction, and HF with reduced ejection fraction were assessed. Multivariable linear and Cox regression models adjusted for demographics, body mass index, coronary disease, atrial fibrillation, hypertension, and diabetes. Mean age was 75±5 years, 40% were men, 19% were Black, and 61% were ever smokers. Mean FEV1/FVC was 72±8%, and ppFVC was 98±17%. In adjusted analyses, lower FEV1/FVC and ppFVC were associated with higher NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; both P
Published: 2022
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4. Association of pulmonary hypertension and right ventricular function with exercise capacity in heart failure

Author: Kanako Teramoto, Morten Sengelov, Erin West, Mario Santos, Wilson Nadruz, Hicham Skali, and Amil M. Shah
Subjects: Heart failure, Pulmonary hypertension, Right ventricular dysfunction, Functional capacity, Respiratory efficiency, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Aim Relationships of pulmonary artery systolic pressure (PASP) and right ventricular (RV) dysfunction with exercise capacity are understudied. To assess the relationship of PASP and RV function with functional capacity and ventilatory efficiency in heart failure (HF) with a wide range of left ventricular ejection fraction (LVEF). Methods and results Five hundred thirty‐two consecutive HF patients referred for cardiopulmonary exercise testing [percent predicted peak VO2 (ppVO2), VE/VCO2 slope] and echocardiography [LVEF, PASP, and RV fractional area change (RVFAC)] were studied. Associations of PASP and RVFAC with ppVO2 and VE/VCO2 slope were assessed by multivariable linear regression and restricted cubic splines. Associations with composite of death, heart transplant, and LV assist device (median 3.9 year follow‐up) was assessed using multivariable Cox proportional hazard models. Mean age was 56 ± 14 years and mean LVEF was 35 ± 15%. Mean PASP was 34 ± 12 mmHg, RVFAC was 41 ± 13%, ppVO2 was 60 ± 21%, and VE/VCO2 slope was 35 ± 12. After adjusting for demographics, co‐morbidities, LVEF, mitral regurgitation severity, and left atrial volume index, higher PASP was associated with worse ppVO2 (P = 0.004) and was more robust in patients with LVEF ≥45% vs.
Published: 2020
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5. Cardiac Structure and Function and Diabetes‐Related Risk of Death or Heart Failure in Older Adults

Author: Riccardo M. Inciardi, Brian Claggett, Deepak K. Gupta, Susan Cheng, Jiankang Liu, Justin B. Echouffo Tcheugui, Chiadi Ndumele, Kunihiro Matsushita, Elizabeth Selvin, Scott D. Solomon, Amil M. Shah, and Hicham Skali
Subjects: cardiac structure and function, death, diabetes, echocardiography, heart failure, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Whether cardiac structure and function abnormalities associated with dysglycemia are sufficient to explain the increased risk of death or heart failure (HF) remains unclear. Methods and Results We analyzed 6059 participants (mean age, 75±5 years; 58% women; and 22% Black individuals) who attended the ARIC (Atherosclerosis Risk in Communities) study visit 5 examination (2011–2013). Participants were categorized as no diabetes, pre‐diabetes, and diabetes (on the basis of medical history and glycated hemoglobin values). We assessed whether diabetes modified the association between echocardiographic measures of cardiac structure and function and the composite of all‐cause death or HF hospitalization and then estimated the extent to which the increased risk of the composite outcome associated with diabetes was explained by cardiac structure and function. Diabetes was prevalent in 33.5% of the subjects. Death or HF occurred in 1111 (18%) at a rate of 3.6 per 100 person‐years. Both measures of cardiac structure and function and diabetes status were significantly associated with worse prognosis after accounting for clinical confounders. While diabetes was consistently associated with a higher risk of events, it did not significantly modify the association between cardiac abnormalities and the risk of death or HF, except for subjects with higher left atrial volume who showed higher relative risk of events (P for interaction
Published: 2022
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6. Depressive Symptoms, Cardiac Structure and Function, and Risk of Incident Heart Failure With Preserved Ejection Fraction and Heart Failure With Reduced Ejection Fraction in Late Life

Author: Katja Vu Bartholdy, Brian L. Claggett, Jenine E. John, Hicham Skali, Scott D. Solomon, Thomas H. Mosley, Janice E. Williams, Anna Kucharska‐Newton, Tor Biering‐Sørensen, and Amil M. Shah
Subjects: depression, echocardiography, heart failure, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Depressive symptoms are associated with heightened risk of heart failure (HF), but their association with cardiac function and with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) in late life is unclear. We aimed to determine the prevalence of depression in HFpEF and in HFrEF in late life, and the association of depressive symptoms with cardiac function and incident HFpEF and HFrEF. Methods and Results We studied 6025 participants (age, 75.3±5.1 years; 59% women; 20% Black race) in the ARIC (Atherosclerosis Risk in Communities) study at visit 5 who underwent echocardiography and completed the Center for Epidemiologic Studies Depression Scale questionnaire. Among HF‐free participants (n=5086), associations of Center for Epidemiologic Studies Depression Scale score with echocardiography and incident adjudicated HFpEF and HFrEF were assessed using multivariable linear and Cox proportional hazards regression. Prevalent HFpEF, but not HFrEF, was associated with a higher prevalence of depression compared with HF‐free participants (P0.05). Over 5.5‐year follow‐up, higher Center for Epidemiologic Studies Depression Scale score was associated with heightened risk of incident HFpEF (hazard ratio [HR] [95% CI], 1.06 [1.04–1.12]; P=0.02), but not HFrEF (HR [95% CI], 1.02 [0.96–1.08]; P=0.54), independent of echocardiographic measures, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), troponin, and hs‐CRP (high‐sensitivity C‐reactive protein) (HR [95% CI], 1.06 [1.00–1.12]; P=0.04). Conclusions Worse depressive symptoms predict incident HFpEF in late life, independent of common comorbidities, cardiac structure and function, and prognostic biomarkers. Further studies are necessary to understand the mechanisms linking depression to risk of HFpEF.
Published: 2021
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7. Pulmonary vascular dysfunction among people aged over 65 years in the community in the Atherosclerosis Risk In Communities (ARIC) Study: A cross-sectional analysis.

Author: Kanako Teramoto, Mário Santos, Brian Claggett, Jenine E John, Scott D Solomon, Dalane Kitzman, Aaron R Folsom, Mary Cushman, Kunihiro Matsushita, Hicham Skali, and Amil M Shah
Subjects: Medicine
Abstract: BackgroundHeart failure (HF) risk is highest in late life, and impaired pulmonary vascular function is a risk factor for HF development. However, data regarding the contributors to and prognostic importance of pulmonary vascular dysfunction among HF-free elders in the community are limited and largely restricted to pulmonary hypertension. Our objective was to define the prevalence and correlates of abnormal pulmonary pressure, resistance, and compliance and their association with incident HF and HF phenotype (left ventricular [LV] ejection fraction [LVEF] ≥ or < 50%) independent of LV structure and function.Methods and findingsWe performed cross-sectional and time-to-event analyses in a prospective epidemiologic cohort study, the Atherosclerosis Risk in Communities study. This is an ongoing, observational study that recruited 15,792 persons aged 45-64 years between 1987 and 1989 (visit 1) from four representative communities in the United States: Minneapolis, Minnesota; Jackson, Mississippi; Hagerstown, Maryland; and Forsyth County, North Carolina. The current analysis included 2,810 individuals aged 66-90 years, free of HF, who underwent echocardiography at the fifth study visit (June 8, 2011, to August 28, 2013) and had measurable tricuspid regurgitation by spectral Doppler. Echocardiography-derived pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR), and pulmonary arterial compliance (PAC) were measured. The main outcome was incident HF after visit 5, and key secondary end points were incident HF with preserved LVEF (HFpEF) and incident HF with reduced LVEF (HFrEF). The mean ± SD age was 76 ± 5 years, 66% were female, and 21% were black. Mean values of PASP, PVR, and PAC were 28 ± 5 mm Hg, 1.7 ± 0.4 Wood unit, and 3.4 ± 1.0 mL/mm Hg, respectively, and were abnormal in 18%, 12%, and 14%, respectively, using limits defined from the 10th and 90th percentile limits in 253 low-risk participants free of cardiovascular disease or risk factors. Left heart dysfunction was associated with abnormal PASP and PAC, whereas a restrictive ventilatory deficit was associated with abnormalities of PASP, PVR, and PAC. PASP, PVR, and PAC were each predictive of incident HF or death (hazard ratio per SD 1.3 [95% CI 1.1-1.4], p < 0.001; 1.1 [1.0-1.2], p = 0.04; 1.2 [1.1-1.4], p = 0.001, respectively) independent of LV measures. Elevated pulmonary pressure was predictive of incident HFpEF (HFpEF: 2.4 [1.4-4.0, p = 0.001]) but not HFrEF (1.4 [0.8-2.5, p = 0.31]). Abnormal PAC predicted HFrEF (HFpEF: 2.0 [1.0-4.0, p = 0.05], HFrEF: 2.8 [1.4-5.5, p = 0.003]), whereas abnormal PVR was not predictive of either (HFpEF: 0.9 [0.4-2.0, p = 0.85], HFrEF: 0.7 [0.3-1.4, p = 0.30],). A greater number of abnormal pulmonary vascular measures was associated with greater risk of incident HF. Major limitations include the use of echo Doppler to estimate pulmonary hemodynamic measures, which may lead to misclassification; inclusions bias related to detectable tricuspid regurgitation, which may limit generalizability of our findings; and survivor bias related to the cohort age, which may result in underestimation of the described associations.ConclusionsIn this study, we observed abnormalities of PASP, PVR, and PAC in 12%-18% of elders in the community. Higher PASP and lower PAC were independently predictive of incident HF. Abnormally high PASP predicted incident HFpEF but not HFrEF. These findings suggest that impairments in pulmonary vascular function may precede clinical HF and that a comprehensive pulmonary hemodynamic evaluation may identify pulmonary vascular phenotypes that differentially predict HF phenotypes.
Published: 2020
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8. Prognostic Value of Cardiopulmonary Exercise Testing in Heart Failure With Reduced, Midrange, and Preserved Ejection Fraction

Author: Wilson Nadruz, Erin West, Morten Sengeløv, Mário Santos, John D. Groarke, Daniel E. Forman, Brian Claggett, Hicham Skali, and Amil M. Shah
Subjects: cardiopulmonary exercise testing, ejection fraction, heart failure, oxygen consumption, preserved ejection fraction, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BackgroundThis study aimed to compare the independent and incremental prognostic value of peak oxygen consumption (VO2) and minute ventilation/carbon dioxide production (VE/VCO2) in heart failure (HF) with preserved (HFpEF), midrange (HFmEF), and reduced (HFrEF) ejection fraction (LVEF). Methods and ResultsIn 195 HFpEF (LVEF ≥50%), 144 HFmEF (LVEF 40–49%), and 630 HFrEF (LVEF
Published: 2017
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9. Kidney Disease Measures and Left Ventricular Structure and Function: The Atherosclerosis Risk in Communities Study

Author: Kunihiro Matsushita, Lucia Kwak, Yingying Sang, Shoshana H. Ballew, Hicham Skali, Amil M. Shah, Josef Coresh, and Scott Solomon
Subjects: albuminuria, cardiac function, cardiac structure, epidemiology, glomerular filtration rate, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BackgroundHeart failure is one of the most important complications of chronic kidney disease (CKD). However, few studies comprehensively investigated left ventricular (LV) structure and function in relation to 2 key CKD measures, estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR). Methods and ResultsAmong 4175 ARIC (Atherosclerosis Risk in Communities) participants (aged 66–90 years during 2011–2013), we quantified the association of eGFR and ACR with echocardiogram parameters of LV mass, size, systolic function, and diastolic function. Adjusting for demographic variables, both CKD measures were significantly associated with most echocardiogram parameters. Additionally accounting for other potential confounders, we observed significantly higher LV mass index according to reduced eGFR (82.3 [95% confidence interval (CI), 77.6–87.0] g/m2 for eGFR
Published: 2017
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10. Chronic Kidney Disease, Heart Failure, and Adverse Cardiac Remodeling in Older Adults

Author: Leo F. Buckley, Brian L. Claggett, Kunihiro Matsushita, Gearoid M. McMahon, Hicham Skali, Josef Coresh, Aaron R. Folsom, Suma H. Konety, Lynne E. Wagenknecht, Thomas H. Mosley, and Amil M. Shah
Subjects: Cardiology and Cardiovascular Medicine
Published: 2023
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11. Coronary Flow Reserve, Inflammation, and Myocardial Strain

Author: Viviany R. Taqueti, Amil M. Shah, Brendan M. Everett, Aruna D. Pradhan, Gregory Piazza, Courtney Bibbo, Jon Hainer, Victoria Morgan, Ana Carolina do A. H. de Souza, Hicham Skali, Ron Blankstein, Sharmila Dorbala, Samuel Z. Goldhaber, Michel R. Le May, Benjamin J.W. Chow, Robert A. deKemp, Fadi G. Hage, Rob S. Beanlands, Peter Libby, Robert J. Glynn, Scott D. Solomon, Paul M. Ridker, and Marcelo F. Di Carli
Subjects: Cardiology and Cardiovascular Medicine
Published: 2023
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12. Weight Loss and Its Predictors During Participation in Cardiac Rehabilitation

Author: Pavel Hushcha, S. Hammad Jafri, Majed M. Malak, Frances Parpos, Pranav Dorbala, Gisele Bousquet, Christine Lutfy, Lindsay Sonis, Lexie Cabral, Lauren Mellett, Donna Polk, and Hicham Skali
Subjects: Cardiac Rehabilitation, Body Weight, Weight Loss, Humans, Obesity, Overweight, Cardiology and Cardiovascular Medicine, Body Mass Index
Abstract: We aimed to assess the prevalence and magnitude of clinically meaningful weight loss among cardiac rehabilitation (CR) participants who were overweight or obese and identify its predictors. We analyzed subjects with body mass index (BMI) ≥25 who were enrolled in a 12-week CR outpatient program from January 1, 2015, to December 31, 2019, and had paired pre- and post-CR weight data. Patients who lost 3% or more of their body weight by the end of the program were compared with the remaining participants. Multivariable logistic regression was used to determine predictors of weight loss. Overall, 129 of 485 subjects (27%) with overweight or obesity reduced their weight by at least 3% (average percent weight change: -5.0% ± 1.8% vs -0.02% ± 2.2%, average weight change: -10.9 ± 5.0 vs -0.1 ± 4.4 pounds, and average BMI change: -1.7 ± 0.7 vs -0.02 ± 0.7 kg/m
Published: 2022
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13. Longitudinal trajectories in renal function before and after heart failure hospitalization among patients with heart failure with preserved ejection fraction in the <scp>PARAGON‐HF</scp> trial

Author: Safia Chatur, Muthiah Vaduganathan, Alexander Peikert, Brian L. Claggett, Finnian R. McCausland, Hicham Skali, Marc A. Pfeffer, Iris E. Beldhuis, Lars Kober, Petar Seferovic, Martin Lefkowitz, John J.V. McMurray, and Scott D. Solomon
Subjects: Heart Failure, Aminobutyrates, Biphenyl Compounds, Aftercare, Tetrazoles, Stroke Volume, Angiotensin-Converting Enzyme Inhibitors, Kidney, Patient Discharge, Hospitalization, Angiotensin Receptor Antagonists, Drug Combinations, Heart failure with preserved ejection fraction, Kidney function, Humans, Valsartan, Sacubitril/valsartan, Cardiology and Cardiovascular Medicine
Abstract: Aims: Worsening renal function may impact long-term outcomes in heart failure (HF). However, little is known about the longitudinal trajectories in renal function in relation to HF hospitalization or how this high-risk clinical event impacts renal outcomes.Methods and results: In PARAGON-HF, we evaluated the association between recency of prior HF hospitalization (occurring pre-randomization) and subsequent first renal composite outcome: (i) time to ≥50% decline in estimated glomerular filtration rate (eGFR); (ii) development of end-stage renal disease; or (iii) death attributable to renal causes. A total of 2306 (48.1%) patients had a history of prior HF hospitalization. Incident rates of the renal outcome were highest in those most recently hospitalized and decreased with longer time from last hospitalization. Treatment effect on the renal outcome of sacubitril/valsartan versus valsartan was similar between patients with (hazard ratio [HR] 0.43; 95% confidence interval [CI] 0.24–0.76) and without (HR 0.63; 95% CI: 0.33–1.18; pinteraction = 0.39) a prior history of HF hospitalization and appeared consistent regardless of timing of prior hospitalization for HF (pinteraction = 0.39). Serial eGFR measurements leading up to and after a HF hospitalization (occurring during the study period) and estimated eGFR trajectories using repeated measures regression models with restricted cubic splines were also examined. Patients experiencing a post-randomization HF hospitalization had a significant decline in eGFR prior to hospitalization while patients without HF hospitalization experienced a relatively stable eGFR trajectory (p < 0.001). A change in the rate of decline of eGFR trajectory was observed 12 months preceding a HF hospitalization, and continued in the post-discharge window to 12 months following hospitalization.Conclusions: Heart failure hospitalization denotes increased risk for kidney disease progression which continues following recovery from HF decompensation in patients with HF with preserved ejection fraction.Clinical Trial Registration: PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction), ClinicalTrials.gov NCT01920711.
Published: 2022
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14. Impact of coronary artery calcium testing on patient management

Author: Wanda Y. Wu, David W. Biery, Adam N. Berman, Grace Hsieh, Sanjay Divakaran, Sumit Gupta, Michael L. Steigner, Ayaz Aghayev, Hicham Skali, Donna M. Polk, Jorge Plutzky, Christopher P. Cannon, Marcelo F. Di Carli, and Ron Blankstein
Subjects: Adult, Male, Cholesterol, LDL, Coronary Artery Disease, Coronary Vessels, Risk Assessment, Article, Predictive Value of Tests, Risk Factors, Humans, Calcium, Female, Radiology, Nuclear Medicine and imaging, Vascular Calcification, Cardiology and Cardiovascular Medicine, Retrospective Studies
Abstract: BACKGROUND: Coronary artery calcium (CAC) scoring can identify individuals who may benefit from aggressive prevention therapies. However, there is a paucity of contemporary data on the impact of CAC testing on patient management. METHODS: Retrospective cohort study of adults who underwent CAC testing at Brigham and Women’s Hospital between 2015 and 2019. Information on baseline medications, follow-up medications, lifestyle modification, and downstream cardiovascular testing within one-year post-CAC were obtained from electronic health records. RESULTS: Of the 839 patients with available baseline and follow-up data, 376 (45%) had a CAC = 0, 289 (34%) had CAC = 1–99, and 174 (21%) had CAC≥100. The mean age at time of CAC testing was 59 ± 9.7 years. Patients with higher CAC scores were more likely to be male, have diabetes and hypertension, and have higher low-density lipoprotein cholesterol and lower high-density lipoprotein cholesterol. A non-zero CAC score was associated with initiation of aspirin (41% increase, p < 0.001), anti-hypertensives (9% increase, p = 0.031), and lipid-lowering therapies (114% increase, p < 0.001), whereas CAC = 0 was not. Among individuals with CAC≥100, 75% were started on new or more intense lipid-lowering therapy. Higher calcium scores correlated with increased physician recommendations for diet (p = 0.008) and exercise (p = 0.004). The proportion of cardiovascular downstream testing following CAC was 9.1%, and the majority of patients who underwent additional testing post-CAC had CAC scores ≥100. CONCLUSION: Approximately half of individuals referred for CAC testing had evidence of calcified coronary plaque, and of those who had significant calcifications (CAC≥100), nearly 90% were prescribed lipid-lowering therapies post-CAC. Rates of downstream non-invasive testing were low and such testing was mostly performed in patients who had at least moderate CAC.
Published: 2022
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15. Right Ventricular Function and Coupling to Pulmonary Circulation in Heart Failure with Preserved Ejection Fraction: The PARAGON-HF Trial

Author: Riccardo M. Inciardi, Martin Abanda, Amil Shah, Maja Cikes, Brian Claggett, Hicham Skali, Muthiah Vaduganathan, Narayana Prasad, Sheldon Litwin, Bela Merkely, Annamaria Kosztin, Klaudia Vivien Nagy, Sanjiv Shah, Wilfred Mullens, Michael Zile, Carolyn S.P. Lam, Marc Pfeffer, John J.V. McMurray, and Scott D. Solomon
Subjects: Cardiology and Cardiovascular Medicine
Published: 2023
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16. Longitudinal Changes in Left Ventricular Diastolic Function in Late Life

Author: Li Zhao, Rani Zierath, Brian Claggett, Pranav Dorbala, Kunihiro Matsushita, Dalane Kitzman, Aaron R. Folsom, Suma Konety, Thomas Mosley, Hicham Skali, and Amil M. Shah
Subjects: Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine
Published: 2023
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17. Diabetes and Progression of Heart Failure

Author: Justin B. Echouffo-Tcheugui, Chiadi E. Ndumele, Sui Zhang, Roberta Florido, Kunihiro Matsushita, Josef Coresh, Hicham Skali, Amil M. Shah, and Elizabeth Selvin
Subjects: Cardiology and Cardiovascular Medicine
Published: 2022
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18. Update on guidance and best practices for nuclear cardiology laboratories during the coronavirus disease 2019 (COVID-19) pandemic: Emphasis on transition to chronic endemic state. An information statement from ASNC, IAEA, and SNMMI

Author: Randall C. Thompson, Lawrence M. Phillips, Vasken Dilsizian, Diana Paez Gutierrez, Andrew J. Einstein, Suzanne F. Crews, Hicham Skali, Felix Keng Yung Jih, Maurizio Dondi, Alessia Gimelli, Timothy M. Bateman, Mouaz H. Al-Mallah, Munir Ghesani, Sharmila Dorbala, and Dennis A. Calnon
Subjects: Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine
Published: 2022
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19. Association of Left Atrial Structure and Function With Heart Failure in Older Adults

Author: Riccardo M. Inciardi, Brian Claggett, Masatoshi Minamisawa, Sung-Hee Shin, Senthil Selvaraj, Alexandra Gonçalves, Wendy Wang, Dalane Kitzman, Kunihiro Matsushita, Narayana G. Prasad, Jimmy Su, Hicham Skali, Amil M. Shah, Lin Yee Chen, and Scott D. Solomon
Subjects: Aged, 80 and over, Heart Failure, Male, Heart Diseases, heart failure, left atrium, speckle tracking, Stroke Volume, Peptide Fragments, Ventricular Function, Left, Natriuretic Peptide, Brain, Humans, Female, Heart Atria, Cardiology and Cardiovascular Medicine, Biomarkers, Aged
Abstract: Limited data exist to characterize novel measures of left atrial (LA) structure and function in older adults without prevalent heart failure (HF).The aim was to assess reference range of LA measures, their associations with N-terminal pro-B-type natriuretic-peptide (NT-proBNP) and the related risk for incident HF or death.We analyzed LA structure (LA maximal [LAViMax] and minimal volume indexed by body surface area) and function (LA emptying fraction, LA reservoir, conduit, and contraction strain) in 4,901 participants from the ARIC (Atherosclerosis Risk In Communities) study (mean age 75 ± 5 years, 40% male, and 19% Black) without prevalent HF. We assessed sex-specific 10th and 90th percentile ARIC-based reference limits in 301 participants free of prevalent cardiovascular disease, and related LA measures to NT-proBNP and incident HF or death (median follow-up of 5.5 years) in the whole ARIC cohort.Approximately 20% of the overall population had LA abnormalities according to the ARIC-based reference limit. Each LA measure was associated with NT-proBNP and, except for LAViMax, with incident HF or death after multivariable adjustment (including left ventricular function and NT-proBNP). Results were consistent in participants with normal LAViMax (P for interaction0.05). LA measures were prognostic for both incident HF with preserved ejection fraction or death and incident HF with reduced ejection fraction or death. When added to HF risk factors and NT-proBNP (baseline C-statistics = 0.74) all LA measures, except for LAViMax, significantly enhanced the prognostic accuracy.Novel measures of LA structure and function, but not standard assessment by LAViMax, are associated with increased risk of incident HF or death regardless of measures of left ventricular function and NT-proBNP.
Published: 2022
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20. Abstract P199: Proteomic Markers of Aortic Stenosis: The Atherosclerosis Risk in Communities Study

Author: Khaled Shelbaya, Victoria Arthur, Leo Buckley, Brian Claggett, Hicham Skali, Christie M Ballantyne, Josef Coresh, Kuni Matsushita, Bing Yu, and Amil M Shah
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Introduction: Although prevalence of aortic stenosis (AS) is increasing, little is known regarding circulating proteins predictive of AS development. Hypothesis: Novel circulating proteins associated with AS hemodynamics and clinical outcomes can be discovered using plasma proteomics. Methods: In the community-based Atherosclerosis Risk in Communities study, we measured plasma proteomics using the SOMAscan aptamer-affinity assay (n=4,877 aptamers; Somalogic Inc.) at study Visits 3 (V3; 1992-94; n=11,430) and 5 (V5; 2011-2013; n=4,899). Multivariable linear regression was used to estimate cross-sectional associations of log-transformed proteins at V5 with aortic valve (AV) peak velocity (Vmax) assessed by protocol echocardiography at a false discovery rate (FDR) of Results: At V5 (age 76 ± 5 years; 43% male; 18% Black adults), 946 proteins were cross-sectionally associated with Vmax. At V3, (age 60 ± 6 years; 46% male; 21% Black), 84 of these were associated with risk of AS-related hospitalization post-V3 (median follow-up 22.2 [IQR 14.4 - 24.8] years, n=912 events). Of these 84 proteins, 52 were also cross-sectionally associated with the Dimensionless index (DI) at V5. Hierarchical clustering based on V5 AV hemodynamic indices identified one cluster of 14 proteins associated with lower hemodynamic AS severity and risk of AV-related hospitalization ( Figure ). Proteins in the remaining three clusters were associated with higher Vmax, lower DI, and higher risk of AV-related hospitalization. The nine proteins in cluster 4 were also associated with lower indexed AV area. Conclusion: We identified 52 circulating proteins with robust associations with AV hemodynamics and hospitalization risk, providing potential novel biomarkers for AS risk.
Published: 2023
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21. Association of left atrial structure and function with heart failure in older adults

Author: Inciardi, Riccardo M., Brian, Claggett, Masatoshi, Minamisawa, Sung-Hee, Shin, Senthil, Selvaraj, Alexandra, Gonçalves, Wendy, Wang, Dalane, Kitzman, Kunihiro, Matsushita, Prasad MD, Narayana G., Jimmy, Su, Hicham, Skali, Shah, Amil M., Lin Yee Chen, and Solomon, Scott D.
Subjects: Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Left atrium – Heart failure – Speckle-tracking
Published: 2023

22. Coronary vasomotor dysfunction portends worse outcomes in patients with breast cancer

Author: Sanjay Divakaran, Courtney F. Bibbo, Jesse Caron, Hicham Skali, Wunan Zhou, Anju Nohria, Viviany R. Taqueti, Sharmila Dorbala, Ron Blankstein, Jon Hainer, Marcelo F. Di Carli, and John D. Groarke
Subjects: medicine.medical_specialty, Ejection fraction, business.industry, Disease, medicine.disease, Breast cancer, Internal medicine, Cohort, Medicine, Biomarker (medicine), Radiology, Nuclear Medicine and imaging, Cumulative incidence, Cardiology and Cardiovascular Medicine, business, Adverse effect, Mace
Abstract: Impaired MFR in the absence of flow-limiting CAD is associated with adverse events. Cardiovascular disease is an important cause of morbidity and mortality in patients with breast cancer. We sought to test the utility of MFR to predict outcomes in a cohort of patients with breast cancer. We retrospectively studied consecutive patients with breast cancer or breast cancer survivors who underwent cardiac stress PET imaging from 2006 to 2017 at Brigham and Women’s Hospital. Patients with a history of clinically overt CAD, LVEF < 45%, or abnormal myocardial perfusion were excluded. Subjects were followed from time of PET to the occurrence of a first major adverse cardiovascular event (MACE) and all-cause death. The final cohort included 87 patients (median age 69.0 years, 98.9% female, mean MFR 2.05). Over a median follow-up of 7.6 years after PET, the lowest MFR tertile was associated with higher cumulative incidence of MACE (adjusted subdistribution hazard ratio 4.91; 95% CI 1.68-14.38; p = 0.004) when compared with the highest MFR tertile. In patients with breast cancer, coronary vasomotor dysfunction was associated with incident cardiovascular events. MFR may have potential as a risk stratification biomarker among patients with/survivors of breast cancer.
Published: 2021
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23. Stages of Valvular Heart Disease Among Older Adults in the Community: The Atherosclerosis Risk in Communities Study

Author: Khaled Shelbaya, Brian Claggett, Pranav Dorbala, Hicham Skali, Scott D. Solomon, Kunihiro Matsushita, Suma Konety, Thomas H. Mosley, and Amil M. Shah
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Background: Limited data exist on American College of Cardiology/American Heart Association valvular heart disease (VHD) stage prevalence, progression, and association with incident cardiovascular diseases in late life. Methods: Participants in the ARIC study (Atherosclerosis Risk in Communities), a prospective community-based cohort study, underwent protocol echocardiography at ARIC visits 5 (2011–2013) and 7 (2018–2019), and their aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation stage were defined according to American College of Cardiology/American Heart Association guidelines. The overall VHD stage prevalence at visit 5 was measured. The associations between VHD stages and incident adjudicated death, heart failure, coronary heart disease, stroke, and atrial fibrillation were assessed with Cox proportional hazard models adjusted for age, sex, race, hypertension, diabetes, prior myocardial infarction, heart failure, body mass index, study center, systolic blood pressure, estimated glomerular filtration rate, and low-density lipoprotein at visit 5. Longitudinal changes in VHD stage prevalence over ≈6 years were estimated with inverse probability of attrition weights to account for participant attrition. Results: Among 6118 ARIC participants, the mean±SD age was 76±5 years, 42% were male, and 22% reported Black race. Stage A VHD was present in 39%, stage B in 17%, and stage C/D in 1.1%;, 0.7% had previously undergone valve replacement or repair. A graded association was observed between stage A, B, and C/D VHD and risk of all-cause mortality, incident heart failure, incident atrial fibrillation, and incident coronary heart disease, but not incident stroke. Similar findings were observed for stages of each valvular lesion individually. During the 6.6 years (interquartile range, 6.1–7.0 years) between visits 5 and 7 (mean age, 81±4 years), the prevalence of freedom from VHD stage decreased from 43% to 24%, whereas the prevalence of stage C/D VHD increased from 1% to 7%. Conclusions: Subclinical VHD is common in older adults, with 39% at risk (stage A) and 17% with progressive VHD (stage B), and is independently associated with risk of incident cardiovascular events. VHD stages progress over 6 years in late life, with a several-fold increase in prevalence of severe VHD (stage C/D), highlighting the public health importance of interventions to mitigate VHD progression.
Published: 2022

24. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author: Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara 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O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C 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Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, 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Paula García-González, Paulo Cury Rezende, Paulo Ricardo Caramori, Pavel S Kozlov, Pedro Canas Silva, Pedro Gabriel Melo Barros E Silva, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peeyush Jain, Peiyu He, Peter A McCullough, Peter H Stone, Peter M Pollak, Peter Douglass, Peter Henriksen, Peter OKane, Peter Ong, Philip Jones, Philip Rogal, Philippe Généreux, Philippe Menasche, Philippe Rheault, Phoebe Goold, Pierre Gervais, Pierre Michaud, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Piotr Slomka, Piyamitr Sritara, Poay-Huan Loh, Poonam Sonawane, Pouneh Samadi, Pragnesh P Parikh, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Precilia Vasquez, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puja K Mehta, Purvez Grant, Pushpa Naik, Qi Zhong, Qian Zhao, Qiang Zhou, Qianqian Yuan, Qin Yu, Qingxian Li, Qiulan Xie, Qiutang Zeng, R J Vindhya, R James Gerlach, Rachel King, Rada Vučić, Radmila Lyubarova, Radoslaw Pracon, 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George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona 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Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits
Subjects: Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract: BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
Published: 2020
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25. High-Sensitivity Cardiac Troponin, Natriuretic Peptide, and Long-Term Risk of Acute Kidney Injury: The Atherosclerosis Risk in Communities (ARIC) Study

Author: Yingying Sang, Yuhree Kim, Ron C. Hoogeveen, Morgan E. Grams, Hicham Skali, Elizabeth Selvin, Josef Coresh, Steven Menez, Scott D. Solomon, Amil M. Shah, Junichi Ishigami, Kunihiro Matsushita, and Christie M. Ballantyne
Subjects: Male, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Clinical Biochemistry, Population, 030204 cardiovascular system & hematology, Revascularization, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Troponin T, Risk Factors, Internal medicine, Natriuretic Peptide, Brain, Natriuretic peptide, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, education, Proportional Hazards Models, education.field_of_study, business.industry, Proportional hazards model, Biochemistry (medical), Hazard ratio, Acute kidney injury, Articles, Acute Kidney Injury, Middle Aged, medicine.disease, Peptide Fragments, Hospitalization, Atherosclerosis Risk in Communities, Cardiology, Female, business, Biomarkers
Abstract: Background Cardiac markers such as high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B natriuretic peptide (NTproBNP) are predictors of developing acute kidney injury (AKI) during hospitalization for surgery or revascularization. However, their associations with the long-term risk of AKI in the general population are uncharacterized. Methods We conducted a prospective cohort study in 10 669 participants of the Atherosclerosis Risk in Communities Study (visit 4, 1996–1998, mean age, 63 years, 56% female, 22% black race) to examine the association of plasma concentrations of hs-cTnT and NTproBNP with the incident hospitalization with AKI. We used multivariable Cox regression analysis to estimate hazard ratios (HRs). Results During follow-up, 1907 participants had an incident hospitalization with AKI. Participants with higher concentrations of hs-cTnT had a higher risk of hospitalization with AKI in a graded fashion (adjusted HR, 1.88 [95%CI , 1.59–2.21] for ≥14 ng/L, 1.36 [1.18–1.57] for 9–13 ng/L, and 1.16 [1.03–1.30] for 5-8 ng/L compared to Conclusions In middle-aged to older black and white adults in the community, higher concentrations of hs-cTnT and NTproBNP were robustly associated with an increased risk of hospitalization with AKI. These results suggest the usefulness of hs-cTnT and NT-proBNP to identify people at risk of AKI in the general population.
Published: 2020
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26. Inter-observer reproducibility and intra-observer repeatability in 99mTc-pyrophosphate scan interpretation for diagnosis of transthyretin cardiac amyloidosis

Author: Hicham Skali, Sarah Cuddy, Marcelo F. Di Carli, Mi-Ae Park, Vasvi Singh, Ron Blankstein, Viviany R. Taqueti, Marie Foley Kijewski, Sharmila Dorbala, Alexandra Taylor, and Rodney H. Falk
Subjects: Reproducibility, biology, business.industry, Inter observer reproducibility, Coefficient of variation, Concordance, Repeatability, 030204 cardiovascular system & hematology, Intra observer, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Transthyretin, 0302 clinical medicine, Cardiac amyloidosis, biology.protein, Medicine, Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine, business, Nuclear medicine
Abstract: The purpose of this study was to determine the inter- and intra-observer variability in 99mtechnetium-pyrophosphate (99mTc-PYP) scan interpretation for diagnosis of transthyretin cardiac amyloidosis (ATTR). Our study cohort comprised 100 consecutive subjects referred for 99mTc-PYP imaging based on clinical suspicion of ATTR cardiac amyloidosis. Myocardial 99mTc-PYP uptake was assessed by both visual (comparison of myocardial to rib uptake) and semi-quantitative (heart-to-contralateral lung uptake ratio, H:CL) methods. Twenty scans were analyzed twice, at least 48 hours apart, by each of two independent observers. Patients with visual scores of ≥ 2 on planar imaging as well as myocardial uptake on SPECT/CT were classified as ATTR positive. Diagnosis of ATTR by visual 99mTc-PYP grade was perfectly reproducible [concordance: positive and negative scans 100% (53/53 and 47/47, respectively). Both inter- and intra-observer correlations for H:CL ratio (r2 = 0.90, 0.99 (Observer 1) and 0.98 (Observer 2), respectively) and repeatability values on Bland–Altman plots were excellent. The coefficient of variation (%) for Observers 1 and 2 was 3.21 (2.14 to 4.29) and 7.49 (4.95 to 10.09), respectively. In addition, there was 100% concordance in positive and negative scan interpretation by visual grading between novice CV imagers (< 3 years’ experience) and an experienced CV imager (10 years’ experience). This study showed excellent inter-observer reproducibility and intra-observer repeatability of 99mTc-PYP visual scan interpretation and H:CL ratio for diagnosis of cardiac ATTR amyloidosis. Cardiac ATTR amyloidosis can be diagnosed reliably using 99mTc-PYP SPECT/CT by novice and experienced CV imagers.
Published: 2020
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27. Absolute Quantitation of Cardiac 99mTc-Pyrophosphate Using Cadmium-Zinc-Telluride–Based SPECT/CT

Author: Hicham Skali, Sirwoo Kim, Sharmila Dorbala, Marie Foley Kijewski, Marcelo F. Di Carli, Vasvi Singh, Mi-Ae Park, Rodney H. Falk, Ron Blankstein, Sarah Cuddy, Kyle Sullivan, Viviany R. Taqueti, and Camden P. Bay
Subjects: Body surface area, business.industry, Coefficient of variation, Repeatability, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, Cadmium zinc telluride, Correlation, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, chemistry, Cardiac amyloidosis, Linear regression, Medicine, Radiology, Nuclear Medicine and imaging, business, Nuclear medicine, Cardiac imaging
Abstract: The primary aims of this study were to determine the correlation between absolute quantitative 99mTc-pyrophosphate metrics and traditional measures of cardiac amyloid burden and to measure the intraobserver repeatability of the quantitative metrics. Methods: We studied 72 patients who underwent 99mTc-pyrophosphate SPECT/CT using a novel general-purpose cadmium-zinc-telluride-based SPECT/CT system. The clinical standard for these studies is visual grading (with grades of 0, 1, 2, and 3 indicating myocardial uptake absent, less than rib uptake, equal to rib uptake, or more than rib uptake, respectively). A visual grade of 2 or more was considered positive. For 72 patients, SUVmax, SUVmean, cardiac amyloid activity (CAA; i.e., SUVmean × left ventricular [LV] volume), and percentage injected dose (%ID) were calculated, and visual grading was performed. The correlation was determined between the 4 quantitative metrics or visual grades and the LV mass index (LVMI) (indexed to body surface area on echocardiography, 67 patients). For a subset of 11 patients, the correlation was determined between the visual or quantitative metrics and the extracellular volume (ECV) on cardiac MRI. Normal linear regression was used to compare the standardized association of each of the 4 quantitative metrics with LVMI, as a surrogate for amyloid burden. Receiver-operating-characteristic curve analysis was used to determine the diagnostic accuracy of quantitative metrics, using visual grading as the reference standard. The intraobserver repeatability of generating quantitative metrics was also determined. Results: All 4 quantitative metrics were highly accurate, with an area under the receiver-operating-characteristic curve of more than 0.96 for diagnosis of transthyretin cardiac amyloidosis. SUVmax, SUVmean, CAA, %ID, and visual grade were moderately positively correlated with LVMI (r = 0.485 for %ID) and strongly positively correlated, albeit in a small cohort, with ECV (r = 0.873, SUVmax). Intraobserver repeatability was excellent, with less than a 2% coefficient of variation for SUVmax, %ID, and CAA and 3.8% for SUVmean All 4 quantitative metrics had a standardized effect of more than 0.324 on LVMI; the largest standardized effect was 0.485, for %ID. Conclusion: In this first (to our knowledge) study of 99mTc-pyrophosphate cardiac imaging using a novel cadmium-zinc-telluride SPECT/CT scanner, SUVmax, SUVmean, CAA, and %ID measured by absolute quantitation of 99mTc-pyrophosphate were moderately correlated with LVMI and strongly correlated, albeit in a small cohort, with ECV. The intraobserver repeatability of generating the quantitative metrics was excellent.
Published: 2020
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28. Association of pulmonary hypertension and right ventricular function with exercise capacity in heart failure

Author: Hicham Skali, Morten Sengeløv, Amil M. Shah, Wilson Nadruz, Kanako Teramoto, Mário Santos, and Erin West
Subjects: Adult, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, Hypertension, Pulmonary, Heart failure, 030204 cardiovascular system & hematology, Ventricular Function, Left, Pulmonary hypertension, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine.artery, Original Research Articles, Functional capacity, medicine, Humans, 030212 general & internal medicine, Original Research Article, Respiratory system, Right ventricular dysfunction, Aged, Mitral regurgitation, Ejection fraction, Exercise Tolerance, Respiratory efficiency, business.industry, Stroke Volume, Exercise capacity, Middle Aged, medicine.disease, Prognosis, Blood pressure, lcsh:RC666-701, Pulmonary artery, Cardiology, Ventricular Function, Right, Cardiology and Cardiovascular Medicine, business
Abstract: Aim Relationships of pulmonary artery systolic pressure (PASP) and right ventricular (RV) dysfunction with exercise capacity are understudied. To assess the relationship of PASP and RV function with functional capacity and ventilatory efficiency in heart failure (HF) with a wide range of left ventricular ejection fraction (LVEF). Methods and results Five hundred thirty‐two consecutive HF patients referred for cardiopulmonary exercise testing [percent predicted peak VO2 (ppVO2), VE/VCO2 slope] and echocardiography [LVEF, PASP, and RV fractional area change (RVFAC)] were studied. Associations of PASP and RVFAC with ppVO2 and VE/VCO2 slope were assessed by multivariable linear regression and restricted cubic splines. Associations with composite of death, heart transplant, and LV assist device (median 3.9 year follow‐up) was assessed using multivariable Cox proportional hazard models. Mean age was 56 ± 14 years and mean LVEF was 35 ± 15%. Mean PASP was 34 ± 12 mmHg, RVFAC was 41 ± 13%, ppVO2 was 60 ± 21%, and VE/VCO2 slope was 35 ± 12. After adjusting for demographics, co‐morbidities, LVEF, mitral regurgitation severity, and left atrial volume index, higher PASP was associated with worse ppVO2 (P = 0.004) and was more robust in patients with LVEF ≥45% vs.
Published: 2020

29. Guidance and best practices for reestablishment of non-emergent care in nuclear cardiology laboratories during the coronavirus disease 2019 (COVID-19) pandemic: An information statement from ASNC, IAEA, and SNMMI

Author: Diana Paez, Hicham Skali, Rob S. Beanlands, Felix Keng, Robert Pagnanelli, Vasken Dilsizian, Sharmila Dorbala, Timothy M. Bateman, Venkatesh L. Murthy, Maurizio Dondi, Andrew J. Einstein, Ignasi Carrió, Randall C. Thompson, Prem Soman, Roxana Campisi, Elisa M. Choi, McGhie G.A. Iain, Mouaz H. Al-Mallah, Donna M. Polk, Alessia Gimelli, and Dennis A. Calnon
Subjects: 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Best practice, Pneumonia, Viral, Cardiology, Emergent care, Betacoronavirus, COVID-19 Testing, Pandemic, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Pandemics, Personal Protective Equipment, Societies, Medical, Clinical Laboratory Techniques, SARS-CoV-2, business.industry, Information Statement, COVID-19, Family medicine, Practice Guidelines as Topic, Nuclear Medicine, Coronavirus Infections, Laboratories, Cardiology and Cardiovascular Medicine, business
Published: 2020
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30. Abstract P088: Valvular Heart Disease Stages And Biomarkers Of Myocardial Stress And Injury Among Older Adults In The Community: The Atherosclerosis Risk In Communities Study

Author: Khaled Shelbaya, Pranav Dorbala, Brian Claggett, Hicham Skali, Scott Solomon, Kunihiro Matsushita, Suma H Konety, Thomas Mosley, and Amil M Shah
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Introduction: The AHA/ACC framework of valvular heart disease (VHD) stages emphasizes the progressive nature of VHD. Limited data exist regarding the association of VHD stages with prognostic cardiac biomarkers of myocardial stress (NT-proBNP) and injury (high sensitivity troponin-T [hs-TnT]). Methods: Among 6,078 participants in the community-based Atherosclerosis Risk in Communities (ARIC) who underwent echocardiography at the 5 th study visit (2011-2013) and were free of prior valve replacement, we classified VHD stages based on quantitative and qualitative assessments of mitral and aortic valve stenosis and regurgitation. Multivariable linear regression models were used to relate VHD stages to concentrations of NT-proBNP and hs-TnT at Visit 5. Biomarker values were log-transformed. Models were adjusted for age, sex, race, hypertension, diabetes, heart failure, prior myocardial infarction, body mass index, atrial fibrillation, study center, and systolic blood pressure at Visit 5. Results: The mean age was 76±5, 58% were women, 22% were Black. Stage A VHD was present in 2,362 participants (39%), Stage B in 1011 (17%), and Stage C or D in 65 (1%). In multivariable models, higher VHD stage was associated with a graded increase in NT-proBNP and hs-TnT concentrations (Figure) . Compared to participants free of VHD, even Stage A (‘at risk’) participants demonstrated higher concentrations of both NT-proBNP (p Conclusion: Worse VHD stages, even in the absence of severe stenosis or regurgitation, are associated with higher concentrations of markers of myocardial stress (NT-proBNP) and injury (hs-TnT) independent of traditional cardiovascular risk factors. Figure: Concentrations (median, IQR) of NT-proBNP and hs-TnT by VHD stage. *p
Published: 2022
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31. Coronary Flow Reserve, Inflammation and Myocardial Strain in the Cardiovascular Inflammation Reduction Trial (CIRT-CFR)

Author: Viviany R. Taqueti, Amil Shah, Brendan M. Everett, Aruna Pradhan, Gregory Piazza, Courtney Bibbo, Jon Hainer, Victoria Morgan, Ana Carolina do A.H. de Souza, Hicham Skali, Ron Blankstein, Sharmila Dorbala, Samuel Z. Goldhaber, Michel R. Le May, Benjamin Chow, Robert A. deKemp, Fadi Hage, Rob SB Beanlands, Peter Libby, Robert Glynn, Scott D. Solomon, Paul M. Ridker, and Marcelo Di Carli
Published: 2022
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32. ASSOCIATION OF BASELINE MODEST ALCOHOL CONSUMPTION AND CORONARY MICROVASCULAR DYSFUNCTION IN THE CARDIOVASCULAR INFLAMMATION REDUCTION TRIAL (CIRT-CFR)

Author: Ana Carolina Do Amaral Henrique De Souza, Filipe Moura, Jon Mark Hainer, Hicham Skali, Ron Blankstein, Sharmila Dorbala, Fadi G. Hage, Rob S.B. Beanlands, Paul M. Ridker, Marcelo F. Di Carli, and Viviany R. Taqueti
Subjects: Cardiology and Cardiovascular Medicine
Published: 2023
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33. Depressive Symptoms, Cardiac Structure and Function, and Risk of Incident Heart Failure With Preserved Ejection Fraction and Heart Failure With Reduced Ejection Fraction in Late Life

Author: Brian Claggett, Katja Vu, Anna Kucharska-Newton, Scott D. Solomon, Tor Biering-Sørensen, Thomas H. Mosley, Hicham Skali, Amil M. Shah, Jenine E. John, and Janice E. Williams
Subjects: Cardiac function curve, Male, medicine.medical_specialty, heart failure, Risk Assessment, Internal medicine, medicine, Humans, echocardiography, Diseases of the circulatory (Cardiovascular) system, Cardiac structure, Depression (differential diagnoses), Depressive symptoms, Aged, Aged, 80 and over, Ejection fraction, business.industry, Heart, Stroke Volume, medicine.disease, Heart failure, RC666-701, depression, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Heart failure with preserved ejection fraction
Abstract: Background Depressive symptoms are associated with heightened risk of heart failure (HF), but their association with cardiac function and with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) in late life is unclear. We aimed to determine the prevalence of depression in HFpEF and in HFrEF in late life, and the association of depressive symptoms with cardiac function and incident HFpEF and HFrEF. Methods and Results We studied 6025 participants (age, 75.3±5.1 years; 59% women; 20% Black race) in the ARIC (Atherosclerosis Risk in Communities) study at visit 5 who underwent echocardiography and completed the Center for Epidemiologic Studies Depression Scale questionnaire. Among HF‐free participants (n=5086), associations of Center for Epidemiologic Studies Depression Scale score with echocardiography and incident adjudicated HFpEF and HFrEF were assessed using multivariable linear and Cox proportional hazards regression. Prevalent HFpEF, but not HFrEF, was associated with a higher prevalence of depression compared with HF‐free participants ( P P =0.59, respectively). Among HF‐free participants, Center for Epidemiologic Studies Depression Scale score was not associated with cardiac structure and function after adjusting for demographics and comorbidities (all P >0.05). Over 5.5‐year follow‐up, higher Center for Epidemiologic Studies Depression Scale score was associated with heightened risk of incident HFpEF (hazard ratio [HR] [95% CI], 1.06 [1.04–1.12]; P =0.02), but not HFrEF (HR [95% CI], 1.02 [0.96–1.08]; P =0.54), independent of echocardiographic measures, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), troponin, and hs‐CRP (high‐sensitivity C‐reactive protein) (HR [95% CI], 1.06 [1.00–1.12]; P =0.04). Conclusions Worse depressive symptoms predict incident HFpEF in late life, independent of common comorbidities, cardiac structure and function, and prognostic biomarkers. Further studies are necessary to understand the mechanisms linking depression to risk of HFpEF.
Published: 2021
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34. Physical and Psychological Well-being Effects of Cardiac Rehabilitation on Patients Following Mitral Valve and Aortic Valve Procedures

Author: Hicham Skali, Lindsay Sonis, Jodi Klein, Pavel Hushcha, Christine Lutfy, S. Hammad Jafri, Gisele Bousquet, Lauren Mellett, Pranav Dorbala, and Donna M. Polk
Subjects: Pulmonary and Respiratory Medicine, Aortic valve, medicine.medical_specialty, medicine.medical_treatment, Transcatheter Aortic Valve Replacement, Quality of life, Internal medicine, Mitral valve, medicine, Clinical endpoint, Humans, Depression (differential diagnoses), Rehabilitation, Cardiac Rehabilitation, business.industry, medicine.anatomical_structure, Treatment Outcome, Psychological well-being, Aortic Valve, cardiovascular system, Cardiology, Quality of Life, Anxiety, Mitral Valve, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: PURPOSE Patients participating in cardiac rehabilitation (CR) following an aortic valve procedure demonstrate improvements in physical capacity and psychological well-being. The primary aim of this study is to evaluate baseline exercise capacity and psychological well-being for mitral valve patients participating in CR and to compare physical and psychological outcomes between mitral valve and aortic valve patients. METHODS The primary endpoint was improvement in 6-min walk test (6MWT) distance. Secondary endpoints included change in exercise min/wk, depression scores (Patient Health Questionnaire-9 [PHQ-9]), anxiety scores (General Anxiety Disorder-7 [GAD-7]), and overall quality of life (Dartmouth Cooperative Functional Assessment [COOP]) scores. RESULTS Between January 2015 and December 2019, 94 patients who underwent an aortic valve procedure and 46 patients who underwent mitral valve procedures were enrolled prospectively in CR. At the completion of their CR program, patients had similar improvements in their 6MWT (mitral valve: 173 ft [125, 238] vs aortic valve 197 ft [121, 295], P = .42); exercise min/wk (mitral valve: 90 min [45, 175] vs aortic valve: 80 min [40, 130], P = .44). Changes in anxiety (GAD-7), depression (PHQ-9), and COOP scores were smaller but similar between the two groups. CONCLUSIONS CR participation resulted in similar improvements in physical activity between patients undergoing mitral valve and aortic valve procedures. Psychological well-being and quality of life scores improved minimally and similarly between the two groups.
Published: 2021

35. Abstract 10392: Association of Frailty with Incident Heart Failure with Preserved and Reduced Ejection Fraction in Late Life: The Aric Study

Author: Diego Ramonfaur, Hicham Skali, Dalane W Kitzman, Priya Palta, Chiadi E Ndumele, Brian Claggett, Suma H Konety, and Amil M Shah
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Introduction: The incidence and prevalence of both frailty and heart failure (HF) are greatest in late life, and both have been associated with inflammation and markers of myocardial injury. While frailty is cross-sectionally associated with HF, the association of frailty with incident HF, and HF with preserved (HFpEF) or reduced ejection fraction (HFrEF) is unclear. Methods: Among 5,517 participants in the Atherosclerosis Risk in Communities study with frailty assessment and free of HF at Visit 5 (2011-2013), frailty was ascertained using information on weight loss, low grip strength, exhaustion, low energy expenditure and slow gait. Frail was defined as the presence of > 3 frailty components, pre-frail as 1-2 components, and robust as 0 components. HF was ascertained through adjudication of hospitalizations with related ICD codes. Multivariable Cox proportional hazard models were used to evaluate the association of frailty status at Visit 5 with incident HF overall, HFpEF (LVEF ≥50%), and HFrEF (LVEF Results: Mean age was 75 +/- 5 years, 58% were female, and 22% were Black. Forty-six percent were classified as robust, 48% as pre-frail, and 6% frail. Frail participants were older and had a higher prevalence of cardiovascular co-morbidities. Over a median follow-up of 7.1 (IQR 5.5-7.8) years, 525 participants developed incident HF (249 HFpEF, 209 HFrEF, 67 HF with unknown LVEF). Both pre-frailty and frailty were associated with heightened risk of incident HF compared to robust participants (Figure). The magnitude of risk associated with frailty status was similar for both HFpEF and HFrEF. Conclusions: Pre-frailty and frailty are both associated with heightened risk of incident HF in late life, independent of traditional cardiovascular risk factors. These associations are similar in magnitude for HFpEF and HFrEF.
Published: 2021
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36. Health status after invasive or conservative care in coronary and advanced kidney disease

Author: Spertus J. A., Jones P. G., Maron D. J., Mark D. B., O'Brien S. M., Fleg J. L., Reynolds H. R., Stone G. W., Sidhu M. S., Chaitman B. R., Chertow G. M., Hochman J. S., Bangalore S, ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo 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H.R., Stone G.W., Sidhu M.S., Chaitman B.R., Chertow G.M., Hochman J.S., Bangalore S, and ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, 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Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic
Subjects: Male, Intention to Treat Analysi, medicine.medical_treatment, Health Status, Myocardial Ischemia, 030204 cardiovascular system & hematology, Coronary Angiography, law.invention, Health Statu, 0302 clinical medicine, Randomized controlled trial, law, Surveys and Questionnaires, Odds Ratio, Surveys and Questionnaire, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, medicine.diagnostic_test, General Medicine, Middle Aged, Intention to Treat Analysis, Cardiology, Female, Human, medicine.medical_specialty, Revascularization, Follow-Up Studie, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, cardiovascular diseases, Healthy Lifestyle, Renal Insufficiency, Chronic, Proportional Hazards Models, Aged, Intention-to-treat analysis, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Odds ratio, medicine.disease, Angiography, Exercise Test, Proportional Hazards Model, business, Kidney disease, Follow-Up Studies
Abstract: BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of
Published: 2020

37. Race- and Gender-Based Differences in Cardiac Structure and Function and Risk of Heart Failure

Author: Alvin Chandra, Hicham Skali, Brian Claggett, Scott D. Solomon, Joseph S. Rossi, Stuart D. Russell, Kunihiro Matsushita, Dalane W. Kitzman, Suma H. Konety, Thomas H. Mosley, Patricia P. Chang, and Amil M. Shah
Subjects: Aged, 80 and over, Heart Failure, Male, Incidence, Stroke Volume, Prognosis, Ventricular Function, Left, White People, Black or African American, Cohort Studies, Survival Rate, Sex Factors, Echocardiography, Risk Factors, Humans, Female, Cardiology and Cardiovascular Medicine, Aged
Abstract: Although heart failure (HF) risk and cardiac structure/function reportedly differ according to race and gender, limited data exist in late life when risk of HF is highest.The goal of this study was to evaluate race/gender-based differences in HF risk factors, cardiac structure/function, and incident HF in late life.This analysis included 5,149 HF-free participants from ARIC (Atherosclerosis Risk In Communities), a prospective epidemiologic cohort study, who attended visit 5 (2011-2013) and underwent echocardiography. Participants were subsequently followed up for a median 5.5 years for incident HF/death.Patients' mean age was 75 ± 5 years, 59% were women, and 20% were Black. Male gender and Black race were associated with lower mean left ventricular ejection fraction. Black race was also associated with greater left ventricular wall thickness and concentricity, differences that persisted after adjusting for cardiovascular comorbidities. After adjusting for cardiovascular comorbidities, men were at higher risk for HF and heart failure with reduced ejection fraction (HFrEF) in Black participants compared with White participants (HF: HR of 2.36 [95% CI: 1.37-4.08] vs 1.16 [95% CI: 0.89-1.51], interaction P = 0.016; HFrEF: HR of 3.70 [95% CI: 1.72-7.95] vs 1.55 [95% CI: 1.01-2.37] respectively, interaction P = 0.039). Black race was associated with a higher incidence of HF overall and HFrEF in men only (HF: 1.65 [95% CI: 1.07-2.53] vs 0.76 [95% CI: 0.49-1.17]; HFrEF: HR of 2.55 [95% CI: 1.46-4.44] vs 0.91 [95% CI: 0.46-1.83]). No race/gender-based differences were observed in risk of incident heart failure with preserved ejection fraction.Among older persons free of HF, men and Black participants exhibit worse systolic performance and are at heightened risk for HFrEF, whereas the risk of heart failure with preserved ejection fraction is similar across gender and race groups.
Published: 2021

38. Reducing radiation dose from myocardial perfusion imaging in subjects with complex congenital heart disease

Author: Hicham Skali, Anne Marie Valente, Marcelo F. DiCarli, Viviany R. Taqueti, Neha Kwatra, Sara L. Partington, Sharmila Dorbala, Michael J. Landzberg, Dillenia Rosica, Keri M. Shafer, John Bruyere, Ron Blankstein, and Frederick D. Grant
Subjects: Adult, Heart Defects, Congenital, Male, Adolescent, Heart disease, 030204 cardiovascular system & hematology, Radiation Dosage, Article, 030218 nuclear medicine & medical imaging, Cohort Studies, Young Adult, 03 medical and health sciences, Myocardial perfusion imaging, 0302 clinical medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Complex congenital heart disease, Child, Aged, Aged, 80 and over, Tomography, Emission-Computed, Single-Photon, medicine.diagnostic_test, business.industry, Radiation dose, Myocardial Perfusion Imaging, Middle Aged, medicine.disease, medicine.anatomical_structure, Positron emission tomography, Great arteries, Child, Preschool, Positron-Emission Tomography, Exercise Test, Female, Radiopharmaceuticals, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Nuclear medicine, Emission computed tomography, Artery
Abstract: INTRODUCTION. The prevalence of defects and effective radiation dose from various myocardial perfusion imaging (MPI) strategies in congenital heart disease (CHD) is unknown. METHODS. We studied 75 subjects with complex CHD (ages 5 to 80 years) referred for MPI between 2002 and 2015. A rest and exercise or pharmacologic stress MPI was performed using (99m)Technetium sestamibi, (82)rubidium or (13)N-ammonia, and Sodium iodide SPECT (single-photon emission computed tomography), SPECT/CT or Cadmium zinc telluride (CZT) SPECT or PET (positron emission tomography)/CT scanners. Deidentified images were interpreted semi-quantitatively in three batches: stress only MPI, stress/rest MPI, and stress/rest MPI with taking into account a history of ventricular septal defect repair. Effective radiation dose was estimated for stress/rest MPI and predicted for 1-day stress-first (normal stress scans), and for 2-day stress/rest MPI (abnormal stress scans). RESULTS. The median age was 18.6 years. The most common type of CHD was transposition of the great arteries (63%). Rest/stress MPI was abnormal in 43% of subjects and 25% of the abnormal scans demonstrated reversible defects. Of the subjects with abnormal MPI, 33% had significant underlying anatomic coronary artery obstruction. Estimated mean effective radiation dose ranged from 2.1 ± 0.6 mSv for (13)N-ammonia PET/CT to 12.5 ± 0.9 mSv for SPECT/CT. Predicted effective radiation dose was significantly lower for stress-first MPI and for 2-day stress/rest protocols. CONCLUSIONS. Due to the relatively high prevalence of abnormal stress MPI, tailored protocols with a stress-first MPI as well as the use of 2-day protocols and advanced imaging technologies including CZT SPECT, novel image reconstruction software, and PET MPI could substantially reduce radiation dose in complex CHD.
Published: 2019
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39. Association between Nonalcoholic Fatty Liver Disease at CT and Coronary Microvascular Dysfunction at Myocardial Perfusion PET/CT

Author: Ron Blankstein, Angel Joel Diaz Martinez, Paco E. Bravo, Marcelo F. Di Carli, Michael L. Steigner, Tomas Vita, Courtney F. Bibbo, Ariana Nodoushani, David J. Murphy, Jon Hainer, Abhishek R. Keraliya, Navkaranbir S. Bajaj, Viviany R. Taqueti, Sharmila Dorbala, Michael T. Osborne, Hicham Skali, and Sophia Jacob
Subjects: Male, medicine.medical_specialty, Coronary Artery Disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, Risk Factors, Positron Emission Tomography Computed Tomography, Internal medicine, Nonalcoholic fatty liver disease, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Myocardial infarction, Aged, Retrospective Studies, Ejection fraction, business.industry, Proportional hazards model, Hazard ratio, Coronary flow reserve, Middle Aged, medicine.disease, 030220 oncology & carcinogenesis, Heart failure, Cardiology, Female, business, Mace
Abstract: Background Cardiovascular disease is a major cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). However, the association of NAFLD with coronary microvascular dysfunction is, to our knowledge, unknown. Purpose To determine whether coronary microvascular dysfunction is more prevalent in patients with NAFLD and to determine whether coronary microvascular dysfunction predicts major adverse cardiac events (MACE) independently of NAFLD. Materials and Methods This retrospective study (2006-2014) included patients without evidence of obstructive epicardial coronary artery disease and healthy left ventricular ejection fraction (≥40%) at a clinical rest and stress myocardial perfusion PET/CT. NAFLD was defined by a mean hepatic attenuation of less than 40 HU at CT and coronary microvascular dysfunction as a coronary flow reserve (CFR) of less than 2.0. A composite of all-cause mortality, myocardial infarction, coronary revascularization, and hospitalization because of heart failure comprised MACE (130 of 886 patients; 14.7%). The relation between NAFLD and MACE was assessed by using multivariable Cox regression analysis. Results Among 886 patients (mean age, 62 years ± 12 [standard deviation]; 631 women [mean age, 62 years ± 12 years] and 255 men [mean age, 61 years ± 12]; and ejection fraction, 63% ± 9), 125 patients (14.1%) had NAFLD and 411 patients (46.4%) had coronary microvascular dysfunction. Coronary microvascular dysfunction was more prevalent (64.8% vs 43.4%; P < .001) and CFR was lower (1.9 ± 1.1 vs 2.2 ± 0.7; P < .001) in patients with NAFLD compared with those without NAFLD. NAFLD independently predicted coronary microvascular dysfunction (P = .01). The interaction of NAFLD and male sex predicted MACE (hazard ratio, 1.45; 95% confidence interval: 1.08, 1.69; P = .008) and coronary microvascular dysfunction remained associated with MACE (adjusted hazard ratio, 1.46; 95% confidence interval: 1.02, 2.07; P = .04). Conclusion Coronary microvascular dysfunction was more prevalent in patients with nonalcoholic fatty liver disease and predicted major adverse cardiac events independently of nonalcoholic fatty liver disease. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Ambale-Venkatesh and Lima in this issue.
Published: 2019
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40. Role of Exercise Treadmill Testing in the Assessment of Coronary Microvascular Disease

Author: Hicham Skali, Courtney F. Bibbo, Viviany R. Taqueti, Jon Hainer, Navkaranbir S. Bajaj, Marcelo F. Di Carli, Wunan Zhou, Ron Blankstein, Sanjay Divakaran, Diana Lopez, Sharmila Dorbala, Ankur Gupta, and Michael T. Osborne
Subjects: medicine.medical_specialty, Myocardial Ischemia, Coronary Artery Disease, Coronary Angiography, Article, Coronary artery disease, Interquartile range, Predictive Value of Tests, Coronary Circulation, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, Coronary flow, Retrospective Studies, Exercise Tolerance, medicine.diagnostic_test, business.industry, Coronary flow reserve, Treadmill testing, Coronary Microvascular Disease, medicine.disease, Positron emission tomography, Cardiology, Exercise Test, Cardiology and Cardiovascular Medicine, business, Tomography, X-Ray Computed, Goals
Abstract: OBJECTIVES: The authors aimed to study the sensitivity and specificity of exercise treadmill testing (ETT) in the diagnosis of coronary microvascular disease (CMD), as well as the prognostic implications of ETT results in patients with CMD. BACKGROUND: ETT is validated to evaluate for flow-limiting coronary artery disease (CAD), however, little is known about its use for evaluating CMD. METHODS: We retrospectively studied 249 consecutive patients between 2006 and 2016 who underwent ETT and positron emission tomography within 12 months. Patients with obstructive CAD or left ventricular systolic dysfunction were excluded. CMD was defined as a coronary flow reserve
Published: 2021

41. Abstract P055: Diabetes, Early Heart Failures Stages (A & B), And Progression To Overt Heart Failure In Older Adults: The Atherosclerosis Risk In Communities Study

Author: Roberta Florido, Hicham Skali, Amil M. Shah, Kunihiro Matsushita, Justin B Echouffo Tcheugui, Sui Zhang, Chiadi E Ndumele, Elizabeth Selvin, and Josef Coresh
Subjects: medicine.medical_specialty, Atherosclerosis Risk in Communities, business.industry, Physiology (medical), Internal medicine, Heart failure, Diabetes mellitus, Cardiology, Medicine, Cardiology and Cardiovascular Medicine, business, Diabetes type ii, medicine.disease
Abstract: Introduction: Diabetes confers a high risk of heart failure (HF). However, the influence of diabetes in preclinical HF (stages A or B) on the progression to overt HF is not well understood. Hypothesis: Diabetes accelerates progression to clinically overt HF, but significantly more so in stage A than B. Methods: We included older adults (aged 66-90 years) without clinical HF (n= 4782) who attended ARIC study visit 5 (2011-2013). We categorized participants into stage A (n=3067) or B (n=1715) HF. Within each stage A or B, we used Cox regression to quantify the associations of diagnosed diabetes and glycemic control (HbA 1C Results: There were 401 HF events during a median 6.3 years follow-up (mean age 75, 59% female, 21% Black, 28% with diabetes). The 7.6-year cumulative HF risk among individuals with diabetes and HbA 1C ≥ 7% vs. those without diabetes was 11.9% vs. 4.5% in stage A, and 18.1% vs. 13.6% in stage B. In stages A and B, individuals with uncontrolled diabetes had significantly higher risks of HF compared to those without diabetes (all P Table ). Uncontrolled diabetes was more strongly associated with HF in stage A than stage B ( P =0.02). In cross-categories of HF stage, diabetes, and glycemic control, individuals with stage B HF and uncontrolled diabetes had greater than 4-fold risk of HF than those with stage A HF without diabetes. Conclusions: Among older adults with preclinical HF stages (A and B), uncontrolled diabetes is associated with substantial short-term (~8 year) risk of HF and should be a focus of aggressive preventive therapies. Newer anti-diabetes therapies such as SGLT2 inhibitors are currently recommended in adults with diabetes and clinical HF, but not stages A and B. Our results suggest that among older adults, such therapies may yield clinical benefits in early HF stages.
Published: 2021
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42. Sex and Race Differences in N-Terminal Pro–B-type Natriuretic Peptide Concentration and Absolute Risk of Heart Failure in the Community

Author: Peder L, Myhre, Brian, Claggett, Bing, Yu, Hicham, Skali, Scott D, Solomon, Helge, Røsjø, Torbjørn, Omland, Kerri L, Wiggins, Bruce M, Psaty, James S, Floyd, Elizabeth, Selvin, Christie M, Ballantyne, and Amil M, Shah
Subjects: Cohort Studies, Heart Failure, Male, Risk Factors, Natriuretic Peptide, Brain, Humans, Female, Prospective Studies, Cardiology and Cardiovascular Medicine, Biomarkers, Peptide Fragments, Aged, Race Factors
Abstract: Sex- and race-based differences in N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations are poorly understood. Clinical decisions are often informed by absolute-as opposed to relative-risk, but absolute risk of incident heart failure (HF) associated with NT-proBNP concentration across these important demographic categories is unclear.To determine whether physiologic determinants of NT-proBNP concentrations account for sex and race differences, and to more uniformly predict HF risk using NT-proBNP in these demographic subgroups.In the longitudinal Atherosclerosis Risk in Communities epidemiologic prospective community-based cohort study, the association of NT-proBNP concentration with relative and absolute risk of HF by sex- and race-based categories was assessed at study visit 2 (1990-1992) and study visit 5 (2011-2013) using Cox and Poisson regression. These data were analyzed from June 2018 to October 2021. The contribution of clinical, anthropometric, echocardiographic, and laboratory parameters to sex- and race-based differences in NT-proBNP concentration was assessed at visit 5 using linear regression. Participants included were free of HF in midlife (visit 2; a total of 12 750 participants) and late life (visit 5; a total of 5191 participants).NT-proBNP concentration.Incident HF or death.Among the 5191 HF-free participants at visit 5, the mean (SD) age was 76.0 (5.2) years, 2104 (41%) were male, 1043 (20%) were Black, and the median (IQR) NT-proBNP concentration was 124 (64-239) pg/. In both midlife and late life, NT-proBNP concentration was lowest in Black men (median [IQR] concentration: visit 2, 30 [14-67] pg/mL; visit 5, 74 [34-153] pg/mL) and highest in White women (median [IQR] concentration: visit 2, 70 [42-111] pg/mL; visit, 5, 154 [82-268] pg/mL). Sex and race differences in NT-proBNP concentration persisted after accounting for age, income, education, area deprivation index, cardiovascular diseases, left ventricular structure (LV), LV function, LV wall stress, weight and fat mass, and estimated glomerular filtration rate. Substantial differences in the absolute risk of incident HF or death existed across the sex- and race-based categories at any NT-proBNP concentration (eg, 7-fold [rate ratio, 6.7; 95% CI, 4.6-9.9] and 3-fold [rate ratio, 2.7; 95% CI, 1.7-4.1] difference at visit 2 and visit 5, respectively, at guideline-recommended thresholds) with higher risk consistently observed among Black men and lower risk in White women. Results were replicated in a cohort of participants from the Cardiovascular Health Study.In this study, sex- and race-based differences in NT-proBNP persisted after accounting for known physiologic determinants. Absolute risk associated with a given value of NT-proBNP varied substantially by sex and race. Consideration of NT-proBNP values in the context of sex and race allows for more uniform prediction of absolute risk across important demographic subgroups.
Published: 2022
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43. Abstract 12910: Use of Optimal Medical Therapy in Patients With Cardiovascular Disease Undergoing Cardiac Rehabilitation

Author: Sonis Lindsay, Hicham Skali, Pranav Dorbala, Gisele Bousquet, Jorge Plutzky, Donna M. Polk, Christopher P. Cannon, Lutfy Christine, S. Hammad Jafri, Ron Blankstein, and Pavel Huschsa
Subjects: medicine.medical_specialty, Rehabilitation, business.industry, medicine.medical_treatment, Disease, medicine.disease, Coronary artery disease, Physiology (medical), Internal medicine, Heart failure, medicine, Cardiology, In patient, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Medical therapy
Abstract: Introduction: Optimal Medical Therapy (OMT) in patients with Coronary Artery Disease (CAD) or Heart Failure (HF) is underused despite known benefits. The rate of OMT use among patients enrolled in Cardiac Rehabilitation (CR) is not well known. Purpose: To describe prevalence and characteristics of OMT use in patients with CAD or HF undergoing CR. Methods: CAD patients were defined as those with prior MI, PCI, CABG, or angina. OMT for CAD patients required all currently guideline-recommended medications (aspirin or antiplatelet, statins, beta-blockers (BB); and ACEi/ARB for concurrent HF or DM). The HF group included patients referred to CR for HFrEF or for another indication and had documented left ventricular systolic dysfunction (LVEF Results: From January 2015 to December 2019, 612 patients (mean age: 65, 23% female) with CAD were enrolled in CR, with 483 (79%) patients meeting all OMT criteria. CAD patients on OMT were more likely to have hypertension (85%), hyperlipidemia (94%) but less angina (8%). Prior MI, hypertension, hyperlipidemia, and 6-minute walk distance were significantly associated with OMT use.Of 131 HF patients (mean age: 64, 21% female) enrolled in CR, 23 (18%) met all 3 OMT criteria—99 (76%) and 128 (98%) patients met only 2 or 1 of OMT criteria, respectively. Use of spironolactone (least prescribed), ARNI, and ACEi/ARBs all increased over the study period. Study limitations include lack of control for contraindications to medications. Conclusion: Although it has improved over time, OMT use remains low (HF 18%, CAD 79%) among patients enrolled in CR. CR may represent a unique opportunity to enhance OMT use.
Published: 2020
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44. Abstract 15318: Longitudinal Changes in Pulmonary Pressure in Late Life: The Atherosclerosis Risk in Communities Study

Author: Dalane W. Kitzman, Suma H Konety, Brian Claggett, Hicham Skali, Thomas H. Mosley, Rani Zierath, Kunihiro Matsushita, and Amil M. Shah
Subjects: Atherosclerosis Risk in Communities, medicine.medical_specialty, business.industry, Physiology (medical), Internal medicine, medicine, Cardiology, Cardiology and Cardiovascular Medicine, business, Pulmonary pressure
Abstract: Introduction: While the prognostic implications of higher pulmonary artery systolic pressure (PASP) are well established, few data exist regarding longitudinal change in pulmonary pressure in the community. We characterized longitudinal changes in PASP over ~6.5 years in late life, and identified predictors of this change. Methods: We studied 1,426 elderly participants in the prospective, community-based Atherosclerosis Risk in Communities (ARIC) study who underwent protocol echocardiography and had assessable tricuspid regurgitation spectral Doppler at 5 th (2011-2013) and 7 th (2018-2019) study visits. We used multivariable linear regression to identify clinical, echocardiographic and biomarker predictors of change in PASP. Results: Mean age was 74±5 years at Visit 5, 32% were men, 24% black, and mean PASP was 27.5±5.0 mmHg. Over a median of 6.5±3.0 years, PASP increased by 5.2±7.7 mmHg on average, with no significant differences by race (white 5.0±7.6, black 5.8±7.9; p=0.40) or sex (women 5.2±7.7, men 5.1±7.8; p=0.95). In models adjusted for heart rate and blood pressure at both visits, and for PASP, clinical and echocardiographic measures at Visit 5, independent predictors of longitudinal increase in PASP at Visit 5 were higher NT-proBNP (p=0.005), larger left atrial volume index (p=0.045), and lower forced expiratory volume at 1 second (p=0.019). Longitudinal increase in PASP was associated with concomitant increases in LAVi, E/e’ ratio, and LV mass index ( Figure ; all p Conclusions: PASP increased by 5±8 mmHg over 6.5±3.0 years in late life, with greater increases associated with higher filling pressure and worse pulmonary function. Increases in PASP are accompanied by longitudinal worsening in LV diastolic - but not systolic - measures.
Published: 2020
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45. Abstract 15216: Longitudinal Changes in Peak Aortic Valve Velocity in Late Life: Atherosclerosis Risk in Communities (ARIC) Study

Author: Suma H Konety, Hicham Skali Lami, Amil M. Shah, Dalane W. Kitzman, Brian Claggett, Kirstine Ravnkilde, Thomas H. Mosley, Vijay Nambi, and Kunihiro Matsushita
Subjects: Aortic valve, Atherosclerosis Risk in Communities, medicine.medical_specialty, medicine.anatomical_structure, business.industry, Physiology (medical), Internal medicine, Cardiology, medicine, Cardiology and Cardiovascular Medicine, business, Aric study
Abstract: Background: Aortic stenosis (AS) is a growing health problem within the aging population. We aimed to quantify longitudinal changes in aortic valve hemodynamics in late life. Methods: We studied 2,512 community-based elderly participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent uniform echocardiographic imaging at study visits 5 (2011-2013) and 7 (2018-2019). Peak aortic valve (AV) velocity was assessed by continuous wave spectral Doppler from the apical 5 chamber view. Participants with heart failure or in atrial fibrillation at either echocardiographic examination were excluded. Results: Mean age at Visit 5 was 74 ± 4 years, 41% were male, 24% black, and the mean AV velocity at Visit 5 was 1.27 ± 0.28 m/s. Over median 6.6 [IQR: 6.1-7.0] years, AV velocity increased by 0.15 ± 0.32 m/s and the mean velocity at Visit 7 was 1.43 ± 0.43 m/s. Of 2,454 participants with peak AV velocity < 2.0 m/s at Visit 5, 123 (5%) developed a peak AV velocity > 2.0 m/s at Visit 7 (mean 2.45 ± 0.46 m/s). In models accounting for blood pressure and heart rate at both study visits, Visit 5 predictors of transitioning to a peak AV velocity > 2.0 m/s included age, male sex, white race, BMI, higher NT-proBNP and hs-troponin T, and greater LA volume index and E/e’ ratio ( Table ). Conclusions: Peak AV velocity increases over 6 years in late life, with ~5% developing a peak velocity > 2.0 m/s. Demographics, higher cardiac biomarkers, and worse diastolic function predict increases in peak AV velocity in late life. These data have important implications for the development of age-related aortic stenosis.
Published: 2020
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46. Abstract 15448: Association of Kidney Dysfunction and Damage to Incident Heart Failure With Reduced and Preserved Ejection Fraction in Older, Community-dwelling Adults: The Atherosclerosis Risk in Communities Study

Author: Hicham Skali, Suma H Konety, Amil M. Shah, Leo F. Buckley, Kunihiro Matsushita, Brian Claggett, Thomas H. Mosley, Josef Coresh, and Lynne E. Wagenknecht
Subjects: medicine.medical_specialty, Kidney, Ejection fraction, business.industry, Kidney dysfunction, medicine.disease, Atherosclerosis Risk in Communities, medicine.anatomical_structure, Physiology (medical), Internal medicine, Heart failure, Epidemiology, medicine, Cardiology, Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract: Introduction: Older adults are at heightened risk for both kidney disease and heart failure, but there is limited data regarding the associations of kidney damage and dysfunction with incident heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction in late life. Hypothesis: Kidney dysfunction, as assessed by lower estimated glomerular filtration rate (eGFR), and kidney damage, as assessed by higher urine albumin-to-creatinine ratio (UACR), are each independently associated with incident HFrEF and HFpEF in late life. Methods: We studied 4,563 elderly participants in the community-based, prospective ARIC study who were free of HF at study Visit 5 (2011-2013) at which time they had UACR measured and Cystatin-C-based eGFR estimated using the CKD-EPI formula. We estimated the association of Visit 5 eGFR and UACR with post-Visit 5 incident HF overall, HFrEF, and HFpEF using multivariable Cox proportional hazards regression models adjusted for demographics, diabetes, hypertension, coronary artery disease, atrial fibrillation, body mass index, pulse pressure, and either eGFR or UACR. Results: The mean age at Visit 5 was 75±5 years, 57% were female, 21% were black. Mean Visit 5 eGFR was 67±18 mL/min per 1.73 m 2 and median UACR was 10.2 [6.2 to 21.4] mg-g. Lower eGFR and higher UACR each associated with older age, wider pulse pressure and higher prevalence of diabetes, hypertension, coronary disease and atrial fibrillation (all pFigure ). Conclusions: Lower eGFR and higher UACR are independently and additively associated with both incident HFrEF and incident HFpEF in late life.
Published: 2020
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47. Abstract 14622: Longitudinal Changes in Left Ventricular Diastolic Function in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study

Author: Amil M. Shah, Aaron R. Folsom, Hicham Skali, Brian Claggett, Kunihiro Matsushita, Dalane W. Kitzman, Suma H Konety, Li Zhao, and Thomas H. Mosley
Subjects: medicine.medical_specialty, business.industry, Diastole, medicine.disease, Atherosclerosis Risk in Communities, Physiology (medical), Internal medicine, Heart failure, medicine, Cardiology, Diastolic function, Risk factor, Cardiology and Cardiovascular Medicine, Aric study, business
Abstract: Introduction: Diastolic dysfunction is a potent risk factor for heart failure (HF). However, there is limited data regarding longitudinal changes of diastolic function in the very old, who are at the highest risk for HF. Methods: We studied 2,559 community-based elderly participants in the prospective ARIC study who underwent protocol echocardiography, were in sinus rhythm at study Visits 5 (2011-2013) and 7 (2018-2019), and did not have an interval myocardial infarction. The primary diastolic measures were Tissue Doppler e’, E/e’ ratio, and left atrial volume index (LAVi). Results: Mean age at Visit 5 was 74±4 years, 59% were women, and 25% black. At Visit 5, mean e’ was 5.8±1.4 cm/s, E/e’ 11.8±3.6, and LAVi 24.3±6.7 ml/m 2 . Over a mean of 6.5±3.1 years, e’ decreased by 0.6±1.4 cm/s, E/e’ increased by 3.1±4.5, and LAVi increased by 1.4±7.7 ml/m 2 . Using validated ARIC-based cut-points, there was significant increase in the proportion of participants with abnormal e’ (18% at Visit 5 to 34 % at Visit 7), E/e’ (20% vs 46%), LAVi (17% vs 25%; all pFigure ). Compared to participants free of cardiovascular (CV) risk factors or CV diseases (n=237), those with CV risk factors or diseases at Visit 5 (n=2,210) demonstrated greater increases in E/e’ (2.3±3.9 vs 3.1±4.5 respectively; p=0.006) and LAVi (0.0±7.0 vs 1.5±7.7 ml/m 2 ; p=0.008) while increases in E/e’ (5.0±5.1; p2 ; p Conclusions: Diastolic function progressively worsens over 6.5 years in late life, particularly among persons with CV risk factors. Further studies are necessary to determine if risk factor prevention or control will mitigate these changes.
Published: 2020
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48. Differential impact of obstructive and restrictive ventilatory patterns on incident heart failure with preserved versus reduced ejection fraction in late-life

Author: Amil M. Shah, Sergio H.R. Ramalho, G Cipriano Junior, Hicham Skali, Brian Claggett, Scott D. Solomon, Dalane W. Kitzman, and Patricia P. Chang
Subjects: Spirometry, medicine.medical_specialty, Vital capacity, Ejection fraction, Lung, medicine.diagnostic_test, business.industry, Atrial fibrillation, medicine.disease, Pulmonary function testing, medicine.anatomical_structure, Heart failure, Internal medicine, Cardiology, Medicine, Cardiology and Cardiovascular Medicine, business, Heart failure with preserved ejection fraction
Abstract: Background Subclinical pulmonary dysfunction predicts cardiovascular (CV) outcomes, especially heart failure (HF). However, the impact of reduced percent predicted forced vital capacity (ppFVC) and forced expired volume in 1 second (FEV1)/FVC on different incident HF phenotypes in late-life is unclear. Purpose Determine the associations of FEV1/FVC and ppFVC with incident HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction in late-life. Methods In the Atherosclerosis Risk in Communities longitudinal cohort study, 3,854 HF-free participants who underwent echocardiography and spirometry at the fifth study visit (2011–2013). The relation between pulmonary function and incident adjudicated HFpEF and HFrEF were examined using multivariable Cox proportional hazards models adjusted for demographics, body mass index, coronary artery disease, atrial fibrillation, hypertension, diabetes, and NT-proBNP. Results Mean age was 75±5 years, 40% were male, 19% black, and 6% current smokers. Mean FEV1/FVC was 72±8, and ppFVC was 98±17%. At a median follow-up of 5.6 years, lower ppFVC was independently associated with incident HFpEF, but not HFrEF (Table). Lower FEV1/FVC ratio was associated with higher risk of incident HFrEF but not HFpEF in models adjusted for demographics, which did not persist after further adjustment for clinical risk factors. Conclusion The relationships of reduced ppFVC and FEV1/FVC with incident HF differ significantly by HF phenotype. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services
Published: 2020
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49. Obstructive and restrictive ventilatory patterns are differentially associated with cardiac structure and function in late-life

Author: Dalane W. Kitzman, Patricia P. Chang, Scott D. Solomon, G Cipriano Junior, Hicham Skali, Sergio H.R. Ramalho, Brian Claggett, and Amil M. Shah
Subjects: Cardiac function curve, Vital capacity, medicine.medical_specialty, Ejection fraction, business.industry, Diastole, Respiratory physiology, medicine.disease, Pulmonary function testing, Internal medicine, Heart failure, Cardiology, Medicine, Systole, Cardiology and Cardiovascular Medicine, business
Abstract: Background Pulmonary and cardiac function both decline with age. However, few data exist regarding the associations of obstructive and restrictive spirometric patterns with cardiac structure and function in late-life. Purpose Determine the associations of reduced percent predicted forced vital capacity (ppFVC) and forced expired volume in 1 second (FEV1)/FVC with cardiac structure and function in late life. Methods In the Atherosclerosis Risk in Communities longitudinal cohort study, 3,854 heart failure free participants underwent echocardiography and spirometry at the fifth study visit (2011–2013). Relationships were examined using multivariable linear regression. Models adjusted for demographics and clinical risk factors (Table legend). Results Mean age was 75±5 years, 40% were male, 19% black, and 6% current smokers. Mean FEV1/FVC was 72±8, and ppFVC was 98±17%. In adjusted analyses, lower FEV1/FVC was associated with higher pulmonary arterial pressure (PASP) but not with measures of left ventricular (LV) structure or function (Table). In contrast, lower ppFVC, was associated with greater LV mass, worse LV strain, higher E/e' ratio, greater left atrial volume index, and higher PASP (all p Conclusion In late life, reductions in both FEV1/FVC and ppFVC are associated with higher pulmonary pressure, but only ppFVC was associated with worse LV structure and function. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services
Published: 2020
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50. Guidance and Best Practices for Nuclear Cardiology Laboratories During the COVID-19 Pandemic: An Information Statement From ASNC and SNMMI

Author: Venkatesh L. Murthy, Sharmila Dorbala, Nathan Better, Prem Soman, Randall C. Thompson, Robert Pagnanelli, Rob S. Beanlands, Donna M. Polk, Mouaz H. Al-Mallah, Alessia Gimelli, Tim M. Bateman, Dennis A. Calnon, Andrew J. Einstein, Vasken Dilsizian, and Hicham Skali
Subjects: medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Statement (logic), business.industry, SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Best practice, Pneumonia, Viral, Cardiology, COVID-19, Laboratories, Hospital, Betacoronavirus, Cardiovascular Diseases, Pandemic, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Medical physics, Cardiology and Cardiovascular Medicine, business, Coronavirus Infections, Pandemics
Published: 2020

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