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1. Relationship of age, atherosclerosis and angiographic stenosis using artificial intelligence

Author: Mouaz H Al-Mallah, Daniele Andreini, Hyuk-Jae Chang, Hugo Marques, Gianluca Pontone, Todd C Villines, James K Min, Guus A de Waard, Paul Knaapen, Faisal Nabi, U Joseph Schoepf, Sanghoon Shin, Yang Gao, Bin Lu, Chang-Wook Nam, Joon-Hyung Doh, Andrew D Choi, Robert Jennings, Jung Hyun Choi, Philippe Généreux, Rebecca Jonas, James Earls, Ae-Young Her, Bon Kwon Koo, Hyung-Bok Park, Jason Cole, Alessia Gimelli, Muhammad Akram Khan, Ryo Nakazato, Roel S Driessen, Michiel J Bom, Randall C Thompson, James J Jang, Michael Ridner, Chris Rowan, Erick Avelar, and Tami R Crabtree
Subjects: Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Objective The study evaluates the relationship of coronary stenosis, atherosclerotic plaque characteristics (APCs) and age using artificial intelligence enabled quantitative coronary computed tomographic angiography (AI-QCT).Methods This is a post-hoc analysis of data from 303 subjects enrolled in the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia) trial who were referred for invasive coronary angiography and subsequently underwent coronary computed tomographic angiography (CCTA). In this study, a blinded core laboratory analysing quantitative coronary angiography images classified lesions as obstructive (≥50%) or non-obstructive (65 had more PV and CP than patients 65 had more CP than younger patients in both obstructive (29.2 mm3 vs 48.2 mm3; p
Published: 2021
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2. AI Evaluation of Stenosis on Coronary CTA, Comparison With Quantitative Coronary Angiography and Fractional Flow Reserve

Author: William F. Griffin, Andrew D. Choi, Joanna S. Riess, Hugo Marques, Hyuk-Jae Chang, Jung Hyun Choi, Joon-Hyung Doh, Ae-Young Her, Bon-Kwon Koo, Chang-Wook Nam, Hyung-Bok Park, Sang-Hoon Shin, Jason Cole, Alessia Gimelli, Muhammad Akram Khan, Bin Lu, Yang Gao, Faisal Nabi, Ryo Nakazato, U. Joseph Schoepf, Roel S. Driessen, Michiel J. Bom, Randall Thompson, James J. Jang, Michael Ridner, Chris Rowan, Erick Avelar, Philippe Généreux, Paul Knaapen, Guus A. de Waard, Gianluca Pontone, Daniele Andreini, James P. Earls, and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
Subjects: Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine
Abstract: Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved. OBJECTIVES: The study compared the performance for detection and grading of coronary stenoses using artificial intelligence-enabled quantitative coronary computed tomography angiography (AI-QCT) analyses to core lab-interpreted coronary computed tomography angiography (CTA), core lab quantitative coronary angiography (QCA), and invasive fractional flow reserve (FFR). BACKGROUND: Clinical reads of coronary CTA, especially by less experienced readers, may result in overestimation of coronary artery disease stenosis severity compared with expert interpretation. AI-based solutions applied to coronary CTA may overcome these limitations. METHODS: Coronary CTA, FFR, and QCA data from 303 stable patients (64 ± 10 years of age, 71% male) from the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic DEtermiNants of Myocardial IsChEmia) trial were retrospectively analyzed using an Food and Drug Administration-cleared cloud-based software that performs AI-enabled coronary segmentation, lumen and vessel wall determination, plaque quantification and characterization, and stenosis determination. RESULTS: Disease prevalence was high, with 32.0%, 35.0%, 21.0%, and 13.0% demonstrating ≥50% stenosis in 0, 1, 2, and 3 coronary vessel territories, respectively. Average AI-QCT analysis time was 10.3 ± 2.7 minutes. AI-QCT evaluation demonstrated per-patient sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 94%, 68%, 81%, 90%, and 84%, respectively, for ≥50% stenosis, and of 94%, 82%, 69%, 97%, and 86%, respectively, for detection of ≥70% stenosis. There was high correlation between stenosis detected on AI-QCT evaluation vs QCA on a per-vessel and per-patient basis (intraclass correlation coefficient = 0.73 and 0.73, respectively; P < 0.001 for both). False positive AI-QCT findings were noted in in 62 of 848 (7.3%) vessels (stenosis of ≥70% by AI-QCT and QCA of
Published: 2023
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3. Coronary CTA With AI-QCT Interpretation

Author: Isabella Lipkin, Anha Telluri, Yumin Kim, Alfateh Sidahmed, Joseph M. Krepp, Brian G. Choi, Rebecca Jonas, Hugo Marques, Hyuk-Jae Chang, Jung Hyun Choi, Joon-Hyung Doh, Ae-Young Her, Bon-Kwon Koo, Chang-Wook Nam, Hyung-Bok Park, Sang-Hoon Shin, Jason Cole, Alessia Gimelli, Muhammad Akram Khan, Bin Lu, Yang Gao, Faisal Nabi, Ryo Nakazato, U. Joseph Schoepf, Roel S. Driessen, Michiel J. Bom, James J. Jang, Michael Ridner, Chris Rowan, Erick Avelar, Philippe Généreux, Paul Knaapen, Guus A. de Waard, Gianluca Pontone, Daniele Andreini, Mouaz H. Al-Mallah, Tami R. Crabtree, James P. Earls, Andrew D. Choi, James K. Min, Cardiology, ACS - Atherosclerosis & ischemic syndromes, and ACS - Heart failure & arrhythmias
Subjects: Male, Computed Tomography Angiography, CCTA, artificial intelligence, atherosclerosis, coronary CT, coronary CTA, coronary artery disease, fractional flow reserve, quantitative coronary angiography, Myocardial Ischemia, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Constriction, Pathologic, Coronary Angiography, Predictive Value of Tests, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Aged, Retrospective Studies, Coronary Stenosis, Myocardial Perfusion Imaging, General Medicine, Middle Aged, Reference Standards, Fractional Flow Reserve, Myocardial, Female
Abstract: BACKGROUND. Deep learning frameworks have been applied to interpretation of coronary CTA performed for coronary artery disease (CAD) evaluation. OBJECTIVE. The purpose of our study was to compare the diagnostic performance of myocardial perfusion imaging (MPI) and coronary CTA with artificial intelligence quantitative CT (AI-QCT) interpretation for detection of obstructive CAD on invasive angiography and to assess the downstream impact of including coronary CTA with AI-QCT in diagnostic algorithms. METHODS. This study entailed a retrospective post hoc analysis of the derivation cohort of the prospective 23-center Computed Tomographic Evaluation of Atherosclerotic Determinants of Myocardial Ischemia (CREDENCE) trial. The study included 301 patients (88 women and 213 men; mean age, 64.4 ± 10.2 [SD] years) recruited from May 2014 to May 2017 with stable symptoms of myocardial ischemia referred for nonemergent invasive angiography. Patients underwent coronary CTA and MPI before angiography with quantitative coronary angiography (QCA) measurements and fractional flow reserve (FFR). CTA examinations were analyzed using an FDA-cleared cloud-based software platform that performs AI-QCT for stenosis determination. Diagnostic performance was evaluated. Diagnostic algorithms were compared. RESULTS. Among 102 patients with no ischemia on MPI, AI-QCT identified obstructive (≥ 50%) stenosis in 54% of patients, including severe (≥ 70%) stenosis in 20%. Among 199 patients with ischemia on MPI, AI-QCT identified nonobstructive (1-49%) stenosis in 23%. AI-QCT had significantly higher AUC (all p < .001) than MPI for predicting ≥ 50% stenosis by QCA (0.88 vs 0.66), ≥ 70% stenosis by QCA (0.92 vs 0.81), and FFR < 0.80 (0.90 vs 0.71). An AI-QCT result of ≥ 50% stenosis and ischemia on stress MPI had sensitivity of 95% versus 74% and specificity of 63% versus 43% for detecting ≥ 50% stenosis by QCA measurement. Compared with performing MPI in all patients and those showing ischemia undergoing invasive angiography, a scenario of performing coronary CTA with AIQCT in all patients and those showing ≥ 70% stenosis undergoing invasive angiography would reduce invasive angiography utilization by 39%; a scenario of performing MPI in all patients and those showing ischemia undergoing coronary CTA with AI-QCT and those with ≥ 70% stenosis on AI-QCT undergoing invasive angiography would reduce invasive angiography utilization by 49%. CONCLUSION. Coronary CTA with AI-QCT had higher diagnostic performance than MPI for detecting obstructive CAD. CLINICAL IMPACT. A diagnostic algorithm incorporating AI-QCT could substantially reduce unnecessary downstream invasive testing and costs. TRIAL REGISTRATION. Clinicaltrials.gov NCT02173275.
Published: 2022
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4. Diabetes, Atherosclerosis, and Stenosis by AI

Author: Rebecca A. Jonas, Tami R. Crabtree, Robert S. Jennings, Hugo Marques, Richard J. Katz, Hyuk-Jae Chang, Wijnand J. Stuijfzand, Alexander R. van Rosendael, Jung Hyun Choi, Joon-Hyung Doh, Ae-Young Her, Bon-Kwon Koo, Chang-Wook Nam, Hyung-Bok Park, Sang-Hoon Shin, Jason Cole, Alessia Gimelli, Muhammad Akram Khan, Bin Lu, Yang Gao, Faisal Nabi, Ryo Nakazato, U. Joseph Schoepf, Roel S. Driessen, Michiel J. Bom, Randall C. Thompson, James J. Jang, Michael Ridner, Chris Rowan, Erick Avelar, Philippe Généreux, Paul Knaapen, Guus A. de Waard, Gianluca Pontone, Daniele Andreini, Mouaz H. Al-Mallah, Marco Guglielmo, Jeroen J. Bax, James P. Earls, James K. Min, Andrew D. Choi, Todd C. Villines, Cardiology, ACS - Atherosclerosis & ischemic syndromes, and ACS - Heart failure & arrhythmias
Subjects: Advanced and Specialized Nursing, Endocrinology, Diabetes and Metabolism, Internal Medicine
Abstract: OBJECTIVE This study evaluates the relationship between atherosclerotic plaque characteristics (APCs) and angiographic stenosis severity in patients with and without diabetes. Whether APCs differ based on lesion severity and diabetes status is unknown. RESEARCH DESIGN AND METHODS We retrospectively evaluated 303 subjects from the Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia (CREDENCE) trial referred for invasive coronary angiography with coronary computed tomographic angiography (CCTA) and classified lesions as obstructive (≥50% stenosed) or nonobstructive using blinded core laboratory analysis of quantitative coronary angiography. CCTA quantified APCs, including plaque volume (PV), calcified plaque (CP), noncalcified plaque (NCP), low-density NCP (LD-NCP), lesion length, positive remodeling (PR), high-risk plaque (HRP), and percentage of atheroma volume (PAV; PV normalized for vessel volume). The relationship between APCs, stenosis severity, and diabetes status was assessed. RESULTS Among the 303 patients, 95 (31.4%) had diabetes. There were 117 lesions in the cohort with diabetes, 58.1% of which were obstructive. Patients with diabetes had greater plaque burden (P = 0.004). Patients with diabetes and nonobstructive disease had greater PV (P = 0.02), PAV (P = 0.02), NCP (P = 0.03), PAV NCP (P = 0.02), diseased vessels (P = 0.03), and maximum stenosis (P = 0.02) than patients without diabetes with nonobstructive disease. APCs were similar between patients with diabetes with nonobstructive disease and patients without diabetes with obstructive disease. Diabetes status did not affect HRP or PR. Patients with diabetes had similar APCs in obstructive and nonobstructive lesions. CONCLUSIONS Patients with diabetes and nonobstructive stenosis had an association to similar APCs as patients without diabetes who had obstructive stenosis. Among patients with nonobstructive disease, patients with diabetes had more total PV and NCP.
Published: 2023
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5. Diabetes, Atherosclerosis and Stenosis by AI

Author: Todd C. Villines, Andrew D. Choi, James K. Min, Tami R. Crabtree, Robert S. Jennings, Marco Guglielmo, Mouaz H. Al-Mallah, Daniele Andreini, Gianluca Pontone, Guus A. de Waard, Paul Knaapen, Philippe Généreux, Erick Avelar, Chris Rowan, Michael Ridner, James J. Jang, Randall C. Thompson, Michiel J. Bom, Roel S. Driessen, U. Joseph Schoepf, Ryo Nakazato, Faisal Nabi, Yang Gao, Bin Lu, Muhammad Akram Khan, Alessia Gimelli, Jason Cole, Sang-Hoon Shin, Hyung-Bok Park, Chang-Wook Nam, Bon-Kwon Koo, Ae-Young Her, Joon-Hyung Doh, Jung Hyun Choi, Hyuk-Jae Chang, Richard J. Katz, Hugo Marques, James P. Earls, and Rebecca A. Jonas
Abstract: Objectives: This study evaluates the relationship between atherosclerotic plaque characteristics (APCs) and angiographic stenosis severity in patients with and without diabetes. Background: Whether APCs differ based on lesion severity and diabetic status is unknown. Methods: We retrospectively evaluated 303 subjects from the CREDENCE trial referred for invasive coronary angiography with coronary computed tomographic angiography (CCTA) and classified lesions as obstructive (>50% stenosed) or non-obstructive using blinded core laboratory analysis of quantitative coronary angiography. CCTA quantified APCs including plaque volume (PV), calcified plaque (CP), noncalcified plaque (NCP), low density noncalcified plaque (LD-NCP), lesion length, positive remodeling (PR), high-risk plaque (HRP) and percent atheroma volume (PAV; plaque volume normalized for vessel volume). The relationship between APCs, stenosis severity and diabetic status was assessed. Results: Among the 303 patients, 95 (31.4%) had diabetes. There were 117 lesions in the diabetic cohort, 58.1% of which were obstructive. Patients with diabetes had greater plaque burden (p=0.004). Patients with diabetes and nonobstructive disease had greater PV (p=0.02), PAV (p=0.02), NCP (p=0.03), PAV NCP (p=0.02), diseased vessels (p=0.03), and max stenosis (p=0.02) than nondiabetic patients with nonobstructive disease. APCs were similar between diabetics with non-obstructive disease and non-diabetic patients with obstructive disease. Diabetic status did not affect HRP or PR. Patients with diabetes had similar APCs in obstructive and non-obstructive lesions. Conclusions: Patients with diabetes and non-obstructive stenosis had an association to similar APCs as patients without diabetes who have obstructive stenosis. Among patients with non-obstructive disease, patients with diabetes had more total PV and NCP.
Published: 2022
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6. 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 Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah 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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Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M 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Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M Rivest, Sandra S Zier, Sandra Ahoud, Sandy Carr, Sanjay Ganapathi, Sanjay Shetty, Sanjeev Sharma, Santa Jimenez, Santhosh Satheesh, Santiago A Garcia, Sara Fernandez, Sara Karlsson, Sara Salkind, Sara Temiyasathit, Sarah Medina Rodriguez, Sarah Beaudry, Sarah Hadjih, Sarah Williams, Sarah Zahrani, Sarju Ralhan, Sasa Hinic, Sasko Kedev, Satinder Singh, Satoshi Yasuda, Satvic Cholenahally Manjunath, Sau Lee, Scott M Kaczkowski, Scott Kinlay, Sean W Hayes, Sebastian Sobczak, Senait Asier, Sergey A Sayganov, Seth I Sokol, Shaheen Pandie, Shaiful Azmi Yahaya, Shamir Mehta, Shao-Ping Nie, Sharad Chandra, Sharder Islam, Sharon Tai, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Sherron C Crook, Shigeyuki Nishimura, Shintaro Nakano, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shobana Ganesan, Shruti Pandey, Shuyang Zhang, Shweta Hande, Siddharth Gadage, Sik-Yin V Tan, Silvia Zottis Poletti, Silvia Riera, Silvia Valbuena, Simon Walsh, Simona Maspoli, Simone Savaris, Si-Ting Feng, So Yang Cho, Solomon Yakubov, Songlin Zhu, Songtao Wang, Sonia Guerrero, Sonika Gupta, Sonja Salinger Martinovic, Sonya Brons, Sorin Brener, Sothinathan Gurunathan, Souheil Saba, Soundarya Nayak, Sowjanya Reddy, Srinivasa Potluri, Sriram Sudarshan, Srun Kuanprasert, Stacie Van Oosterhout, Stamatios Lerakis, Stanley E Cobos, Stefan C Bertog, Stefan M Simović, Stefan Weikl, Stefano Di Marco, Stefano Provasoli, Stephanie A Tirado, Stephanie C Boer, Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian 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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7. The effect of scan and patient parameters on the diagnostic performance of AI for detecting coronary stenosis on coronary CT angiography

Author: Rebecca A. Jonas, Emil Barkovich, Andrew D. Choi, William F. Griffin, Joanna Riess, Hugo Marques, Hyuk-Jae Chang, Jung Hyun Choi, Joon-Hyung Doh, Ae-Young Her, Bon-Kwon Koo, Chang-Wook Nam, Hyung-Bok Park, Sang-Hoon Shin, Jason Cole, Alessia Gimelli, Muhammad Akram Khan, Bin Lu, Yang Gao, Faisal Nabi, Ryo Nakazato, U. Joseph Schoepf, Roel S. Driessen, Michiel J. Bom, Randall C. Thompson, James J. Jang, Michael Ridner, Chris Rowan, Erick Avelar, Philippe Généreux, Paul Knaapen, Guus A. de Waard, Gianluca Pontone, Daniele Andreini, Marco Guglielmo, Mouaz H. Al-Mallah, Robert S. Jennings, Tami R. Crabtree, James P. Earls, Cardiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Heart failure & arrhythmias, and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
Subjects: Male, Artificial intelligence, Computed Tomography Angiography, Coronary Stenosis, CCTA, Atherosclerosis, Coronary artery disease, Coronary computed tomography angiography, Image quality, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Middle Aged, Coronary Angiography, Predictive Value of Tests, Radiology Nuclear Medicine and imaging, Humans, Female, Radiology, Nuclear Medicine and imaging, Tomography, X-Ray Computed, Aged, Retrospective Studies
Abstract: Publisher Copyright: © 2022 The Authors Objectives: To determine whether coronary computed tomography angiography (CCTA) scanning, scan preparation, contrast, and patient based parameters influence the diagnostic performance of an artificial intelligence (AI) based analysis software for identifying coronary lesions with ≥50% stenosis. Background: CCTA is a noninvasive imaging modality that provides diagnostic and prognostic benefit to patients with coronary artery disease (CAD). The use of AI enabled quantitative CCTA (AI-QCT) analysis software enhances our diagnostic and prognostic ability, however, it is currently unclear whether software performance is influenced by CCTA scanning parameters. Methods: CCTA and quantitative coronary CT (QCT) data from 303 stable patients (64 ± 10 years, 71% male) from the derivation arm of the CREDENCE Trial were retrospectively analyzed using an FDA-cleared cloud-based software that performs AI-enabled coronary segmentation, lumen and vessel wall determination, plaque quantification and characterization, and stenosis determination. The algorithm's diagnostic performance measures (sensitivity, specificity, and accuracy) for detecting coronary lesions of ≥50% stenosis were determined based on concordance with QCA measurements and subsequently compared across scanning parameters (including scanner vendor, model, single vs dual source, tube voltage, dose length product, gating technique, timing method), scan preparation technique (use of beta blocker, use and dose of nitroglycerin), contrast administration parameters (contrast type, infusion rate, iodine concentration, contrast volume) and patient parameters (heart rate and BMI). Results: Within the patient cohort, 13% demonstrated ≥50% stenosis in 3 vessel territories, 21% in 2 vessel territories, 35% in 1 vessel territory while 32% had 400 mg/ml 95.2%; p = 0.0287) in the context of low injection flow rates. On a per patient basis there were no significant differences in AI diagnostic performance measures across all measured scanner, scan technique, patient preparation, contrast, and individual patient parameters. Conclusion: The diagnostic performance of AI-QCT analysis software for detecting moderate to high grade stenosis are unaffected by commonly used CCTA scanning parameters and across a range of common scanning, scanner, contrast and patient variables. Condensed abstract: An AI-enabled quantitative CCTA (AI-QCT) analysis software has been validated as an effective tool for the identification, quantification and characterization of coronary plaque and stenosis through comparison to blinded expert readers and quantitative coronary angiography. However, it is unclear whether CCTA screening parameters related to scanner parameters, scan technique, contrast volume and rate, radiation dose, or a patient's BMI or heart rate at time of scan affect the software's diagnostic measures for detection of moderate to high grade stenosis. AI performance measures were unaffected across a broad range of commonly encountered scanner, patient preparation, scan technique, intravenous contrast and patient parameters. publishersversion published
Published: 2022
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8. Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial

Author: Roxy Senior, Harmony R. Reynolds, James K. Min, Daniel S. Berman, Michael H. Picard, Bernard R. Chaitman, Leslee J. Shaw, Courtney B. Page, Sajeev C. Govindan, Jose Lopez-Sendon, Jesus Peteiro, Gurpreet S. Wander, Jaroslaw Drozdz, Jose Marin-Neto, Joseph B. Selvanayagam, Jonathan D. Newman, Christophe Thuaire, Johann Christopher, James J. Jang, Raymond Y. Kwong, Sripal Bangalore, Gregg W. Stone, Sean M. O’Brien, William E. Boden, David J. Maron, and Judith S. Hochman
Subjects: Male, Internationality, Single Photon Emission Computed Tomography Computed Tomography, Computed Tomography Angiography, Myocardial Perfusion Imaging, Coronary Stenosis, Coronary Artery Disease, Middle Aged, Coronary Angiography, Coronary Vessels, Article, Cohort Studies, Predictive Value of Tests, Positron-Emission Tomography, Humans, Female, Cardiology and Cardiovascular Medicine, Aged
Abstract: Detection of ≥50% diameter stenosis left main coronary artery disease (LMD) has prognostic and therapeutic implications. Noninvasive stress imaging or an exercise tolerance test (ETT) are the most common methods to detect obstructive coronary artery disease, though stress test markers of LMD remain ill-defined.The authors sought to identify markers of LMD as detected on coronary computed tomography angiography (CTA), using clinical and stress testing parameters.This was a post hoc analysis of ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), including randomized and nonrandomized participants who had locally determined moderate or severe ischemia on nonimaging ETT, stress nuclear myocardial perfusion imaging, or stress echocardiography followed by CTA to exclude LMD. Stress tests were read by core laboratories. Prior coronary artery bypass grafting was an exclusion. In a stepped multivariate model, the authors identified predictors of LMD, first without and then with stress testing parameters.Among 5,146 participants (mean age 63 years, 74% male), 414 (8%) had LMD. Predictors of LMD were older age (P 0.001), male sex (P 0.01), absence of prior myocardial infarction (P 0.009), transient ischemic dilation of the left ventricle on stress echocardiography (P = 0.05), magnitude of ST-segment depression on ETT (P = 0.004), and peak metabolic equivalents achieved on ETT (P = 0.001). The models were weakly predictive of LMD (C-index 0.643 and 0.684).In patients with moderate or severe ischemia, clinical and stress testing parameters were weakly predictive of LMD on CTA. For most patients with moderate or severe ischemia, anatomical imaging is needed to rule out LMD. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
Published: 2022

9. Relationship of age, atherosclerosis and angiographic stenosis using artificial intelligence

Author: Hyuk Jae Chang, Todd C. Villines, Jung Hyun Choi, Gianluca Pontone, Michiel J. Bom, Hugo Marques, James J. Jang, Chris Rowan, Ryo Nakazato, Mouaz H. Al-Mallah, Bin Lu, Chang-Wook Nam, Muhammad Akram Khan, Ae-Young Her, Joon-Hyung Doh, Roel S. Driessen, Paul Knaapen, Sanghoon Shin, Robert S Jennings, Hyung-Bok Park, Guus A. de Waard, U. Joseph Schoepf, Randall C. Thompson, Tami R Crabtree, Yang Gao, Philippe Généreux, Alessia Gimelli, Andrew D. Choi, Faisal Nabi, Jason H. Cole, James K. Min, Erick Avelar, Michael Ridner, Bon Kwon Koo, James P. Earls, Daniele Andreini, Rebecca A Jonas, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Comprehensive Health Research Centre (CHRC) - pólo NMS, Cardiology, ACS - Atherosclerosis & ischemic syndromes, and ACS - Heart failure & arrhythmias
Subjects: Coronary angiography, Male, Myocardial ischemia, diagnostic imaging, Computed Tomography Angiography, Coronary Artery Disease, Coronary Angiography, Severity of Illness Index, Computed tomographic, Lesion, Artificial Intelligence, Predictive Value of Tests, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, Prospective Studies, Computed tomography angiography, Aged, medicine.diagnostic_test, business.industry, Incidence, carotid artery diseases, Coronary Stenosis, Lesion types, Middle Aged, medicine.disease, Coronary Vessels, Plaque, Atherosclerotic, United States, Invasive coronary angiography, Stenosis, RC666-701, Female, Artificial intelligence, medicine.symptom, coronary angiography, atherosclerosis, business, Cardiology and Cardiovascular Medicine, computed tomography angiography, Follow-Up Studies
Abstract: ObjectiveThe study evaluates the relationship of coronary stenosis, atherosclerotic plaque characteristics (APCs) and age using artificial intelligence enabled quantitative coronary computed tomographic angiography (AI-QCT).MethodsThis is a post-hoc analysis of data from 303 subjects enrolled in the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia) trial who were referred for invasive coronary angiography and subsequently underwent coronary computed tomographic angiography (CCTA). In this study, a blinded core laboratory analysing quantitative coronary angiography images classified lesions as obstructive (≥50%) or non-obstructive (ResultsThe cohort was 64.4±10.2 years and 29% women. Overall, patients >65 had more PV and CP than patients 65 had more CP than younger patients in both obstructive (29.2 mm3 vs 48.2 mm3; p3 vs 49.4 mm3; pConclusionAI-QCT identifies a unique APC signature that differs by age and degree of stenosis and provides a foundation for AI-guided age-based approaches to atherosclerosis identification, prevention and treatment.
Published: 2021
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10. 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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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

11. Stress Myocardial Perfusion Imaging vs Coronary Computed Tomographic Angiography for Diagnosis of Invasive Vessel-Specific Coronary Physiology: Predictive Modeling Results From the Computed Tomographic Evaluation of Atherosclerotic Determinants of Myocardial Ischemia (CREDENCE) Trial

Author: Alessia Gimelli, Chris J. Rowan, Guus A. de Waard, Gianluca Pontone, Michiel J. Bom, Yao Lu, Faisal Nabi, U. Joseph Schoepf, Roel S. Driessen, Yang Gao, Inge J. van den Hoogen, Sanghoon Shin, James J. Jang, Credence Investigators, Chang-Wook Nam, Hyung-Bok Park, Mouaz H. Al-Mallah, Ryo Nakazato, Jason H. Cole, James K. Min, Leslee J. Shaw, Michael Ridner, Philippe Généreux, Alexander R. van Rosendael, Erick Avelar, Muhammad Akram Khan, Bin Lu, Joon-Hyung Doh, Fay Y. Lin, Bon-Kwon Koo, Wijnand J. Stuijfzand, Randall C. Thompson, Jagat Narula, Jeroen J. Bax, Daniele Andreini, Ae-Young Her, Hyuk Jae Chang, Jung Hyun Choi, Daniel S. Berman, Umberto Gianni, Paul Knaapen, Cardiology, ACS - Atherosclerosis & ischemic syndromes, and ACS - Heart failure & arrhythmias
Subjects: Male, medicine.medical_specialty, Myocardial Ischemia, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, Coronary artery disease, 03 medical and health sciences, Myocardial perfusion imaging, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Aged, Original Investigation, medicine.diagnostic_test, business.industry, Myocardial Perfusion Imaging, Magnetic resonance imaging, Middle Aged, medicine.disease, Prognosis, Plaque, Atherosclerotic, Fractional Flow Reserve, Myocardial, Stenosis, Atheroma, Positron emission tomography, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Tomography, X-Ray Computed, Perfusion
Abstract: Key PointsQuestionAre atherosclerotic plaque measurements associated with physiologic measures of invasive fractional flow reserve? FindingsIn this analysis of the CREDENCE clinical trial that included 612 patients, nonobstructive and obstructive measures of atherosclerotic plaque were significantly associated with invasive fractional flow reserve. A comprehensive set of atherosclerotic plaque features improved the accuracy of classifying vessel-specific reduced fractional flow reserve vs rest/stress myocardial perfusion imaging measurements. MeaningUsing coronary computed tomographic angiography for detection of atherosclerotic plaque features associated with coronary physiology may improve diagnostic certainty and guide clinical management of symptomatic patients.ImportanceStress imaging has been the standard for diagnosing functionally significant coronary artery disease. It is unknown whether novel, atherosclerotic plaque measures improve accuracy beyond coronary stenosis for diagnosing invasive fractional flow reserve (FFR) measurement. ObjectiveTo compare the diagnostic accuracy of comprehensive anatomic (obstructive and nonobstructive atherosclerotic plaque) vs functional imaging measures for estimating vessel-specific FFR. Design, Setting, and ParticipantsControlled clinical trial of diagnostic accuracy with a multicenter derivation-validation cohort of patients referred for nonemergent invasive coronary angiography. A total of 612 patients (64 [10] years; 30% women) with signs and symptoms suggestive of myocardial ischemia from 23 sites were included. Patients were recruited from 2014 to 2017. Data analysis began in August 2018. InterventionsPatients underwent invasive coronary angiography with measurement of invasive FFR, coronary computed tomographic angiography (CCTA) quantification of atherosclerotic plaque and FFR by CT (FFR-CT), and semiquantitative scoring of rest/stress myocardial perfusion imaging (by magnetic resonance, positron emission tomography, or single photon emission CT). Multivariable generalized linear mixed models were derived and validated calculating the area under the receiver operating characteristics curve. Main Outcomes and MeasuresThe primary end point was invasive FFR of 0.80 or less. ResultsOf the 612 patients, the mean (SD) age was 64 (10) years, and 426 (69.9%) were men. An invasive FFR of 0.80 or less was measured in 26.5% of 1727 vessels. In the derivation cohort, CCTA vessel-specific factors associated with FFR 0.80 or less were stenosis severity, percentage of noncalcified atheroma volume, lumen volume, the number of lesions with high-risk plaque (>= 2 of low attenuation plaque, positive remodeling, napkin ring sign, or spotty calcification), and the number of lesions with stenosis greater than 30%. Fractional flow reserve-CT was not additive to this model including stenosis and atherosclerotic plaque. Significant myocardial perfusion imaging predictors were the summed rest and difference scores. In the validation cohort, the areas under the receiver operating characteristic curve were 0.81 for CCTA vs 0.67 for myocardial perfusion imaging (P
Published: 2020
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12. Predictive Model for High-Risk Coronary Artery Disease

Author: Jean-Claude Tardif, Andrey Espinoza, Manjushri Bhapkar, Christopher B. Fordyce, Daniel B. Mark, Manesh R. Patel, Sreekanth Vemulapalli, Vincent L. Sorrell, James E. Udelson, Kerry L. Lee, James J. Jang, Pamela S. Douglas, W. Schuyler Jones, Udo Hoffmann, and Adrian Coles
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, CAD, Imaging study, 030204 cardiovascular system & hematology, Chest pain, medicine.disease, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Text mining, Internal medicine, Angiography, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Risk assessment
Abstract: Background: Patients with high-risk coronary artery disease (CAD) may be difficult to identify. Methods: Using the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) cohort randomized to coronary computed tomographic angiography (n=4589), 2 predictive models were developed for high-risk CAD, defined as left main stenosis (≥50% stenosis) or either (1) ≥50% stenosis [50] or (2) ≥70% stenosis [70] of 3 vessels or 2-vessel CAD involving the proximal left anterior descending artery. Pretest predictors were examined using stepwise logistic regression and assessed for discrimination and calibration. Results: High-risk CAD was identified in 6.6% [50] and 2.4% [70] of patients. Models developed to predict high-risk CAD discriminated well: [50], bias-corrected C statistic=0.73 (95% CI, 0.71−0.76); [70], bias-corrected C statistic=0.73 (95% CI, 0.68−0.77). Variables predictive of CAD in both models included family history of premature CAD, age, male sex, lower glomerular filtration rate, diabetes mellitus, elevated systolic blood pressure, and angina. Additionally, smoking history was predictive of [50] CAD and sedentary lifestyle of [70] CAD. Both models characterized high-risk CAD better than the Pooled Cohort Equation (area under the curve=0.70 and 0.71 for [50] and [70], respectively) and Diamond-Forrester risk scores (area under the curve=0.68 and 0.71, respectively). Both [50] and [70] CAD was associated with more frequent invasive interventions and adverse events than non-high-risk CAD (all P Conclusions: In contemporary practice, 2.4% to 6.6% of stable, symptomatic patients requiring noninvasive testing have high-risk CAD. A simple combination of pretest clinical variables improves prediction of high-risk CAD over traditional risk assessments. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01174550.
Published: 2019
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13. Effectiveness of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease

Author: Ashok Krishnaswami, Anne C.H. Goh, Elaine Allen, Alan S. Go, James J. Jang, Robert J. Lundstrom, and Jonathan G. Zaroff
Subjects: medicine.medical_specialty, medicine.medical_treatment, Subgroup analysis, Coronary Artery Disease, 030204 cardiovascular system & hematology, Global Health, Revascularization, law.invention, End stage renal disease, 03 medical and health sciences, Percutaneous Coronary Intervention, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, Risk Factors, law, Internal medicine, Humans, Medicine, 030212 general & internal medicine, Coronary Artery Bypass, business.industry, Incidence, Percutaneous coronary intervention, Survival Rate, Relative risk, Conventional PCI, Cardiology, Kidney Failure, Chronic, Observational study, Cardiology and Cardiovascular Medicine, business
Abstract: The optimal coronary revascularization strategy (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI]) in patients with end-stage renal disease (ESRD) remains uncertain. We performed an updated systematic review and meta-analysis of observational studies comparing CABG and PCI in patients with ESRD using a random-effects model for the primary outcome of long-term all-cause mortality. Our review registered through PROSPERO included observational studies published after 2011 to ensure overlap with previous studies and identified 7 new studies for a total of 23. We found that the median sample size in the selected studies was 125 patients (25 to 15,784) with a large variation in the covariate risk adjustment and only 3 studies reporting the indications for the revascularization strategy. CABG was associated with a small reduction in mortality (relative risk 0.92, 95% CI 0.89 to 0.96) with significant heterogeneity demonstrated (p = 0.005, I(2) = 48.6%). Subgroup analysis by categorized "year of study initiation" (1990, 1991 to 2003,2004) further confirmed the summary estimate trending toward survival benefit of CABG along with a substantial decrease in heterogeneity after 2004 (p = 0.64, I(2) = 0%). In conclusion, our updated systematic review and meta-analysis demonstrated that in patients with ESRD referred for coronary revascularization, CABG was associated with a small decrease in the relative risk of long-term mortality compared with PCI. The generalizability of the finding to all patients with ESRD referred for coronary revascularization is limited because of a lack of known indications for coronary revascularization, substantial variation in covariate risk adjustment, and lack of randomized clinical trial data.
Published: 2016
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14. PREDICTION OF LEFT MAIN DISEASE USING CLINICAL AND STRESS TEST PARAMETERS

Author: James J. Jang, Sajeev Chakanalil Govindan, Daniel S. Berman, Joseph B. Selvanayagam, Bernard R. Chaitman, William E. Boden, Gregg W. Stone, Gurpreet Singh Wander, Jerome L. Fleg, Jesús Peteiro, Judith S. Hochman, Jose Lopez-Sendon, Sean M. O'Brien, Roxy Senior, Sripal Bangalore, David J. Maron, Harmony R. Reynolds, Courtney Page, James K. Min, Leslee J. Shaw, Jarosław Drożdż, Jonathan D. Newman, Michael H. Picard, José Antonio Marin-Neto, and Christophe Thuaire
Subjects: medicine.medical_specialty, business.industry, Stress test, Internal medicine, Cardiology, Medicine, Cardiology and Cardiovascular Medicine, business, Left main disease
Published: 2020
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15. Elevated osteoprotegerin is associated with abnormal ankle brachial indices in patients infected with HIV: a cross‐sectional study

Author: James J Jang, Aron I Schwarcz, Daniel A Amaez, Mark Woodward, Jeffrey W Olin, Marla J Keller, and Alison D Schecter
Subjects: Immunologic diseases. Allergy, RC581-607
Abstract: Background Patients infected with HIV have an increased risk for accelerated atherosclerosis. Elevated levels of osteoprotegerin, an inflammatory cytokine receptor, have been associated with a high incidence of cardiovascular disease (including peripheral arterial disease, or PAD), acute coronary syndrome, and cardiovascular mortality. The objective of this study was to determine whether PAD is prevalent in an HIV‐infected population, and to identify an association with HIV‐specific and traditional cardiovascular risk factors, as well as levels of osteoprotegerin. Methods One hundred and two patients infected with HIV were recruited in a cross‐sectional study. To identify the prevalence of PAD, ankle‐brachial indices (ABIs) were measured. Four standard ABI categories were utilized: ≤ 0.90 (definite PAD); 0.91‐0.99 (borderline); 1.00‐1.30 (normal); and >1.30 (high). Medical history and laboratory measurements were obtained to determine possible risk factors associated with PAD in HIV‐infected patients. Results The prevalence of PAD (ABI ≤ 0.90) in a young HIV‐infected population (mean age: 48 years) was 11%. Traditional cardiovascular risk factors, including advanced age and previous cardiovascular history, as well as elevated C‐reactive protein levels, were associated with PAD. Compared with patients with normal ABIs, patients with high ABIs had significantly elevated levels of osteoprotegerin [1428.9 (713.1) pg/ml vs. 3088.6 (3565.9) pg/ml, respectively, p = 0.03]. Conclusions There is a high prevalence of PAD in young HIV‐infected patients. A number of traditional cardiovascular risk factors and increased osteoprotegerin concentrations are associated with abnormal ABIs. Thus, early screening and aggressive medical management for PAD may be warranted in HIV‐infected patients.
Published: 2010
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16. Discordance Between Echocardiography and MRI in the Assessment of Mitral Regurgitation Severity

Author: Steven D. Wolff, Roberto M. Lang, Marjorie Subero, Randy Cohen, Kavya Jain, Azhar Supariwala, Srinivasa Gurram, Edgar Argulian, Seth Uretsky, Farooq A. Chaudhry, James J. Jang, and Linda D. Gillam
Subjects: Mitral regurgitation, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, macromolecular substances, Asymptomatic, Internal medicine, Multicenter trial, Cohort, Cardiology, medicine, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Observer variation, Reference standards, Mitral valve surgery
Abstract: Background The decision to undergo mitral valve surgery is often made on the basis of echocardiographic criteria and clinical assessment. Recent changes in treatment guidelines recommending surgery in asymptomatic patients make the accurate assessment of mitral regurgitation (MR) severity even more important. Objectives The purpose of this study was to compare echocardiography and magnetic resonance imaging (MRI) in the assessment of MR severity using the degree of left ventricular (LV) remodeling after surgery as the reference standard. Methods In this prospective multicenter trial, MR severity was assessed in 103 patients using both echocardiography and MRI. Thirty-eight patients subsequently had isolated mitral valve surgery, and 26 of these had an additional MRI performed 5 to 7 months after surgery. The pre-surgical estimate of regurgitant severity was correlated with the postoperative decrease in LV end-diastolic volume. Results Agreement between MRI and echocardiographic estimates of MR severity was modest in the overall cohort (r = 0.6; p Conclusions The data suggest that MRI is more accurate than echocardiography in assessing the severity of MR. MRI should be considered in those patients when MR severity as assessed by echocardiography is influencing important clinical decisions, such as the decision to undergo MR surgery.
Published: 2015
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17. Prognostic Value of Coronary Artery Calcium in the PROMISE Study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)

Author: Mayil S. Krishnam, Matthew J. Budoff, Thomas Mayrhofer, Maros Ferencik, Udo Hoffmann, Pamela S. Douglas, Michael T. Lu, Kerry L. Lee, Daniel O. Bittner, Adrian Coles, and James J. Jang
Subjects: Male, Comparative Effectiveness Research, Time Factors, Computed Tomography Angiography, Myocardial Infarction, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Chest pain, Coronary Angiography, 030218 nuclear medicine & medical imaging, Coronary artery disease, Electrocardiography, 0302 clinical medicine, Risk Factors, Myocardial infarction, Prospective Studies, Prospective cohort study, Computed tomography angiography, medicine.diagnostic_test, Middle Aged, Prognosis, Hospitalization, Predictive value of tests, Cardiology, Disease Progression, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Echocardiography, Stress, medicine.medical_specialty, Asymptomatic, Article, Angina Pectoris, Diagnosis, Differential, 03 medical and health sciences, Predictive Value of Tests, Physiology (medical), Internal medicine, Multidetector Computed Tomography, medicine, Humans, Angina, Unstable, Vascular Calcification, Aged, Proportional Hazards Models, business.industry, medicine.disease, Surgery, Dyspnea, North America, Exercise Test, business
Abstract: Background: Coronary artery calcium (CAC) is an established predictor of future major adverse atherosclerotic cardiovascular events in asymptomatic individuals. However, limited data exist as to how CAC compares with functional testing (FT) in estimating prognosis in symptomatic patients. Methods: In the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), patients with stable chest pain (or dyspnea) and intermediate pretest probability for obstructive coronary artery disease were randomized to FT (exercise electrocardiography, nuclear stress, or stress echocardiography) or anatomic testing. We evaluated those who underwent CAC testing as part of the anatomic evaluation (n=4209) and compared that with results of FT (n=4602). We stratified CAC and FT results as normal or mildly, moderately, or severely abnormal (for CAC: 0, 1–99 Agatston score [AS], 100–400 AS, and >400 AS, respectively; for FT: normal, mild=late positive treadmill, moderate=early positive treadmill or single-vessel ischemia, and severe=large ischemic region abnormality). The primary end point was all-cause death, myocardial infarction, or unstable angina hospitalization over a median follow-up of 26.1 months. Cox regression models were used to calculate hazard ratios (HRs) and C statistics to determine predictive and discriminatory values. Results: Overall, the distribution of normal or mildly, moderately, or severely abnormal test results was significantly different between FT and CAC (FT: normal, n=3588 [78.0%]; mild, n=432 [9.4%]; moderate, n=217 [4.7%]; severe, n=365 [7.9%]; CAC: normal, n=1457 [34.6%]; mild, n=1340 [31.8%]; moderate, n=772 [18.3%]; severe, n=640 [15.2%]; P 0), whereas fewer than half of events occurred in patients with mildly, moderately, or severely abnormal FT (n=57 of 132, 43%; P P Conclusions: Among stable outpatients presenting with suspected coronary artery disease, most patients experiencing clinical events have measurable CAC at baseline, and fewer than half have any abnormalities on FT. However, an abnormal FT was more specific for cardiovascular events, leading to overall similarly modest discriminatory abilities of both tests. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01174550.
Published: 2017

18. Cardiac-Specific Conversion Factors to Estimate Radiation Effective Dose From Dose-Length Product in Computed Tomography

Author: Carla M. Thompson, Yanping Xu, Boyu Peng, Andrew J. Einstein, Sigal Trattner, Jill E. Jacobs, M. Robert Peters, Munir Ghesani, Sachin Jambawalikar, Anjali Chelliah, S.S. Halliburton, James J. Jang, and Hussein R. Al-Khalidi
Subjects: Scanner, medicine.medical_specialty, Tomography Scanners, X-Ray Computed, Computed Tomography Angiography, Dose Length Product, Coronary Artery Disease, 030204 cardiovascular system & hematology, Radiation, Coronary Angiography, Radiation Dosage, Effective dose (radiation), 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Computer Simulation, Vascular Calcification, Cardiac imaging, business.industry, Phantoms, Imaging, Helical scan, Equipment Design, Coronary Vessels, Confidence interval, Radiological weapon, Radiology, Cardiology and Cardiovascular Medicine, business, Nuclear medicine
Abstract: Objectives This study sought to determine updated conversion factors (k-factors) that would enable accurate estimation of radiation effective dose (ED) for coronary computed tomography angiography (CTA) and calcium scoring performed on 12 contemporary scanner models and current clinical cardiac protocols and to compare these methods to the standard chest k-factor of 0.014 mSv·mGy−1cm−1. Background Accurate estimation of ED from cardiac CT scans is essential to meaningfully compare the benefits and risks of different cardiac imaging strategies and optimize test and protocol selection. Presently, ED from cardiac CT is generally estimated by multiplying a scanner-reported parameter, the dose-length product, by a k-factor which was determined for noncardiac chest CT, using single-slice scanners and a superseded definition of ED. Methods Metal-oxide-semiconductor field-effect transistor radiation detectors were positioned in organs of anthropomorphic phantoms, which were scanned using all cardiac protocols, 120 clinical protocols in total, on 12 CT scanners representing the spectrum of scanners from 5 manufacturers (GE, Hitachi, Philips, Siemens, Toshiba). Organ doses were determined for each protocol, and ED was calculated as defined in International Commission on Radiological Protection Publication 103. Effective doses and scanner-reported dose-length products were used to determine k-factors for each scanner model and protocol. Results k-Factors averaged 0.026 mSv·mGy−1cm−1 (95% confidence interval: 0.0258 to 0.0266) and ranged between 0.020 and 0.035 mSv·mGy−1cm−1. The standard chest k-factor underestimates ED by an average of 46%, ranging from 30% to 60%, depending on scanner, mode, and tube potential. Factors were higher for prospective axial versus retrospective helical scan modes, calcium scoring versus coronary CTA, and higher (100 to 120 kV) versus lower (80 kV) tube potential and varied among scanner models (range of average k-factors: 0.0229 to 0.0277 mSv·mGy−1cm−1). Conclusions Cardiac k-factors for all scanners and protocols are considerably higher than the k-factor currently used to estimate ED of cardiac CT studies, suggesting that radiation doses from cardiac CT have been significantly and systematically underestimated. Using cardiac-specific factors can more accurately inform the benefit-risk calculus of cardiac-imaging strategies.
Published: 2017

19. A pilot study to assess the utility of five established variables to standardize exercise treadmill test reporting

Author: James J. Jang, Sheng-Fang Jiang, Thomas Alloggiamento, Matthew D. Solomon, Ashok Krishnaswami, Jamal S. Rana, Christine Tsou, Walter P. Kwan, William K.W. Ho, and Andrew W. Praserthdam
Subjects: Cart, Male, medicine.medical_specialty, Myocardial Infarction, Pilot Projects, 030204 cardiovascular system & hematology, Logistic regression, California, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Heart Rate, Predictive Value of Tests, Risk Factors, Cause of Death, Heart rate, Medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Treadmill, Lead (electronics), Exercise, Retrospective Studies, business.industry, Retrospective cohort study, Recovery of Function, Middle Aged, medicine.disease, Test (assessment), Survival Rate, Health Records, Personal, Physical therapy, Exercise Test, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Background The prognostic utility of 5 established variables (functional capacity, Duke treadmill score, chronotropic response to exercise, heart rate recovery, and premature ventricular contractions) together after routine exercise treadmill testing (ETT) has not been determined. Methods We assessed the combined prognostic ability of 5 established variables for the primary outcome (myocardial infarction [MI], coronary revascularization [CR] or all-cause mortality) and the secondary outcome of unnecessary downstream testing (defined as receipt of further noninvasive imaging without CR, MI, or death) compared with standard methods. Using a retrospective study design, 1857 consecutive patients were enrolled in the year 2014 and followed until December 31, 2015. Optimal discrimination and global fit statistics were assessed from logistic regression models. Classification and regression tree (CART) methodology was used for the final model. Results The mean [SD] age was 56.0 [12.5]years; median comorbidities (2, IQR 2) with 26% having an equivocal report. Compared to other models, a model with age, sex, and the 5 established variables showed an improvement in discrimination for the primary [c-statistic 0.85 versus (0.69–0.79)] and secondary [c-statistic 0.73 versus (0.65–0.71)] outcomes with substantial improvement in global fit. The final, optimal, 10-fold cross-validated CART model had a c-statistic of 0.78. Conclusions The utility of the 5-established variables, based on the current study, resides in its ability to decrease unnecessary downstream testing and improve cardiovascular event prognostication. This is accomplished by removing the subjective interpretation of currently used ETT variables that can lead to an equivocal report.
Published: 2016

20. Rationale and Design of the CREDENCE Trial: computed TomogRaphic evaluation of atherosclerotic DEtermiNants of myocardial IsChEmia

Author: Muhammad Akram Khan, Asim Rizvi, Ji Hyun Lee, Gianluca Pontone, Faisal Nabi, Alessia Gimelli, Michael Ridner, Hyuk Jae Chang, Jonathon Leipsic, Ryo Nakazato, Paul Knaapen, Millie Gomez, Leslee J. Shaw, Donghee Han, Daniele Andreini, James K. Min, James J. Jang, Bríain ó Hartaigh, Fay Y. Lin, Quynh A. Truong, Subha V. Raman, Jason H. Cole, Christopher K. Zarins, Jackie Szymonifika, Cardiology, and ICaR - Ischemia and repair
Subjects: Adult, Male, medicine.medical_specialty, Myocardial Ischemia, Ischemia, Coronary Artery Disease, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, Myocardial perfusion scintigraphy, Severity of Illness Index, Myocardial blood flow, Coronary artery disease, Study Protocol, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, medicine, Clinical endpoint, Humans, Coronary computed tomography angiography, Prospective Studies, 030212 general & internal medicine, Medical diagnosis, Angiology, business.industry, Reproducibility of Results, medicine.disease, Plaque, Atherosclerotic, 3. Good health, Cardiac surgery, Fractional Flow Reserve, Myocardial, Stenosis, Cardiology, Female, Radiology, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Background Coronary computed tomography angiography (CCTA) allows for non-invasive assessment of obstructive coronary artery disease (CAD) beyond measures of stenosis severity alone. This assessment includes atherosclerotic plaque characteristics (APCs) and calculation of fractional flow reserve (FFR) from CCTA (FFRCT). Similarly, stress imaging by myocardial perfusion scintigraphy (MPS) provides vital information. To date, the diagnostic performance of integrated CCTA assessment versus integrated MPS assessment for diagnosis of vessel-specific ischemia remains underexplored. Methods CREDENCE will enroll adult individuals with symptoms suspicious of CAD referred for non-emergent invasive coronary angiography (ICA), but without known CAD. All participants will undergo CCTA, MPS, ICA and FFR. FFR will be performed for lesions identified at the time of ICA to be ≥40 and
Published: 2016
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21. Valvular heart disease in patients exposed to pergolide: insights from the clinical presentation

Author: James J. Jang, Valerie C. Kwai Ben, Sarah Berkheimer, Robin D. Fross, Stephen K. VanDenEeden, Kathleen B. Albers, and Ashok Krishnaswami
Subjects: Pergolide, medicine.medical_specialty, medicine.diagnostic_test, Epidemiology, Cross-sectional study, business.industry, valvular heart disease, Chest pain, medicine.disease, Internal medicine, Predictive value of tests, medicine.artery, Pulmonary artery, medicine, Cardiology, Pharmacology (medical), medicine.symptom, Prospective cohort study, business, Electrocardiography, medicine.drug
Abstract: Purpose The aim of this study was to determine whether the presence of symptoms would aid in the detection of valvular heart disease (VHD) in those exposed to pergolide. Methods Utilizing a prospective, cross-sectional study design, patients with an exposure to pergolide were asked regarding the presence or absence of chest pain, shortness of breath or lower extremity edema through a questionnaire. Echocardiograms were obtained on the same day as the questionnaire and were blinded to all staff involved in the study. The sensitivity, specificity, positive and negative predictive value of the reported symptoms towards the outcome moderate or severe valvular regurgitation were obtained. Using the area under the receiver-operating characteristic curve, we also ascertained whether a relationship existed between symptoms, pergolide dose and presence of VHD. To understand the associations between symptoms and echocardiographic covariates, a logistic regression analysis was performed adjusted for age and gender. Results The sensitivity, specificity, positive and negative predictive value of symptom presentation and total dose was sufficiently low that it did not aid in the determination whether significant valvular regurgitation was present. Multivariable analysis noted a significant association with indexed left atrial volume (p = 0.011), estimated pulmonary artery pressure (p = 0.047) and shortness of breath. Conclusions The presence or absence of symptoms does not help guide whether valvular regurgitation is present or absent in individuals exposed to pergolide. Therefore, echocardiography is needed to confirm or refute pergolide-associated VHD. Copyright © 2012 John Wiley & Sons, Ltd.
Published: 2012
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22. Contemporary Management of Postcatheterization Pseudoaneurysms

Author: James J. Jang, Geoffrey W. Webber, Jeffrey W. Olin, and Susan Gustavson
Subjects: medicine.medical_specialty, business.industry, Angiography, Thrombin, Anastomosis, urologic and male genital diseases, medicine.disease, Thrombosis, Hemostatics, Diagnostic catheterization, Catheterization, Surgery, Pseudoaneurysm, Aneurysm, Hematoma, Axillary artery, Physiology (medical), medicine.artery, medicine, Humans, Brachial artery, Cardiology and Cardiovascular Medicine, business, Aneurysm, False, Ultrasonography
Abstract: A pseudoaneurysm (PSA) is a contained rupture; there is a disruption in all 3 layers of the arterial wall (Figure 1). PSAs may occur under 4 circumstances: (1) after catheterization (Figure 2); (2) at the site of native artery and synthetic graft anastomosis (eg, aortofemoral bypass graft); (3) trauma; and (4) infection (eg, mycotic PSA) (Figure 3). This review will focus on PSAs that occur after cardiac and peripheral endovascular procedures. PSAs occur when an arterial puncture site does not adequately seal. Pulsatile blood tracks into the perivascular space and is contained by the perivascular structures, which then take on the appearance of a sac. Hematoma and the surrounding tissue form the wall of the PSA. Figure 1. Artist’s rendition of a postcatheterization PSA with proper placement of the needle for thrombin injection. There is a disruption in all 3 layers of the arterial wall. In essence, this represents a contained rupture. Figure 2. Arteriogram that demonstrates an axillary artery PSA after a diagnostic arteriographic procedure. Note the disruption in the vessel wall (white arrow) and the larger PSA sac (black arrow). Figure 3. Ultrasound of a spontaneous PSA in the left brachial artery. Note the absence of a tract. The PSA chamber is directly connected to the brachial artery. This type of PSA must be treated surgically. This patient had infective endocarditis. Postcatheterization PSA is one of the most common vascular complications of cardiac and peripheral angiographic procedures. The incidence of PSA after diagnostic catheterization ranges from 0.05% to 2%.1 When coronary or peripheral intervention is performed, the incidence increases to 2% to 6%. In 1 series where diagnostic ultrasound was performed on 536 consecutive patients who underwent catheterization, the incidence of PSA was 7.7%, with 83% of the PSAs associated with interventional procedures.2 Despite a low …
Published: 2007
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23. Discordance between MRI and echocardiography in the assessment of mitral regurgitation severity: prediction of surgical response suggests mri may be more accurate

Author: Leo Marcoff, Linda D. Gillam, Farooq A. Chaudhry, James J. Jang, Randy Cohen, Seth Uretsky, Steven D. Wolff, Edgar Argulian, Sai Priyanka Gudiwada, and Konstantinos Koulogiannis
Subjects: Medicine(all), medicine.medical_specialty, Pathology, Mitral regurgitation, Radiological and Ultrasound Technology, business.industry, food and beverages, Forward flow, Stroke volume, macromolecular substances, Imaging modalities, Clinical Practice, Text mining, Multicenter trial, Poster Presentation, medicine, Radiology, Nuclear Medicine and imaging, Radiology, Cardiology and Cardiovascular Medicine, business, Angiology
Abstract: Background The assessment of mitral regurgitation (MR) severity is often based on echocardiographic criteria and clinical assessment. MRI can also quantify MR severity, indirectly as the difference between left ventricular (LV) stroke volume and forward flow. In clinical practice these imaging modalities can be discordant. The purpose of this prospective, multicenter trial is to compare the two techniques in assessing the severity of MR.
Published: 2015

24. Developmental Endothelial Locus-1 (Del-1), a Novel Angiogenic Protein

Author: Gary Spektor, Annie Fong, John P. Cooke, Bob S. Hu, Shuichiro Kaji, Randy Schatzman, Thomas Quertermous, Hoai Ky V. Ho, James J. Jang, and Phillip C. Yang
Subjects: Angiogenesis, Basic fibroblast growth factor, Ischemia, Collateral Circulation, Hindlimb, Biology, Injections, Intramuscular, Extracellular matrix, Mice, chemistry.chemical_compound, In vivo, Physiology (medical), medicine, Animals, Angiogenic Proteins, Cell adhesion molecule, Calcium-Binding Proteins, Prostheses and Implants, Integrin alphaVbeta3, medicine.disease, Magnetic Resonance Imaging, Cell biology, Femoral Artery, Mice, Inbred C57BL, Gene Expression Regulation, chemistry, Immunology, Intercellular Signaling Peptides and Proteins, Immunohistochemistry, Female, Carrier Proteins, Cardiology and Cardiovascular Medicine, Cell Adhesion Molecules, Oligopeptides
Abstract: Background— Developmentally regulated endothelial locus-1 (Del-1) is an extracellular matrix protein that is expressed by endothelial cells during embryological vascular development. We speculated that Del-1 may be reexpressed in ischemia and may be involved in endogenous angiogenesis. Methods and Results— Del-1 protein was detected by immunohistochemistry in murine ischemic hindlimb after femoral artery excision. To determine whether exogenous Del-1 would augment angiogenesis in vivo, Del-1 or vehicle was administered for 3 weeks by intramuscular injection of murine ischemic hindlimbs. Angiogenesis was quantified by gadolinium-MRI perfusion and capillary densitometry. We used a disc angiogenesis system (DAS) to characterize the angiogenic response to vehicle (PBS), Del-1, Del-1 mutant (altered RGD domain), Del-1 minor (truncated discoidin-I–like domain), or basic fibroblast growth factor. After 14 days, the discs were extracted and sectioned to quantify vascular growth by morphometry. Endogenous Del-1 protein expression was increased in ischemic hindlimbs. Administration of Del-1 increased hindlimb vascular flow index and capillary density. In the DAS, Del-1 doubled fibrovascular growth, as did basic fibroblast growth factor. However, angiogenesis was not enhanced by the Del-1 mutant or Del-1 minor proteins. Conclusions— Del-1 is expressed in ischemic tissue. Del-1 stimulates angiogenesis, an effect that is dependent on the RGD motif and a second signaling sequence in the discoidin-I–like domain. Exogenous intramuscular administration of Del-1 significantly enhances angiogenesis in the murine ischemic hindlimb. Del-1 may prove to be a novel therapeutic agent for patients with ischemia.
Published: 2004
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25. Nicotine Accelerates Angiogenesis and Wound Healing in Genetically Diabetic Mice

Author: Luis F. Fajardo, John P. Cooke, James J. Jang, Johannes Jacobi, Uma Sundram, and Hayan Dayoub
Subjects: Nicotine, Pathology, medicine.medical_specialty, Time Factors, Angiogenesis, Basic fibroblast growth factor, Neovascularization, Physiologic, Aorta, Thoracic, In Vitro Techniques, Receptors, Nicotinic, Pharmacology, Pathology and Forensic Medicine, Neovascularization, Mice, chemistry.chemical_compound, medicine, Animals, Nicotinic Agonists, Therapeutic angiogenesis, Wound Healing, integumentary system, business.industry, Nicotinic agonist, Diabetes Mellitus, Type 2, chemistry, Epibatidine, Blood Vessels, medicine.symptom, business, Wound healing, Regular Articles, medicine.drug
Abstract: Recently, we have discovered an endogenous cholinergic pathway for angiogenesis mediated by endothelial nicotinic acetylcholine receptors (nAChRs). Since angiogenesis plays a major role in wound repair, we hypothesized that activation of nAChRs with nicotine would accelerate wound healing in a murine excisional wound model. In genetically diabetic and control mice full-thickness skin wounds (0.8 cm) were created on the dorsum and topically treated over 7 days with either vehicle (phosphate-buffered saline, PBS) or nicotine (10(-8) mol/L, 10(-9) mol/L; each, n = 5). Wound size was measured over 14 days followed by resection, histological analysis, and quantitation of vascularity. In diabetic animals an agonist (epibatidine, 10(-10) mol/L) or antagonist (hexamethonium, 10(-4) mol/L) of nAChRs as well as the positive control basic fibroblast growth factor (bFGF, 25 microg/kg) were also tested. To further study the role of endothelial nAChRs in angiogenesis, we used an ex vivo vascular explant model. In diabetic mice wound healing was markedly impaired. Nicotine significantly accelerated wound healing as assessed by closure rate and histological score. The effects of nicotine were equal to bFGF and were mimicked by epibatidine and blocked by hexamethonium. Histomorphometry revealed increased neovascularization in animals treated with nicotine. Furthermore, capillary-like sprouting from vascular explants was significantly enhanced by nicotine. In conclusion, agonist-induced stimulation of nAChRs accelerates wound healing in diabetic mice by promoting angiogenesis. We have discovered a cholinergic pathway for angiogenesis that is involved in wound healing, and which is a potential target for therapeutic angiogenesis.
Published: 2002
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26. Abstract 16446: Discordant Imaging Results in Patients Referred for Mitral Valve Surgery: What Can the Left Ventricle Tell Us?

Author: Linda D. Gillam, Konstantinos Koulogiannis, Steven D. Wolff, James J. Jang, Marjorie Subero, Randy Cohen, Seth Uretsky, Leo Marcoff, Edgar Argulian, and Farooq A. Chaudhry
Subjects: medicine.medical_specialty, Mitral regurgitation, medicine.diagnostic_test, business.industry, Volume overload, Magnetic resonance imaging, Stroke volume, medicine.anatomical_structure, Ventricle, Physiology (medical), Internal medicine, medicine, Cardiology, In patient, Cardiology and Cardiovascular Medicine, business, Prospective cohort study, Mitral valve surgery
Abstract: Introduction: The assessment of mitral regurgitation (MR) severity is often based on echocardiographic (Echo) criteria and clinical assessment. Recently MRI has been used to quantify MR. In clinical practice these imaging modalities can be discordant. In an ongoing multicenter prospective study, we evaluated the degree of discordance between Echo and MRI in patients with isolated MR. We also correlated the pre-surgical MR volume (MRVol) to the decrease in left ventricular end-diastolic volume (LV EDV) after successful mitral valve surgery (MVS). Hypothesis: Does the post-surgical change in LV EDV correlate with MRVol? Methods: The study included 96 pts (60 ± 14yrs, male 57%) with isolated MR (19 fxnl, 43 degen, 34 other). 31 pts had isolated MVS. Each pt had MRVol quantified using Echo (PISA method) and MRI (LV stroke volume - forward flow). MR severity was categorized as mild Results: MRI and Echo estimates of mitral RVol. were correlated (y=0.6x + 26) (r=0.6, p Conclusions: There is often discordance between Echo PISA and MRI when quantifying MRVol even in patients referred for surgery. To the degree that post-surgical LV remodeling reflects the reduction in LV volume overload achieved with successful MVS, these data suggest that MRVol quantified by MRI may be more accurate than MRVol quantified by Echo PISA.
Published: 2014
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27. Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: a prospective multicenter trial

Author: Seth, Uretsky, Linda, Gillam, Roberto, Lang, Farooq A, Chaudhry, Edgar, Argulian, Azhar, Supariwala, Srinivasa, Gurram, Kavya, Jain, Marjorie, Subero, James J, Jang, Randy, Cohen, and Steven D, Wolff
Subjects: Male, Observer Variation, Ventricular Remodeling, Patient Selection, Mitral Valve Insufficiency, Stroke Volume, Middle Aged, Magnetic Resonance Imaging, Severity of Illness Index, Treatment Outcome, Echocardiography, Predictive Value of Tests, Humans, Female, Prospective Studies, Aged, Follow-Up Studies
Abstract: The decision to undergo mitral valve surgery is often made on the basis of echocardiographic criteria and clinical assessment. Recent changes in treatment guidelines recommending surgery in asymptomatic patients make the accurate assessment of mitral regurgitation (MR) severity even more important.The purpose of this study was to compare echocardiography and magnetic resonance imaging (MRI) in the assessment of MR severity using the degree of left ventricular (LV) remodeling after surgery as the reference standard.In this prospective multicenter trial, MR severity was assessed in 103 patients using both echocardiography and MRI. Thirty-eight patients subsequently had isolated mitral valve surgery, and 26 of these had an additional MRI performed 5 to 7 months after surgery. The pre-surgical estimate of regurgitant severity was correlated with the postoperative decrease in LV end-diastolic volume.Agreement between MRI and echocardiographic estimates of MR severity was modest in the overall cohort (r = 0.6; p0.0001), and there was a poorer correlation in the subset of patients sent for surgery (r = 0.4; p = 0.01). There was a strong correlation between post-surgical LV remodeling and MR severity as assessed by MRI (r = 0.85; p0.0001), and no correlation between post-surgical LV remodeling and MR severity as assessed by echocardiography (r = 0.32; p = 0.1).The data suggest that MRI is more accurate than echocardiography in assessing the severity of MR. MRI should be considered in those patients when MR severity as assessed by echocardiography is influencing important clinical decisions, such as the decision to undergo MR surgery.
Published: 2014

28. The Association of Gender to Cardiovascular Outcomes After Coronary Artery Revascularization in Patients With End-Stage Renal Disease

Author: Alan S. Go, Thomas K. Leong, Ashok Krishnaswami, Tara I. Chang, and James J. Jang
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Retrospective cohort study, General Medicine, Odds ratio, Logistic regression, Revascularization, medicine.disease, Confidence interval, End stage renal disease, Surgery, Relative risk, Internal medicine, medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business
Abstract: Background Inadequate recruitment of women and an exclusion of patients with end-stage renal disease (ESRD) in coronary revascularization trials have led to knowledge gaps of gender-based outcomes. Hypothesis Women have equivalent cardiovascular outcomes when compared to men. Methods We conducted a retrospective observational study utilizing Kaiser Permanente Northern California (KPNC) databases and identified 1015 adults with ESRD who underwent coronary revascularization between 1996 and 2008. We ascertained baseline characteristics, primary (mortality at 5 years) and secondary (myocardial infarction [MI] and repeat revascularization) outcomes from KPNC databases, state death certificates, and Social Security Administration files. A multivariable logistic regression was used to determine the association of gender to the prespecified outcomes. Results Men and women were similar in age (P = 0.23). The mean number of baseline comorbidities was higher in women (2.7, 95% confidence interval [CI]: 2.5-2.9) compared to men (2.3, 95% CI: 2.1-2.4, P = 0.0002). The risk-adjusted odds ratios (OR) of female gender to death at 5 years (OR: 1.12, 95% CI: 0.83-1.52), MI (OR: 1.19, 95% CI: 0.86-1.64), and repeat revascularization (OR: 1.01, 95% CI: 0.70-1.45) were similar to men. Age modified the effect of gender for the primary outcome death (Pinteraction
Published: 2014
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29. The association of gender to cardiovascular outcomes after coronary artery revascularization in patients with end-stage renal disease

Author: Ashok, Krishnaswami, Tara I, Chang, James J, Jang, Thomas K, Leong, and Alan S, Go
Subjects: Male, Chi-Square Distribution, Time Factors, Databases, Factual, Age Factors, Myocardial Infarction, Clinical Investigations, Health Maintenance Organizations, Coronary Artery Disease, Middle Aged, California, Logistic Models, Sex Factors, Treatment Outcome, Risk Factors, Multivariate Analysis, Myocardial Revascularization, Odds Ratio, Humans, Kidney Failure, Chronic, Female, Aged, Retrospective Studies
Abstract: BACKGROUND: Inadequate recruitment of women and an exclusion of patients with end‐stage renal disease (ESRD) in coronary revascularization trials have led to knowledge gaps of gender‐based outcomes. HYPOTHESIS: Women have equivalent cardiovascular outcomes when compared to men. METHODS: We conducted a retrospective observational study utilizing Kaiser Permanente Northern California (KPNC) databases and identified 1015 adults with ESRD who underwent coronary revascularization between 1996 and 2008. We ascertained baseline characteristics, primary (mortality at 5 years) and secondary (myocardial infarction [MI] and repeat revascularization) outcomes from KPNC databases, state death certificates, and Social Security Administration files. A multivariable logistic regression was used to determine the association of gender to the prespecified outcomes. RESULTS: Men and women were similar in age (P = 0.23). The mean number of baseline comorbidities was higher in women (2.7, 95% confidence interval [CI]: 2.5‐2.9) compared to men (2.3, 95% CI: 2.1‐2.4, P = 0.0002). The risk‐adjusted odds ratios (OR) of female gender to death at 5 years (OR: 1.12, 95% CI: 0.83‐1.52), MI (OR: 1.19, 95% CI: 0.86‐1.64), and repeat revascularization (OR: 1.01, 95% CI: 0.70‐1.45) were similar to men. Age modified the effect of gender for the primary outcome death (P (interaction)
Published: 2014

30. Angiogenesis Is Impaired by Hypercholesterolemia

Author: Luis F. Fajardo, James J. Jang, John P. Cooke, Helen H. Kwan, and Hoai Ky V. Ho
Subjects: medicine.medical_specialty, Apolipoprotein B, Angiogenesis, Hypercholesterolemia, Neovascularization, Physiologic, Angiogenesis Inhibitors, Endogeny, Arginine, Nitric Oxide, Nitric oxide, Mice, chemistry.chemical_compound, Apolipoproteins E, Oral administration, Physiology (medical), Internal medicine, Animals, Medicine, Enzyme Inhibitors, Dose-Response Relationship, Drug, biology, business.industry, Antagonist, Mice, Inbred C57BL, Endocrinology, chemistry, Competitive antagonist, biology.protein, Female, Fibroblast Growth Factor 2, Nitric Oxide Synthase, Cardiology and Cardiovascular Medicine, business, Asymmetric dimethylarginine
Abstract: Background —Many angiogenic factors require endothelium-derived nitric oxide (NO) to exert their effects. Recently, an endogenous competitive antagonist of NO synthase has been characterized: asymmetric dimethylarginine (ADMA). Elevated plasma levels of ADMA reduce NO synthesis in hypercholesterolemia. Accordingly, we hypothesized that hypercholesterolemia impairs angiogenesis by an ADMA-dependent mechanism. Methods and Results —Angiogenesis was assessed with the use of a disk angiogenesis system implanted subcutaneously in normal (E + ) mice or apolipoprotein (apo)E-deficient hypercholesterolemic (E − ) mice. After 2 weeks, the disks were removed, and the fibrovascular growth area was used as an index of angiogenesis. Basal and fibroblast growth factor–stimulated angiogenesis was impaired in E − mice, associated with an elevation in plasma ADMA. Oral administration of l -arginine reversed the impairment of angiogenesis in E − mice. By contrast, oral administration of l -nitroarginine (an exogenous antagonist of NO synthase) reduced angiogenesis. When added directly to the disk, ADMA dose-dependently inhibited basal and fibroblast growth factor–induced angiogenesis, an effect that was reversed by oral administration of l -arginine. Conclusions —The derangement of the NO synthase pathway that occurs in hypercholesterolemia is associated with an impairment of angiogenesis. The lipid-induced impairment of angiogenesis can be reversed by oral administration of l -arginine and can be mimicked in normocholesterolemic animals by administration of an NO synthase antagonist. The data are consistent with the hypothesis that ADMA is an endogenous inhibitor of angiogenesis.
Published: 2000
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31. Blockade of Nitric Oxide Synthesis Reduces Myocardial Oxygen Consumption In Vivo

Author: KaLee A. Ahlin, James J. Jang, Andrew J. Sherman, Adel S. Yaacoub, Gopalakrishnan Srinivasan, Kathleen R. Harris, Debra A. Quinn, Francis J. Klocke, and Cornelius A. Davis
Subjects: Hemodynamics, Blood Pressure, Pharmacology, Nitric Oxide, Nitroarginine, Ventricular Function, Left, Nitric oxide, chemistry.chemical_compound, Dogs, Oxygen Consumption, Heart Rate, In vivo, Coronary Circulation, Physiology (medical), Heart rate, Animals, Medicine, Enzyme Inhibitors, biology, business.industry, Myocardium, Fissipedia, Heart, Carbon Dioxide, biology.organism_classification, Myocardial Contraction, Blockade, Oxygen, NG-Nitroarginine Methyl Ester, chemistry, Anesthesia, Circulatory system, Systemic administration, Nitric Oxide Synthase, Cardiology and Cardiovascular Medicine, business
Abstract: Background Although cardiac myocytes and coronary vascular endothelium are known to express a constitutive form of NO synthase, the in vivo effects of tonic endogenous production of NO on myocardial O 2 consumption and contractile performance remain unclear. Methods and Results The effects of blockade of NO synthase were determined in intact dogs. Myocardial O 2 consumption decreased systematically over a wide range of hemodynamic demand after the systemic administration of N ω -nitro- l -arginine methyl ester (L-NAME) or N ω -nitro- l -arginine. Decreases after doses of 1 and 10 mg/kg L-NAME averaged 23±3.8% and 34±7.2% at a heart rate of 90 bpm in open-chest animals. Similar reductions occurred after the administration of L-NAME and N ω -nitro- l -arginine in chronically instrumented animals and were unaffected by β-adrenergic blockade. Intracoronary infusion of L-NAME in chronically instrumented animals reduced both myocardial O 2 consumption and regional segment shortening, even at a dose that did not increase systemic arterial pressure. Conclusions The blockade of NO synthesis reduces myocardial O 2 consumption in vivo. The decrease in O 2 consumption is accompanied by a decrease in segment shortening. It involves a direct myocardial action of NO, is unaffected by β-blockade, and is consistent with in vitro studies indicating that low levels of NO augment contractile performance by inhibition of a cGMP-dependent phosphodiesterase.
Published: 1997
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32. BETTER ESTIMATING RADIATION EFFECTIVE DOSE FROM CARDIAC COMPUTED TOMOGRAPHY (CT): A COMPREHENSIVE EXAMINATION OF THE RELATIONSHIP BETWEEN EFFECTIVE DOSE AND DOSE-LENGTH PRODUCT

Author: Andrew J. Einstein, M. Robert Peters, David J. Brenner, Udo Hoffmann, James J. Jang, Munir Ghesani, Sigal Trattner, Sachin Jambawalikar, Anjali Chelliah, Carla M. Thompson, Yanping Xu, and S.S. Halliburton
Subjects: Cardiac computed tomography, business.industry, Dose Length Product, Conversion factor, Medicine, Radiation, Cardiology and Cardiovascular Medicine, Nuclear medicine, business, Effective dose (radiation)
Abstract: Radiation from CT is commonly quantified in term of effective dose (ED), estimated by multiplying the scanner reported dose-length product (DLP) by a conversion factor, referred to as the k factor. Current guidelines suggest a k factor of 0.014 mSv·mGy-1cm-1 for chest CT. While this value is
Published: 2016
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33. Predictive values of Framingham risk and coronary artery calcium scores in the detection of obstructive CAD in patients with normal SPECT

Author: Ashok Krishnaswami, James J. Jang, and Yun-Yi Hung
Subjects: Male, medicine.medical_specialty, CAD, Coronary Artery Disease, Single-photon emission computed tomography, Coronary Angiography, Risk Assessment, Coronary artery disease, Myocardial perfusion imaging, Predictive Value of Tests, Risk Factors, Internal medicine, medicine, Humans, cardiovascular diseases, Retrospective Studies, Tomography, Emission-Computed, Single-Photon, Framingham Risk Score, medicine.diagnostic_test, business.industry, Myocardial Perfusion Imaging, Calcinosis, Retrospective cohort study, medicine.disease, Stenosis, Logistic Models, Predictive value of tests, Cardiology, Calcium, Female, Radiology, Cardiology and Cardiovascular Medicine, business, Tomography, X-Ray Computed
Abstract: A subgroup of patients with normal stress myocardial perfusion imaging (MPI) have obstructive coronary artery disease (CAD) on coronary computed tomographic angiography (CCTA). A retrospective study was performed to identify factors associated with obstructive CAD in patients with normal MPI. Bivariate differences between patients with obstructive (>50% stenosis) and nonobstructive (100 Agatston Units [AU]) were independently associated with obstructive CAD ( P = .006 and P < .0001, respectively). Patients with normal MPI had 13 times and 98 times higher odds of having obstructive CAD if they had a FRS ≥10% versus 100 AU versus ≤100 AU, respectively. Increased FRS and CACS may stratify patients who may benefit from further evaluation for significant CAD despite normal MPI.
Published: 2011

34. Valvular heart disease in patients exposed to pergolide: insights from the clinical presentation

Author: Ashok, Krishnaswami, Kathleen B, Albers, Robin D, Fross, James J, Jang, Sarah B, Berkheimer, Valerie C, Kwai Ben, and Stephen K, Vandeneeden
Subjects: Male, Time Factors, Databases, Factual, Dose-Response Relationship, Drug, Heart Valve Diseases, California, Electrocardiography, Cross-Sectional Studies, Logistic Models, Predictive Value of Tests, Dopamine Agonists, Multivariate Analysis, Humans, Female, Prospective Studies, Aged, Pergolide
Abstract: The aim of this study was to determine whether the presence of symptoms would aid in the detection of valvular heart disease (VHD) in those exposed to pergolide.Utilizing a prospective, cross-sectional study design, patients with an exposure to pergolide were asked regarding the presence or absence of chest pain, shortness of breath or lower extremity edema through a questionnaire. Echocardiograms were obtained on the same day as the questionnaire and were blinded to all staff involved in the study. The sensitivity, specificity, positive and negative predictive value of the reported symptoms towards the outcome moderate or severe valvular regurgitation were obtained. Using the area under the receiver-operating characteristic curve, we also ascertained whether a relationship existed between symptoms, pergolide dose and presence of VHD. To understand the associations between symptoms and echocardiographic covariates, a logistic regression analysis was performed adjusted for age and gender.The sensitivity, specificity, positive and negative predictive value of symptom presentation and total dose was sufficiently low that it did not aid in the determination whether significant valvular regurgitation was present. Multivariable analysis noted a significant association with indexed left atrial volume (p = 0.011), estimated pulmonary artery pressure (p = 0.047) and shortness of breath.The presence or absence of symptoms does not help guide whether valvular regurgitation is present or absent in individuals exposed to pergolide. Therefore, echocardiography is needed to confirm or refute pergolide-associated VHD.
Published: 2011

35. DIAGNOSTIC ACCURACY OF SYMPTOMS IN DETERMINING THE PRESENCE OF VALVULAR HEART DISEASE IN PATIENTS EXPOSED TO PERGOLIDE MESYLATE

Author: Stephen Van Den Eeeden, Sarah Berkheimer, Ashok Krishnaswami, Valeri C. Kwai Ben, James J. Jang, Kathleen B. Albers, and Robin D. Fross
Subjects: medicine.medical_specialty, Pergolide Mesylate, business.industry, Internal medicine, valvular heart disease, medicine, Cardiology, In patient, Diagnostic accuracy, medicine.disease, business, Cardiology and Cardiovascular Medicine
Published: 2011
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36. No change in B-type natriuretic peptide levels assessed in the late postoperative period in patients with severe mitral regurgitation after mitral valve surgery

Author: Ashok Krishnaswami, Mario Pompili, James J. Jang, Sarah Berkheimer, and Hon Lee
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Time Factors, medicine.drug_class, Pilot Projects, Kaplan-Meier Estimate, Preoperative care, Risk Assessment, Severity of Illness Index, California, Risk Factors, Mitral valve, Internal medicine, Natriuretic Peptide, Brain, medicine, Natriuretic peptide, Odds Ratio, Humans, In patient, Prospective Studies, Cardiac Surgical Procedures, Aged, Mitral regurgitation, Analysis of Variance, Ejection fraction, business.industry, Mitral Valve Insufficiency, Middle Aged, Confidence interval, medicine.anatomical_structure, Cross-Sectional Studies, Logistic Models, Treatment Outcome, Cardiology, Linear Models, Mitral Valve, Surgery, Female, Cardiology and Cardiovascular Medicine, business, Mitral valve surgery, Biomarkers
Abstract: The impact of mitral valve (MV) surgery on levels of B-type natriuretic peptide (BNP) postoperatively has not been clearly evaluated. The aim of this study was to assess whether BNP levels decrease three to six months after MV surgery in patients with severe mitral regurgitation (MR). We prospectively enrolled patients who were referred for MV surgery with severe MR. BNP levels were measured prior to and after surgery. The mean age was 61.3 ± 13.6 years; 75% were male (n = 52). There was no difference between the mean preoperative and postoperative BNP (242.9 ± 280.3 pg/ml, 290.8 ± 549.8 pg/ml, P = 0.45) obtained at a mean of 138.7 ± 33.5 days with the bias-corrected bootstrapped 95% confidence intervals, 117.6-321.8 pg/ml and 185.4-483.8 pg/ml, respectively. Postoperative BNP tended to increase as the amount of MR increased (no MR: 212.7 ± 197.5 pg/ml, 1+MR: 592.9 ± 1174.9 pg/ml, 2+MR: 133.6 ± 121.6 pg/ml, 3+MR: 547.7 ± 332.0 pg/ml; P < 0.0001). A mild inverse correlation was noted with postoperative BNP and postoperative ejection fraction (r = -0.2596). A decrease in the ejection fraction was noted after surgery (51.7 ± 11.1%, 56.3 ± 9.6%; P = 0.03). Our findings contradict an intuitive thought that BNP levels should decrease after MV surgery for MR.
Published: 2011

37. Asymmetric dimethylarginine and coronary artery calcium scores are increased in patients infected with human immunodeficiency virus

Author: Sarah Berkheimer, Ashok Krishnaswami, James J. Jang, and Maqdooda Merchant
Subjects: Adult, Male, medicine.medical_specialty, Homocysteine, Inflammation, HIV Infections, Coronary Artery Disease, Fibrinogen, Arginine, Coronary Angiography, Risk Assessment, California, Nitric oxide, chemistry.chemical_compound, Risk Factors, Internal medicine, medicine, Humans, Chi-Square Distribution, business.industry, Case-control study, Calcinosis, Middle Aged, medicine.disease, Thrombosis, Up-Regulation, chemistry, Case-Control Studies, Cardiology, HIV-1, RNA, Viral, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Asymmetric dimethylarginine, business, Tomography, X-Ray Computed, Chi-squared distribution, Biomarkers, medicine.drug
Abstract: Objective Patients infected with human immunodeficiency virus (HIV) have an increased risk for cardiovascular events and mortality. Elevated concentrations of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, are associated with increased subclinical atherosclerosis and cardiovascular events. The objective of this study was to determine whether plasma ADMA levels are increased in patients infected with HIV and whether this is associated with cardiovascular risk factors, inflammatory/thrombotic biomarkers, and elevated coronary artery calcium scores (CACS). Methods HIV-infected patients and control patients were recruited in a case-control study. Medical history and laboratory measurements including plasma ADMA and biomarkers for inflammation and thrombosis such as C-reactive protein (CRP), fibrinogen, and homocysteine were obtained in both cohorts. Using multidetector computed tomography, CACS were measured in Agatston Units (AU). Bivariate differences between HIV-infected and control patients were analyzed. Results HIV-infected patients ( n = 37, male = 27, age = 45 years) had significantly higher concentrations of ADMA (0.40 ± 0.10 μmol/l) compared to a similarly matched cohort of non-HIV-infected patients ( n = 43, male = 27, age = 45 years), (0.35 ± 0.07 μmol/l, p = 0.03). There were no significant differences in CRP, homocysteine, and fibrinogen between the two cohorts. However, HIV-infected patients had a higher CACS distribution compared to control patients [0.0 (8.5) vs. 0.0 (0.0) AU, p = 0.01]. In a multivariable regression analysis HIV-infected patients with a relative CACS of 75–90% for age and gender had the highest ADMA concentrations (0.48 ± 0.09 μmol/l, p = 0.04) among all CACS subgroups. Conclusion : HIV-infected patients have significantly higher ADMA concentrations compared to control patients. In addition, increased CACS was associated with elevated ADMA concentrations. Thus, increased ADMA levels appear to be associated with the presence of subclinical atherosclerosis in HIV-infected patients.
Published: 2010

38. Sinus of valsalva pseudoaneurysm and mechanical aortic valve endocarditis

Author: James J, Jang, Kenneth S, Battaglia, and Valerie C, Kwai Ben
Subjects: Male, Postoperative Care, Reoperation, Prosthesis-Related Infections, Endocarditis, Bacterial, Middle Aged, Sinus of Valsalva, Staphylococcal Infections, Anti-Bacterial Agents, Aortic Aneurysm, Blood Vessel Prosthesis, Vancomycin, Aortic Valve, Heart Valve Prosthesis, Staphylococcus epidermidis, Humans, Methicillin Resistance, Tomography, Spiral Computed, Aneurysm, False, Echocardiography, Transesophageal
Abstract: We present the case of a 54-year-old male with a St. Jude aortic valve replacement who presented with fever and a new diastolic murmur. An echocardiogram identified a pseudoaneurysm that appeared to originate from the left sinus of Valsalva. In anticipation of open valve surgery, a 64-slice computed tomographic (CT) angiogram was performed to characterize the size and location of the pseudoaneurysm. In addition, the CT scan was able to rule out significant coronary artery disease and obviate the need to perform a potentially high-risk catheterdirected angiogram in the setting of an infected pseudoaneurysm.
Published: 2010

39. Abstract 4211: Depth of Myocardial Bridges on Computed Tomographic Angiography is Associated with Myocardial Perfusion Defects on Single Photon Emission Computed Tomography

Author: James J Jang, Ashok Krishnaswami, Mateo Go, and Kenneth S Battaglia
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Although considered a relatively benign congenital coronary anomaly, myocardial bridges have been associated with myocardial ischemia, infarctions, and sudden cardiac death. The aim of this study was to identify characteristics of myocardial bridges on computed tomographic angiography (CTA) associated with abnormal defects on myocardial perfusion imaging (MPI). A retrospective study was performed to identify patients who had myocardial bridges detected by 64-slice multidetector cardiac CTA and prior stress single photon emission computed tomography (SPECT) MPI. Using axial, oblique, and curved multi-planar reformatted images, myocardial bridge characteristics, including length and maximum depth of the tunneled segments, were compared in patients with and without corresponding coronary perfusion defects on SPECT MPI. From a total of 272 patients who had both SPECT MPI and cardiac CTA performed, 23 patients (8%, males= 9, mean age= 57 years) were identified with myocardial bridges. The left anterior descending artery was the predominant affected coronary artery (20/23, 87%). Eight patients (35%) with myocardial bridges had corresponding perfusion defects on SPECT MPI. Increased depth of the tunneled segment was significantly associated with abnormal SPECT MPI compared to normal SPECT MPI (4.1 ± 2.0mm vs. 1.9 ± 0.9mm, respectively, p< 0.002). The length of the tunneled segment did not differ in patients with or without abnormal SPECT MPI (27.8 ± 15.6mm vs. 20.9 ± 12.6mm, respectively, p=0.26). This is the first study to correlate SPECT MPI and 64-slice multidetector cardiac CTA in the evaluation of myocardial bridges. Increased maximum depth of the tunneled segment on cardiac CTA is significantly associated with myocardial perfusion defects.
Published: 2008
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40. Images in vascular medicine. Giant cell arteritis presenting with acute myocardial infarction

Author: Jeffrey W. Olin, James J. Jang, and Peter D. Gorevic
Subjects: Systemic disease, Pathology, medicine.medical_specialty, Giant Cell Arteritis, Anti-Inflammatory Agents, Myocardial Infarction, Subclavian Artery, Administration, Oral, Coronary Angiography, medicine, Humans, Myocardial infarction, Angioplasty, Balloon, Coronary, Ultrasonography, Doppler, Color, Vascular Medicine, Aged, business.industry, Vascular disease, medicine.disease, Giant cell arteritis, Prednisone, Female, Stents, Cardiology and Cardiovascular Medicine, Vasculitis, business, Tomography, X-Ray Computed
Published: 2007

41. Peripheral Arterial Disease

Author: James J. Jang and Jonathan L. Halperin
Published: 2007
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42. Images in cardiovascular medicine. Pseudoaneurysm and intracardiac fistula caused by an infected paclitaxel-eluting coronary stent

Author: James J, Jang, Ashok, Krishnaswami, Junming, Fang, Mateo, Go, and Valerie C Kwai, Ben
Subjects: Male, Fistula, Paclitaxel, Coronary Aneurysm, Middle Aged, Staphylococcal Infections, Coronary Angiography, Antineoplastic Agents, Phytogenic, Humans, Stents, Angioplasty, Balloon, Coronary, Tomography, X-Ray Computed, Aneurysm, False, Echocardiography, Transesophageal
Published: 2007

43. Pseudoaneurysm and Intracardiac Fistula Caused by an Infected Paclitaxel-Eluting Coronary Stent

Author: Valerie C. Kwai Ben, Ashok Krishnaswami, James J. Jang, Mateo Go, and Junming Fang
Subjects: medicine.medical_specialty, business.industry, Fistula, medicine.medical_treatment, Percutaneous coronary intervention, medicine.disease, Chest pain, Intracardiac injection, Surgery, Pseudoaneurysm, Catheter, Physiology (medical), Coronary stent, medicine, Myocardial infarction, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: A 54-year-old man with end-stage renal disease presented with chest pain. Five months before presentation the patient had a right-foot cellulitis that was treated with amoxicillin clavulanate. Two weeks later, the patient suffered an inferior wall ST-elevation myocardial infarction that required immediate percutaneous coronary intervention with paclitaxel-eluting stents (Taxus, Boston Scientific, Natick, Mass) in the proximal and mid-right coronary artery (RCA). Over the next 4 months, the patient had recurrent fevers and grew Staphylococcus aureus on repeat blood cultures. The source of infection was attributed to recurrent infected dialysis catheters. The patient had 3 catheter replacements and was treated with intravenous vancomycin and oral rifampin. On examination, the patient had a continuous murmur along the right sternal border and an elevated troponin I level of 2.45 …
Published: 2007
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44. Claudication secondary to Perclose use after percutaneous procedures

Author: James J. Jang, Michael C. Kim, Jeffrey W. Olin, Bruce H. Gray, and J. Michael Bacharach
Subjects: Adult, Male, medicine.medical_specialty, Percutaneous, Catheterization, Peripheral, medicine, Humans, Radiology, Nuclear Medicine and imaging, Aged, Surgical repair, Peripheral Vascular Diseases, Surgical instrumentation, medicine.diagnostic_test, Arterial stenosis, business.industry, Suture Techniques, Angiography, Coronary Stenosis, Percutaneous balloon angioplasty, Ultrasonography, Doppler, General Medicine, Middle Aged, Hemostasis, Surgical, Surgery, Femoral Artery, Hemostasis, Female, Stents, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, Claudication, business
Abstract: The use of suture-mediated arterial closure devices has dramatically increased with the increased number of percutaneous procedures being performed. Complications from suture-mediated closure devices have been underreported. Specifically, arterial stenosis resulting in claudication has not been previously described in detail. We present nine patients who presented with various leg symptoms after Perclose was used to achieve arterial hemostasis following percutaneous procedures. All cases were found to have significant arterial stenoses from the Perclose sutures. Once diagnosis was correctly made, the patients either underwent surgical repair or percutaneous balloon angioplasty and in all cases the symptoms abated.
Published: 2006

45. Primary cardiac lymphoma: diagnosis and treatment guided by transesophageal echocardiogram perfusion imaging

Author: Martin E. Goldman, Stephan B. Danik, and James J. Jang
Subjects: Male, medicine.medical_specialty, Lymphoma, Perfusion scanning, Antineoplastic Agents, Transesophageal echocardiogram, Intracardiac injection, Heart Neoplasms, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Thrombus, medicine.diagnostic_test, business.industry, Primary Cardiac Lymphoma, Magnetic resonance imaging, Middle Aged, equipment and supplies, medicine.disease, Prognosis, Treatment Outcome, Angiography, cardiovascular system, Radiology, Cardiology and Cardiovascular Medicine, business, human activities, Perfusion, Echocardiography, Transesophageal
Abstract: al Primary cardiac lymphoma (PCL) can be detected by a variety of imaging modalities such as angiography, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), computed tomography, and magnetic resonance imaging. The use of contrast perfusion echocardiography under TEE guidance to diagnose and follow the treatment of PCL has not been previously described. We report a case of a left atrial (LA) intracardiac mass that was clinically suggestive of a thrombus. Contrast perfusion echocardiography with TEE was able to exclude the diagnosis of thrombus and
Published: 2006

46. ADMA regulates angiogenesis: genetic and metabolic evidence

Author: Patrick Vallance, Masumi Kimoto, Vinod Achan, John P. Cooke, Christopher Heeschen, James J. Jang, M Stuehlinger, and Hoai Ky V. Ho
Subjects: 0301 basic medicine, medicine.medical_specialty, Endothelium, Arginine, Blotting, Western, Hypercholesterolemia, Ischemia, Neovascularization, Physiologic, Mice, Transgenic, Hindlimb, Nitric oxide, 03 medical and health sciences, chemistry.chemical_compound, Mice, 0302 clinical medicine, Internal medicine, medicine, Animals, biology, business.industry, medicine.disease, Dimethylargininase, Nitric oxide synthase, Mice, Inbred C57BL, Disease Models, Animal, 030104 developmental biology, medicine.anatomical_structure, Endocrinology, chemistry, biology.protein, Female, Nitric Oxide Synthase, Cardiology and Cardiovascular Medicine, Asymmetric dimethylarginine, business, 030217 neurology & neurosurgery
Abstract: Endothelium-derived nitric oxide (NO) plays an important role in transducing the effects of angiogenic factors. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthase (NOS). We used a murine model of hindlimb ischemia to investigate whether genetic or metabolic changes in ADMA levels could impair angiogenic response in vivo. Hindlimb ischemia was surgically induced in C57BL/6J mice, apo E-deficient mice, or transgenic mice overexpressing dimethylarginine dimethylaminohydrolase (DDAH). Some animals were also treated with the NOS antagonist L-nitro-arginine, or the NO precursor L-arginine. Angiogenesis was quantified in the hindlimb skeletal muscle by capillary/myocyte ratio. Plasma or tissue ADMA levels were measured by HPLC. In normal mice, hindlimb ischemia increased tissue ADMA twofold, and reduced DDAH and NOS expression. This was associated with a reduced NOS activity (by over 80%) three days following surgery. On day seven, a threefold increase in DDAH expression and a fall in tissue ADMA levels were associated with a sevenfold increase in NOS activity, whereas NOS expression did not increase above baseline. In DDAH transgenic mice, the elevation of ADMA and decrement in NOS activity was blunted during hindlimb ischemia. Plasma ADMA levels were increased in apo E-mice (1.79 ± 0.45 versus 1.07 ± 0.08 μmol/l; p = 0.008). Capillary index was significantly reduced in apo E-mice up to seven weeks after surgery (0.25 ± 0.05 versus 0.62 ± 0.08; p < 0.001). The effect of hypercholesterolemia on capillary index was reversed by L-arginine, and (in wild-type mice) mimicked by administration of the NOS antagonist L-nitro-arginine. In conclusion, metabolic or genetic changes in plasma and tissue ADMA levels affect tissue NO production and angiogenic response to ischemia.
Published: 2005

47. Nicotine stimulates angiogenesis and promotes tumor growth and atherosclerosis

Author: Frances L. Johnson, Anjali Pathak, Robert S. Hu, Michael Weis, James J. Jang, Christopher Heeschen, Philip S. Tsao, John P. Cooke, and Shuichiro Kaji
Subjects: medicine.medical_specialty, Nicotine, Lung Neoplasms, Angiogenesis, Arteriosclerosis, Prostacyclin, General Biochemistry, Genetics and Molecular Biology, Neovascularization, chemistry.chemical_compound, Carcinoma, Lewis Lung, Mice, Internal medicine, medicine, Animals, Tube formation, Neovascularization, Pathologic, General Medicine, Vascular endothelial growth factor, Vascular endothelial growth factor B, Mice, Inbred C57BL, Endocrinology, Nicotinic agonist, chemistry, medicine.symptom, medicine.drug
Abstract: We provide anatomic and functional evidence that nicotine induces angiogenesis. We also show that nicotine accelerates the growth of tumor and atheroma in association with increased neovascularization. Nicotine increased endothelial-cell growth and tube formation in vitro, and accelerated fibrovascular growth in vivo. In a mouse model of hind-limb ischemia, nicotine increased capillary and collateral growth, and enhanced tissue perfusion. In mouse models of lung cancer and atherosclerosis, we found that nicotine enhanced lesion growth in association with an increase in lesion vascularity. These effects of nicotine were mediated through nicotinic acetylcholine receptors at nicotine concentrations that are pathophysiologically relevant. The endothelial production of nitric oxide, prostacyclin and vascular endothelial growth factor might have a role in these effects.
Published: 2001

48. YOUNG PATIENTS INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS HAVE ELEVATED CONCENTRATIONS OF ASYMMETRIC DIMETHYLARGININE AND CORONARY ARTERY CALCIFICATION

Author: James J. Jang, Ashok Krishnaswami, Sarah Berkheimer, and Kaiser Permanente
Subjects: chemistry.chemical_compound, medicine.medical_specialty, chemistry, business.industry, Internal medicine, Coronary artery calcification, Human immunodeficiency virus (HIV), medicine, Cardiology, Cardiology and Cardiovascular Medicine, medicine.disease_cause, Asymmetric dimethylarginine, business
Published: 2010
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49. The Top 12 Advances in Vascular Medicine

Author: Joshua A. Beckman, Jeffrey W. Olin, James J. Jang, Thorn W. Rooke, and Michael R. Jaff
Subjects: medicine.medical_specialty, business.industry, medicine.drug_class, Sildenafil, Angiogenesis, Low molecular weight heparin, 030204 cardiovascular system & hematology, Clopidogrel, Bioinformatics, Cilostazol, Surgery, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, chemistry, Medicine, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Therapeutic angiogenesis, Cardiology and Cardiovascular Medicine, business, Vascular Medicine, medicine.drug, Discovery and development of direct thrombin inhibitors
Abstract: In the past decade, impressive strides have been made in the diagnosis and management of atherosclerotic, aneurysmal, and thromboembolic diseases, thanks in large part to the explosive growth in both vascular biology and clinical vascular medicine. We review what we consider to be the top 12 advances in this field: the discovery of nitric oxide, the metabolic syndrome, new thrombophilic disorders, therapeutic angiogenesis, endoluminal treatment of chronic venous disease, and a variety of drugs, including sildenafil, cilostazol, low-molecular-weight heparins, oral direct thrombin inhibitors, clopidogrel, statins, and angiotensin-converting enzyme inhibitors and angiotensin-receptor blocking agents.
Published: 2004
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50. Genetic determinants of nicotine-induced angiogenesis

Author: Yan Wang, Hanh M. Bui, Christopher Heeschen, Edwin Chang, John P. Cooke, Johannes Jacobi, and James J. Jang
Subjects: Nicotine, Angiogenesis, business.industry, medicine, Pharmacology, business, Cardiology and Cardiovascular Medicine, medicine.drug
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