Utility of Mechanistic Target of Rapamycin Inhibitors in Cardiac Sarcoidosis.

Background: Cardiac sarcoidosis is an uncommon but potentially devastating manifestation of sarcoidosis, which is a multisystem inflammatory granulomatous disease. Although corticosteroids are the mainstay of treatment, given the number of complications associated with their long-term use, there is increasing interest in the use of steroid-sparing agents. Recent basic and translational studies have suggested a role for the mechanistic target of rapamycin (mTOR) pathway in cardiac sarcoidosis.

Prognostic value of left ventricular mass measured on coronary computed tomography angiography.

Background: Left ventricular (LV) mass is a well-established prognostic indicator for cardiovascular risk. Measurement of LV mass on coronary computed tomography angiography (CCTA) is considered optional. We aimed to assess for associations between LV mass measured on CCTA with all-cause mortality (ACM) risk and to determine age- and sex-specific distributions.

Clinical correlates of a single-item physical activity questionnaire among patients undergoing stress SPECT myocardial perfusion imaging.

Background: There has been an increasing call for employing ultrashort exercise activity questionnaires as a clinical "vital sign". To-date, this has not been applied to patients undergoing cardiac stress testing.

Methods: We evaluated 1136 patients who completed a one-item exercise questionnaire before undergoing stress SPECT myocardial perfusion imaging (MPI).

Use of a single-item exercise questionnaire predicts prognostic risk among patients undergoing stress PET-MPI.

Background: Exercise activity reduces mortality and favorably influences mediators of risk, including myocardial flow reserve (MFR) and chronotropic responsiveness. Comprehensive research regarding the relationship between exercise activity, MFR, and chronotropic response to pharmacological stress, as assessed by heart rate response (HRR) among patients undergoing PET myocardial perfusion imaging (MPI) has not been performed. Thus, we aimed to evaluate the relationship between exercise activity as assessed by a practical single-item questionnaire, MFR and HRR, and longitudinal clinical risk.

10-year experience of utilizing a stress-first SPECT myocardial perfusion imaging.

Background: Despite its potential benefits, the utilization of stress-only protocol in clinical practice has been limited. We report utilizing stress-first single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).

Methods: We assessed 12,472 patients who were referred for SPECT-MPI between 2013 and 2020.

Downward myocardial creep during stress PET imaging is inversely associated with mortality.

Purpose: The myocardial creep is a phenomenon in which the heart moves from its original position during stress-dynamic PET myocardial perfusion imaging (MPI) that can confound myocardial blood flow measurements. Therefore, myocardial motion correction is important to obtain reliable myocardial flow quantification. However, the clinical importance of the magnitude of myocardial creep has not been explored.

Comparative predictors of mortality among patients referred for stress single-photon emission computed tomography versus positron emission tomography myocardial perfusion imaging.

Background: There is currently little information regarding the usage and comparative predictors of mortality among patients referred for single-photon emission computed tomography (SPECT) versus positron emission tomography (PET) myocardial perfusion imaging (MPI) within multimodality imaging laboratories.

Methods: We compared the clinical characteristics and mortality outcomes among 15,718 patients referred for SPECT-MPI and 6202 patients referred for PET-MPI between 2008 and 2017.

Results: Approximately two-thirds of MPI studies were performed using SPECT-MPI.

Is typical angina still prognostically important? The influence of "treatment bias" upon prognostic assessments.

Background: Since typical angina has become less frequent, it is unclear if this symptom still has prognostic significance.

Methods: We evaluated 38,383 patients undergoing stress/rest SPECT myocardial perfusion imaging followed for a median of 10.9 years.

Automated Motion Correction for Myocardial Blood Flow Measurements and Diagnostic Performance of Rb PET Myocardial Perfusion Imaging.

Motion correction (MC) affects myocardial blood flow (MBF) measurements in Rb PET myocardial perfusion imaging (MPI); however, frame-by-frame manual MC of dynamic frames is time-consuming. This study aims to develop an automated MC algorithm for time-activity curves used in compartmental modeling and compare the predictive value of MBF with and without automated MC for significant coronary artery disease (CAD). In total, 565 patients who underwent PET-MPI were considered.

The emerging role of digital health in the management of asthma.

The most common reasons seen for lack of asthma control include misconceptions about disease control, low controller treatment adherence, poor inhaler technique, and the resulting underuse of controllers and overuse of short-acting beta2 agonists (SABAs). Narrowing these care gaps may be achieved through well-designed patient education that considers the patient's motivation, beliefs, and capabilities regarding their asthma and its management and empowers the patient to become an active participant in treatment decisions. Digital health technologies (DHTs) and digital therapeutic (DT) devices provide new opportunities to monitor treatment behaviors, improve communication between healthcare providers and patients, and generate data that inform educational interactions.

Increasing frequency of dyspnea among patients referred for cardiac stress testing.

Objective: To assess the frequency, change in prevalence, and prognostic significance of dyspnea among contemporary patients referred for cardiac stress testing.

Patients And Methods: We evaluated the prevalence of dyspnea and its relationship to all-cause mortality among 33,564 patients undergoing stress/rest SPECT-MPI between January 1, 2002 and December 31, 2017. Dyspnea was assessed as a single-item question.

Comparison of coronary artery calcium scores among patients referred for cardiac imaging tests.

Background: While coronary artery calcium (CAC) can now be evaluated by multiple imaging modalities, there is presently scant study regarding how CAC scores may vary among populations of varying clinical risk.

Methods: We evaluated the distribution of CAC scores among three patient groups: 18,941 referred for CAC scanning, 5101 referred for diagnostic coronary CT angiography (CCTA), and 3307 referred for diagnostic positron emission tomography (PET) myocardial perfusion imaging (MPI). We assessed the relationship between CAC score and myocardial ischemia, obstructive coronary artery disease (CAD), and all-cause mortality across imaging modalities.

Artificial Intelligence for Quantitative Modeling in Drug Discovery and Development: An Innovation and Quality Consortium Perspective on Use Cases and Best Practices.

Recent breakthroughs in artificial intelligence (AI) and machine learning (ML) have ushered in a new era of possibilities across various scientific domains. One area where these advancements hold significant promise is model-informed drug discovery and development (MID3). To foster a wider adoption and acceptance of these advanced algorithms, the Innovation and Quality (IQ) Consortium initiated the AI/ML working group in 2021 with the aim of promoting their acceptance among the broader scientific community as well as by regulatory agencies.

Decline in typical angina among patients referred for cardiac stress testing.

Objective: To evaluate temporal trends in the prevalence of typical angina and its clinical correlates among patients referred for stress/rest SPECT myocardial perfusion imaging (MPI).

Patients And Methods: We evaluated the prevalence of chest pain symptoms and their relationship to inducible myocardial ischemia among 61,717 patients undergoing stress/rest SPECT-MPI between January 2, 1991 and December 31, 2017. We also assessed the relationship between chest pain symptom and angiographic findings among 6,579 patients undergoing coronary CT angiography between 2011 and 2017.

High-Resolution X-ray Spectromicroscopy Reveals Process-Structure Correlations in sub-5-μm Diameter Carbon Nanotube-Polymer Composite Dry-Spun Yarns.

A persistent lack of detailed and quantitative structural analysis of these hierarchical carbon nanotube (CNT) ensembles precludes establishing processing-structure-property relationships that are essential to enhance macroscale performance (e.g., in mechanical, electrical, thermal applications).

Association between hypercholesterolemia and mortality risk among patients referred for cardiac imaging test: Evidence of a "cholesterol paradox?".

Aim: Some observational studies have observed a lower, rather than higher, mortality rate in association with hypercholesterolemia during follow-up of patients after cardiac stress testing. We aim to assess the relationship of hypercholesterolemia and other CAD risk factors to mortality across a wide spectrum of patients referred for various cardiac tests.

Methods And Results: We identified four cardiac cohorts: 64,357 patients undergoing coronary artery calcium (CAC) scanning, 10,814 patients undergoing coronary CT angiography (CCTA), 31,411 patients without known CAD undergoing stress/rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and 5051 patients with known CAD undergoing stress/rest SPECT-MPI.

Association between plaque localization in proximal coronary segments and MACE outcomes in patients with mild CAC: Results from the EISNER study.

Objective: Coronary artery calcium score (CAC) is a validated tool to predict and reclassify cardiovascular risk. Additional metrics such as regional distribution and extent of CAC over Agatston CAC score may allow further risk stratification. In this study, we evaluate the prognostic significance of proximal CAC involvement in asymptomatic population from the prospective EISNER (Early-Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) registry, focusing on patients with mild CAC (score 1-99).

Ischemia With Nonobstructive Coronary Arteries: Insights From the ISCHEMIA Trial.

Background: Ischemia with nonobstructive coronary arteries (INOCA) is common clinically, particularly among women, but its prevalence among patients with at least moderate ischemia and the relationship between ischemia severity and non-obstructive atherosclerosis severity are unknown.

Objectives: The authors investigated predictors of INOCA in enrolled, nonrandomized participants in ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), sex differences, and the relationship between ischemia and atherosclerosis in patients with INOCA.

Methods: Core laboratories independently reviewed screening noninvasive stress test results (nuclear imaging, echocardiography, magnetic resonance imaging or nonimaging exercise tolerance testing), and coronary computed tomography angiography (CCTA), blinded to results of the screening test.

Benefit of Early Revascularization Based on Inducible Ischemia and Left Ventricular Ejection Fraction.

Background: The utility of performing early myocardial revascularization among patients presenting with inducible myocardial ischemia and low left ventricular ejection fraction (LVEF) is currently unknown.

Objectives: In this study, we sought to assess the relationship between stress-induced myocardial ischemia, revascularization, and all-cause mortality (ACM) among patients with normal vs low LVEF.

Methods: We evaluated 43,443 patients undergoing stress-rest single-photon emission computed tomography myocardial perfusion imaging from 1998 to 2017.

Relationship between ischaemia, coronary artery calcium scores, and major adverse cardiovascular events.

Aims: Positron emission tomography (PET) myocardial perfusion imaging (MPI) is often combined with coronary artery calcium (CAC) scanning, allowing for a combined anatomic and functional assessment. We evaluated the independent prognostic value of quantitative assessment of myocardial perfusion and CAC scores in patients undergoing PET.

Methods And Results: Consecutive patients who underwent Rb-82 PET with CAC scoring between 2010 and 2018, with follow-up for major adverse cardiovascular events (MACE), were identified.

Development and validation of ischemia risk scores.

Background: The likelihood of ischemia on myocardial perfusion imaging is central to physician decisions regarding test selection, but dedicated risk scores are lacking. We derived and validated two novel ischemia risk scores to support physician decision making.

Methods: Risk scores were derived using 15,186 patients and validated with 2,995 patients from a different center.