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Ciccarone Articles

Ciccarone Center Research


American Journal of Cardiology

Landmark Articles

  • This study shifts the focus from prediction of events to detection of disease in the effort to improve personalized decision-making and outcomes. It also discusses innovative future strategies for risk estimation and treatment allocation in preventive cardiology.
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  • Much attention has been directed toward lifestyle modifications as effective means of reducing cardiovascular disease risk. We review recent observational and interventional trials investigating the effects of physical activity on markers of (or causal factors for) atherosclerotic burden and vascular disease. There is a strong correlation between physical activity and triglyceride reduction, apolipoprotein B reduction, HDL increase, change in LDL particle size, increase in tissue plasminogen activator activity, and decrease in CAC. Further research is needed to elucidate the effect on inflammatory markers and intima-media thickness.
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Thoracic aortic distensibility and thoracic aortic calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA]).
By: Al-Mallah MH, Nasir K, Katz R, Takasu J, Lima JA, Bluemke DA, Hundley G, Blumenthal RS, Budoff MJ.
Using multivariate analysis, thoracic aortic calcification (TAC) was independently associated with aortic distensibility (AD) after adjusting for age, gender, ethnicity, and other covariates. Our analysis demonstrated that increased arterial stiffness is associated with increased TAC, independent of ethnicity and other atherosclerotic risk factors.
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Relation of C-reactive protein to abdominal adiposity
By: Brooks GC, Blaha MJ, Blumenthal RS.
The association between high-sensitivity C-reactive protein (hsCRP) and abdominal adiposity persists when taking into account body mass index. Elevation of hsCRP might be reversible with weight loss and exercise. In conclusion, clinical measurements of abdominal adiposity readily provide data elucidating the systemic inflammatory state of patients and can help guide intensity of lifestyle modifications, thus leading to reduction of this inflammation.
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Perceived usefulness of cardiac computed tomography as assessed by referring physicians and its effect on patient management.
By: Blankstein R, Murphy MK, Nasir K, Gazelle GS, Batlle JC, Al-Mallah M, Shturman L, Hoffmann U, Cury RC, Abbara S, Brady TJ, Lee TH.

Despite the growing use of computed tomographic angiography (CTA), the effect on patient management is less clear. We sought to determine the perceived usefulness of the results provided by CTA and to assess whether and how it influences patient management. Comprehensive prospective data were collected from 184 consecutive patients who presented for clinical CTA for the evaluation of coronary artery disease from March to July 2008. In addition, a detailed survey was sent to each referring physician for each patient examined to assess whether they found the results of the CTA useful and whether it had any influence on subsequent patient management. Of 184 CTA examinations, which had been ordered by 82 different providers, 108 surveys (59%) were completed by 53 different physicians. No significant differences were found in either the patient or provider characteristics for the completed versus noncompleted surveys. Of the 184 CTA examinations, the severity of coronary disease detected by CTA was severe for 26%, mild to moderate in 47%, and not present in 27% of the patients. Clinicians considered the test results to be useful in virtually all cases and thought the results led to significant risk reclassification in 58% of the patients. If CTA had not been available, the clinicians indicated that they would have ordered an invasive test for 46% of the patients and noninvasive tests for 32%. After CTA, changes in medical therapies were made for 31%, invasive angiography was planned for 19%, and noninvasive testing was scheduled for 6% of the patients. In conclusion, of 53 different referring clinicians from different medical specialties, CTA was considered to almost always be useful; however, the effect on subsequent medical management was more variable.

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Noninvasive assessment of gender differences in coronary plaque composition with multidetector computed tomographic angiography.
By: Nasir K, Gopal A, Blankstein R, Ahmadi N, Pal R, Khosa F, Shaw LJ, Blumenthal RS, Budoff MJ.
Few data are available that show gender differences in plaque morphology and composition. This report aims to assess the differences in coronary plaque burden and composition in a noninvasive manner between women and men using multidetector computed tomographic angiography. Results show that gender differences exist, not only in the atherosclerotic disease burden, but also in the underlying plaque composition. Women tended to have more exclusively noncalcified plaque and were less likely to have calcified or mixed plaques compared to men. Future studies are needed to elucidate whether these underlying differences in plaque composition might explain the reduced risk of cardiac events in women.
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Effect of Beta-blocker therapy on rehospitalization rates in women versus men with heart failure and preserved ejection fraction.
By: Farasat SM, Bolger DT, Shetty V, Menachery EP, Gerstenblith G, Kasper EK, Najjar SS.

Beta blockers are empirically used in many patients with heart failure (HF) and preserved ejection fraction (HFpEF) because they allow more time for diastolic filling and because they improve outcomes in patients with systolic HF. However, recent data suggest that impaired chronotropic and vasodilator responses to exercise, which can worsen with beta blockade, may play a key role in the pathophysiology of HFpEF. We prospectively examined the association between beta-blocker therapy after hospitalization for decompensated HF and HF rehospitalization at 6 months in 66 consecutive patients with HFpEF (71 +/- 13 years old, 68% women, 42% Black). Subjects were stratified based on receiving (BB+; 15 men, 28 women) or not receiving (BB-) beta-blockers at hospital discharge. In men, HF rehospitalization occurred less frequently in the BB+ than in the BB- group, albeit nonsignificantly (20% vs 50%, p = 0.29). In women, HF rehospitalization occurred more frequently in the BB+ than in the BB- group (75% vs 18%, p <0.001). In univariate analyses, discharge beta-blocker was associated with HF rehospitalization in women (odds ratio [OR] 14.00, 95% confidence interval [CI] 3.09 to 63.51, p = 0.001), but not in men (OR 0.25, 95% CI 0.03 to 1.92, p = 0.18). In a forward logistic regression model that offered all univariate predictors of HF rehospitalization, discharge beta blocker remained an independent predictor of HF rehospitalization in women (OR 11.06, 95% CI 1.98 to 61.67, p = 0.006). In conclusion, this small observational study suggests that beta-blocker therapy may be associated with a higher risk of HF rehospitalization in women with HFpEF. The risks and benefits of beta-blocker therapy in patients with HFpEF should be evaluated in randomized, controlled trials.

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Assessment of subclinical coronary atherosclerosis in asymptomatic patients with type 2 diabetes mellitus with single photon emission computed tomography and coronary computed tomography angiography.
By: Choi EK, Chun EJ, Choi SI, Chang SA, Choi SH, Lim S, Rivera JJ, Nasir K, Blumenthal RS, Jang HC, Chang HJ.
We evaluated the characteristics of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus (DM) using single photon emission computed tomography (SPECT) and coronary computed tomographic angiography (CCTA). In conclusion, a significant percentage of patients with DM and normal eletrocardiographic findings, no peripheral arterial disease, and normal findings on SPECT have evidence of occult CAD on CCTA. Furthermore, a small percentage had had a cardiac event by mid-term follow-up.
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