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Ciccarone Articles

Ciccarone Center Research

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Cardiac CT

Landmark Articles

Impact of coronary artery calcification on all-cause mortality in individuals with and without hypertension.
By: Graham G, Blaha MJ, Budoff MJ, Rivera JJ, Agatston A, Raggi P, Shaw LJ, Berman D, Rana JS, Callister T, Rumberger JA, Min J, Blumenthal RS, Nasir K.
This study found that the addition of CAC scores contributed significantly in predicting mortality, in addition to traditional risk factors alone, among those with and without hypertension.
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Cigarette smoking is associated with increased mortality in both the presence and absence of coronary artery calcification.
By: McEvoy JW, Blaha MJ, Rivera JJ, Budoff MJ, Khan AN, Shaw LJ, Berman DS, Raggi P, Min JK, Rumberger JA, Callister TQ, Blumenthal RS, Nasir K.

The aim of this study was to further explore the interplay between smoking status, coronary artery calcium (CAC), and all-cause mortality. Smoking is a risk factor for death across the entire spectrum of subclinical coronary atherosclerosis. Smokers with any CAC had significantly higher mortality than smokers without CAC, a finding with implications for smokers undergoing lung cancer CT-based screening. However, the absence of CAC might not be as useful a "negative risk factor" in active smokers, because this group has mortality rates similar to nonsmokers with mild-to-moderate atherosclerosis.

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Mortality rates in smokers and nonsmokers in the presence or absence of coronary artery calcification.
By: McEvoy JW, Blaha MJ, Rivera JJ, Budoff MJ, Khan AN, Shaw LJ, Berman DS, Raggi P, Min JK, Rumberger JA, Callister TQ, Blumenthal RS, Nasir K.

The aim of this study was to further explore the interplay between smoking status, coronary artery calcium (CAC), and all-cause mortality. Smoking is a risk factor for death across the entire spectrum of subclinical coronary atherosclerosis. Smokers with any CAC had significantly higher mortality than smokers without CAC, a finding with implications for smokers undergoing lung cancer CT-based screening. However, the absence of CAC might not be as useful a "negative risk factor" in active smokers, because this group has mortality rates similar to nonsmokers with mild-to-moderate atherosclerosis.

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Utility of coronary artery calcium scoring in the evaluation of patients with chest pain.
By: Tota-Maharaj R, McEvoy JW, Blaha MJ, Silverman MG, Nasir K, Blumenthal RS.
Although further research is needed, carefully selected patients presenting to the emergency department with a normal electrocardiogram, normal cardiac biomarkers, and no CAC may be considered for early discharge without further testing.
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Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals.
By: Nasir K, Clouse M.

Arteriosclerotic cardiovascular disease is the leading cause of death in the United States, with coronary artery disease (CAD) accounting for half of all cardiovascular disease deaths. Current risk assessment approaches for coronary heart disease, such as the Framingham risk score, substantially misclassify intermediate- to long-term risk for the occurrence of CAD in asymptomatic individuals. A screening modality such as a simple non-contrast-enhanced, or noncontrast, computed tomographic (CT) detection of coronary artery calcium (CAC) improves the ability to accurately predict risk in vulnerable groups and adds information above and beyond global risk assessment as shown by the recent Multi-Ethnic Study of Atherosclerosis. In addition, absence of CAC is associated with a very low risk of future CAD and as a result can be used to identify a group among which further testing and pharmacotherapies can be avoided. The Expert Consensus Document by the American College of Cardiology Foundation and the American Heart Association now recommends screening individuals at intermediate risk but did not find enough evidence to recommend CAC testing and further stratification of those in the low- or high-risk categories for CAD. In addition, emerging guidelines have suggested that absence of CAC can act as a "gatekeeper" for further testing among low- and intermediate-risk patients presenting with chest pain. This review of the current literature outlines the role of CAC testing in both asymptomatic and symptomatic individuals.

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Utility of coronary artery calcium scoring in the evaluation of patients with chest pain.
By: Tota-Maharaj R, McEvoy JW, Blaha MJ, Silverman MG, Nasir K, Blumenthal RS.
Although further research is needed, carefully selected patients presenting to the emergency department with chest pain and with a normal electrocardiogram, normal cardiac biomarkers, and CAC = 0 may be considered for early discharge without further testing.
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Rhinotillexis: a possible heuristic to reduce inappropriate noninvasive cardiac imaging?
By: McEvoy JW, Blaha MJ, Blumenthal RS.
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Computed tomography scans in the evaluation of fatty liver disease in a population based study: the multi-ethnic study of atherosclerosis.
By: Zeb I, Li D, Nasir K, Katz R, Larijani VN, Budoff MJ.

Fatty liver disease is a common clinical entity in hepatology practice. This study evaluates the prevalence and reproducibility of computed tomography (CT) measures for diagnosis of fatty liver and compares commonly used CT criteria for the diagnosis of liver fat. Fatty liver can be reliably diagnosed using nonenhanced CT scans.

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Coronary artery calcium for the prediction of mortality in young adults <45 years old and elderly adults >75 years old.
By: Tota-Maharaj R, Blaha MJ, McEvoy JW, Blumenthal RS, Muse ED, Budoff MJ, Shaw LJ, Berman DS, Rana JS, Rumberger J, Callister T, Rivera J, Agatston A, Nasir K.
The value of coronary artery calcium for predicting mortality extends to both elderly patients and those <45 years old. Elderly persons with no CAC have a lower mortality rate than younger persons with high CAC.
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Gender differences in coronary plaque composition and burden detected in symptomatic patients referred for coronary computed tomographic angiography.
By: Qureshi W, Blaha MJ, Nasir K, Al-Mallah MH.
Symptomatic women have a lower prevalence of obstructive coronary artery disease and are less likely to have mixed coronary plaque compared to symptomatic men. Future studies are needed to determine the prognostic implications of these findings.
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