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Ciccarone Articles

Ciccarone Center Research


Cardiac CT

Landmark Articles

Comparison of cardiac computed tomography examination appropriateness under the 2010 revised versus the 2006 original Appropriate Use Criteria.
By: Wasfy MM, Brady TJ, Abbara S, Nasir K, Hoffmann U, Cury RC, Di Carli MF, Blankstein R.

The 2006 Cardiac CT Appropriate Use Criteria (AUC) were recently revised in 2010. In addition to rating an expanded number of indications, the new criteria adjusted the appropriateness of existing indications to reflect changes in clinical practice and new evidence since 2006. The revision of the AUC for cardiac CT had a significant effect on examination appropriateness. In comparison to the 2006 AUC, the 2010 AUC provided improved clarification of examination appropriateness. This shift was because of the inclusion of many previously unaddressed indications and the designation of more examinations as either appropriate or inappropriate.

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Comparison of the Diamond-Forrester method and Duke Clinical Score to predict obstructive coronary artery disease by computed tomographic angiography.
By: Wasfy MM, Brady TJ, Abbara S, Nasir K, Ghoshhajra BB, Truong QA, Hoffmann U, Di Carli MF, Blankstein R.


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Potential implications of coronary artery calcium testing for guiding aspirin use among asymptomatic individuals with diabetes.
By: Silverman MG, Blaha MJ, Budoff MJ, Rivera JJ, Raggi P, Shaw LJ, Berman D, Callister T, Rumberger JA, Rana JS, Blumenthal RS, Nasir K.
We conclude that CAC can help risk stratify individuals with diabetes and may aid in selection of patients who may benefit from therapies such as low-dose aspirin for primary prevention of CVD.
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A graphical method for assessing risk factor threshold values using the generalized additive model: the multi-ethnic study of atherosclerosis.
By: Setodji CM, Scheuner M, Pankow JS, Blumenthal RS, Chen H, Keeler E.
We suggest the use of a technique used in the estimation of the effect of risk factors on health outcomes in multivariate regression settings, while accounting for mixture distributions in the outcome of interest and adjusting for covariates. These empirically based thresholds of risk factors could be informative in terms of the highest or lowest point of a risk factor beyond which no additional impact on the outcome should be expected.
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Comparison of exercise treadmill testing with cardiac computed tomography angiography among patients presenting to the emergency room with chest pain: the Rule Out Myocardial Infarction Using Computer-Assisted Tomography (ROMICAT) study.
By: Blankstein R, Ahmed W, Bamberg F, Rogers IS, Schlett CL, Nasir K, Fontes J, Tawakol A, Brady TJ, Nagurney JT, Hoffmann U, Truong QA.
Although patients with a high number of clinical risk factors are more likely to have obstructive coronary artery disease, those who are young or who would be expected to have a very high exercise capacity are unlikely to have coronary stenosis and therefore may benefit from initial treadmill testing instead of CTA.
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Potential use of coronary artery calcium progression to guide the management of patients at risk for coronary artery disease events.
By: McEvoy JW, Blaha MJ, Nasir K, Blumenthal RS, Jones SR.
We believe that the data argues against the use of CAC progression as a clinical surrogate marker of preventive therapy efficacy. Further studies with non-statin medications and with concomitant outcome data are needed. However, CAC progression has potential for monitoring subclinical coronary artery disease (CAD) in some patients with mild CAC and may facilitate treatment decisions. In this review we provide recommendations for repeat CAC testing and discuss when repeat CAC testing may be helpful to assess CAD progression.
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Prediction of coronary artery calcium progression in individuals with low Framingham Risk Score: the Multi-Ethnic Study of Atherosclerosis.
By: Okwuosa TM, Greenland P, Burke GL, Eng J, Cushman M, Michos ED, Ning H, Lloyd-Jones DM.
In individuals at low predicted risk, according to Framingham Risk Scores, traditional risk factors predicted CAC progression in the short term with good discrimination and calibration. Prediction improved minimally when various novel markers were added to the model.
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The relationship between resting heart rate and incidence and progression of coronary artery calcification: the Multi-Ethnic Study of Atherosclerosis (MESA).
By: Rubin J, Blaha MJ, Budoff MJ, Rivera JJ, Shaw LJ, Blankstein R, Mallah MA, Carr JJ, Jones DL, Blumenthal RS, Nasir K.
We conclude that elevated resting heart rate, a well-described predictor of cardiovascular mortality with unclear mechanism, is associated with increased incidence and progression of coronary atherosclerosis among individuals free of CVD at baseline.
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Coronary artery calcium scanning should be used for primary prevention: pros and cons.
By: Nasir K, Shaw LJ, Budoff MJ, Ridker PM, Peña JM.
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Plaque composition and stenosis severity: is there any hope for plaque regression?
By: Al-Mallah MH, Nasir K.
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