João A C Lima

Johns Hopkins Medicine, Baltimore, Maryland, United States

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Publications (452)3146.56 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The association of egg consumption with subclinical coronary atherosclerosis remains unknown. Our aim was to examine the association between egg consumption and prevalence of coronary artery calcium (CAC). Cross-sectional study of 23,417 asymptomatic adult men and women without a history of cardiovascular disease (CVD) or hypercholesterolemia, who underwent a health screening examination including cardiac computed tomography for CAC scoring and completed a validated food frequency questionnaire at the Kangbuk Samsung Hospital Total Healthcare Centers, South Korea (March 2011-April 2013). The prevalence of detectable CAC (CAC score > 0) was 11.2%. In multivariable-adjusted models, CAC score ratio (95% confidence interval [CI]) comparing participants eating ≥ 7 eggs/wk to those eating < 1 egg/wk was 1.80 (1.14-2.83; P for trend = 0.003). The multivariable CAC score ratio (95% CI) associated with an increase in consumption of 1 egg/day was 1.54 (1.11-2.14). The positive association seemed to be more pronounced among participants with low vegetable intake (P for interaction = 0.02) and those with high BMI (P for interaction = 0.05). The association was attenuated and no longer significant after further adjustment for dietary cholesterol. Egg consumption was associated with an increased prevalence of subclinical coronary atherosclerosis and with a greater degree of coronary calcification in asymptomatic Korean adults, which may be mediated by dietary cholesterol. The association was particularly pronounced among individuals with low vegetable intake and those with high BMI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Atherosclerosis 08/2015; 241(2). DOI:10.1016/j.atherosclerosis.2015.05.036 · 3.97 Impact Factor
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    ABSTRACT: To evaluate the association between brachial-ankle pulse wave velocity (baPWV), a convenient, non-radiating, readily available measurement of arterial stiffness, and coronary artery calcium (CAC), a reliable marker of coronary atherosclerosis, in a large sample of young and middle-aged asymptomatic adults; and to assess the incremental value of baPWV for detecting prevalent CAC beyond traditional risk factors. Cross-sectional study of 15,185 asymptomatic Korean adults who voluntarily underwent a comprehensive health screening program including measurement of baPWV and CAC. BaPWV was measured using an oscillometric method with cuffs placed on both arms and ankles. CAC burden was assessed using a multi-detector CT scan and scored following Agatston's method. The prevalence of CAC > 0 and CAC > 100 increased across baPWV quintiles. The multivariable-adjusted odds ratios (95% CI) for CAC > 0 comparing baPWV quintiles 2-5 versus quintile 1 were 1.06 (0.87-1.30), 1.24 (1.02-1.50), 1.39 (1.15-1.69) and 1.60 (1.31-1.96), respectively (P trend < 0.001). Similarly, the relative prevalence ratios for CAC > 100 were 1.30 (0.74-2.26), 1.59 (0.93-2.71), 1.74 (1.03-2.94) and 2.59 (1.54-4.36), respectively (P trend < 0.001). For CAC > 100, the area under the ROC curve for baPWV alone was 0.71 (0.68-0.74), and the addition of baPWV to traditional risk factors significantly improved the discrimination and calibration of models for detecting prevalent CAC > 0 and CAC > 100. BaPWV was independently associated with the presence and severity of CAC in a large sample of young and middle-aged asymptomatic adults. BaPWV may be a valuable tool for identifying apparently low-risk individuals with increased burden of coronary atherosclerosis. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Atherosclerosis 08/2015; 241(2). DOI:10.1016/j.atherosclerosis.2015.05.031 · 3.97 Impact Factor
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    ABSTRACT: Aortic pulse wave velocity (PWV), which substantially increases with arterial stiffness and aging, is a major predictor of cardiovascular mortality. It is commonly estimated using applanation tonometry at carotid and femoral arterial sites (cfPWV). More recently, several cardiovascular magnetic resonance (CMR) studies have focused on the measurement of aortic arch PWV (archPWV). Although the excellent anatomical coverage of CMR offers reliable segmental measurement of arterial length, accurate transit time (TT) determination remains a challenge. Recently, it has been demonstrated that Fourier-based methods were more robust to low temporal resolution than time-based approaches. We developed a wavelet-based method, which enables temporal localization of signal frequencies, to estimate TT from ascending and descending aortic CMR flow curves. This method (archPWVWU) combines the robustness of Fourier-based methods to low temporal resolution with the possibility to restrict the analysis to the reflectionless systolic upslope. We compared this method with Fourier-based (archPWVF) and time domain upslope (archPWVTU) methods in relation to linear correlations with age, cfPWV and effects of decreasing temporal resolution by factors of 2, 3 and 4. We studied 71 healthy subjects (45 ± 15 years, 29 females) who underwent CMR velocity acquisitions and cfPWV measurements. Comparison with age resulted in the highest correlation for the wavelet-based method (archPWVWU:r = 0.84,p < 0.001; archPWVTU:r = 0.74,p < 0.001; archPWVF:r = 0.63,p < 0.001). Associations with cfPWV resulted in the highest correlations for upslope techniques whether based on wavelet (archPWVWU:r = 0.58,p < 0.001) or time (archPWVTU:r = 0.58,p < 0.001) approach. Furthermore, while decreasing temporal resolution by 4-fold induced only a minor decrease in correlation of both archPWVWU (r decreased from 0.84 to 0.80) and archPWVF (r decreased from 0.63 to 0.51) with age, it induced a major decrease for the archPWVTU age relationship (r decreased from 0.74 to 0.38). By CMR, measurement of aortic arch flow TT using systolic upslopes resulted in a better correlation with age and cfPWV, as compared to the Fourier-based approach applied on the entire cardiac cycle. Furthermore, methods based on harmonic decomposition were less affected by low temporal resolution. Since the proposed wavelet approach combines these two advantages, it might help to overcome current technical limitations related to CMR temporal resolution and evaluation of patients with highly stiff arteries.
    Journal of Cardiovascular Magnetic Resonance 07/2015; 17(1):65. DOI:10.1186/s12968-015-0164-7 · 5.11 Impact Factor
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    ABSTRACT: To balance competing cardiovascular benefits and metabolic risks of statins, markers of type 2 diabetes (T2D) susceptibility are needed. We sought to define a competing risk/benefit of statin therapy on T2D and cardiovascular disease (CVD) events using liver attenuation and coronary artery calcification (CAC). 3153 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) without CVD, T2D/impaired fasting glucose, or baseline statin therapy had CT imaging for CAC and hepatic attenuation (hepatic steatosis). Cox models and rates of CVD and T2D were calculated to assess the role of liver attenuation in T2D and the relative risks/benefits of statins on CVD and T2D. 216 T2D cases were diagnosed at median 9.1 years follow-up. High liver fat and statin therapy were associated with diabetes (HR 2.06 [95%CI 1.52-2.79, P < 0.0001] and 2.01 [95%CI 1.46-2.77, P < 0.0001], respectively), after multivariable adjustment. With low liver fat and CAC = 0, the number needed to treat (NNT) for statin to prevent one CVD event (NNT 218) was higher than the number needed to harm (NNH) with an incident case of T2D (NNH 68). Conversely, those with CAC >100 and low liver fat were more likely to benefit from statins for CVD reduction (NNT 29) relative to T2D risk (NNH 67). Among those with CAC >100 and fatty liver, incremental reduction in CVD with statins (NNT 40) was less than incremental risk increase for T2D (NNH 24). Liver fat is associated with incident T2D and stratifies competing metabolic/CVD risks with statin therapy. Hepatic fat may inform T2D surveillance and lipid therapeutic strategies. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Atherosclerosis 07/2015; 242(1):211-217. DOI:10.1016/j.atherosclerosis.2015.07.018 · 3.97 Impact Factor
  • Veit Sandfort · Joao A C Lima · David A Bluemke
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    ABSTRACT: The process of coronary artery disease progression is infrequently visualized. Intravascular ultrasound has been used to gain important insights but is invasive and therefore limited to high-risk patients. For low-to-moderate risk patients, noninvasive methods may be useful to quantitatively monitor plaque progression or regression and to understand and personalize atherosclerosis therapy. This review discusses the potential for coronary computed tomography angiography to evaluate the extent and subtypes of coronary plaque. Computed tomographic technology is evolving and image quality of the method approaches the level required for plaque progression monitoring. Methods to quantify plaque on computed tomography angiography are reviewed as well as a discussion of their use in clinical trials. Limitations of coronary computed tomography angiography compared with competing modalities include limited evaluation of plaque subcomponents and incomplete knowledge of the value of the method especially in patients with low-to-moderate cardiovascular risk. © 2015 American Heart Association, Inc.
    Circulation Cardiovascular Imaging 07/2015; 8(7). DOI:10.1161/CIRCIMAGING.115.003316 · 6.75 Impact Factor
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    ABSTRACT: Left atrium (LA) strain, volume and function are important markers of cardiovascular disease and myocardial impairment. We aimed to assess the accuracy of LA biplane volume and function measured by Multimodality Tissue Tracking (MTT). Also we assessed the inter-study reproducibility for cardiovascular magnetic resonance (CMR) derived LA volume and function parameters. Thirty subjects (mean age: 71.3 ± 8.7, 87 % male) including twenty subjects with cardiovascular events and ten healthy subjects, with CMR were evaluated in the Multi-Ethnic Study of Atherosclerosis (MESA). LA volumes were computed by the modified biplane method from 2- and 4-chamber projections and the Simpson's method from short-axis slices using both methods - manual and semi-automated delineation using MTT. LA total, active and passive ejection fractions were calculated. Pearson's correlation and Bland-Altman analysis were used to compare the measurements. In a second sample of 25 subjects (age: 65.7 ± 7.1, 72 % males) inter study, intra and inter reader reliability analysis was performed. The intra-class correlation coefficient (ICC) was evaluated. Left atrial MTT structural and functional parameters were not different from manual delineation, yet image analysis was only half as time consuming on average with MTT. Maximal volume MTT was not different between the Simpson's and Biplane methods, functional parameters, however were different. MTT allowed us to measure multiple LA parameters with good-excellent (ICC; 0.88- 0.98, p < 0.001) intra-and inter reader reproducibility and fair-good (ICC; 0.44-0.82, p < 0.05-0.001) inter study reproducibility. MTT derived LA biplane volume and function is accurate and reproducible and is suited for use in longitudinal studies.
    Journal of Cardiovascular Magnetic Resonance 07/2015; 17(1):52. DOI:10.1186/s12968-015-0152-y · 5.11 Impact Factor
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    ABSTRACT: Cumulative blood pressure (BP) exposure may adversely influence myocardial function, predisposing individuals to heart failure later in life. This study sought to investigate how cumulative exposure to higher BP influences left ventricular (LV) function during young to middle adulthood. The CARDIA (Coronary Artery Risk Development in Young Adults) study prospectively enrolled 5,115 healthy African Americans and whites in 1985 and 1986 (baseline). At the year 25 examination, LV function was measured by 2-dimensional echocardiography; cardiac deformation was assessed in detail by speckle-tracking echocardiography. We used cumulative exposure of BP through baseline and up to the year 25 examination (millimeters of mercury × year) to represent long-term exposure to BP levels. Linear regression and logistic regression were used to quantify the association of BP measured repeatedly through early adulthood (18 to 30 years of age) up to middle age (43 to 55 years). Among 2,479 participants, cumulative BP measures were not related to LV ejection fraction; however, high cumulative exposure to systolic blood pressure (SBP) and diastolic blood pressure (DBP) were associated with lower longitudinal strain rate (both p < 0.001). For diastolic function, higher cumulative exposures to SBP and DBP were associated with low early diastolic longitudinal peak strain rate. Of note, higher DBP (per SD increment) had a stronger association with diastolic dysfunction compared with SBP. Higher cumulative exposure to BP over 25 years from young adulthood to middle age is associated with incipient LV systolic and diastolic dysfunction in middle age. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Cardiology 06/2015; 65(25):2679-87. DOI:10.1016/j.jacc.2015.04.042 · 15.34 Impact Factor
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    ABSTRACT: Increased QRS score and wide spatial QRS-T angle are independent predictors of cardiovascular mortality in the general population. Our main objective was to assess whether a QRS score ≥5 and/or QRS-T angle ≥105° enable screening of patients for myocardial scar features. Seventy-seven patients age ≤70 years with QRS score ≥5 AND/OR spatial QRS-T angle ≥105° as well as left ventricular ejection fraction (LVEF) >35% were enrolled in the study. All participants underwent complete clinical examination, signal averaged ECG (SAECG), 30-minute ambulatory electrocardiogram recording for T-wave alternans (TWA), and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Relationship between QRS score, QRS-T angle with scar presence and pattern, as well as gray zone, core, and total scar size by LGE-CMR were assessed. Myocardial scar was present in 41 (53%) patients, of whom 19 (46%) exhibited a typical ischemic pattern. QRS score but not QRS-T angle was related to total scar size and gray zone size (R(2) = 0.12, P = 0.002; R(2) = 0.17; P ≤ 0.0001, respectively). Patients with QRS scores ≥6 had significantly greater myocardial scar and gray zone size, increased QRS duration and QRS-T angle, a higher prevalence of late potentials presence, increased LV end-diastolic volume and decreased LVEF. There was a significant independent and positive association between TWA value and total scar (P = 0.001) and gray zone size (P = 0.01). Patients with preserved LVEF and myocardial scar by CMR also have electrocardiographic features that could be involved in ventricular arrhythmogenesis. © 2015 Wiley Periodicals, Inc.
    Annals of Noninvasive Electrocardiology 06/2015; DOI:10.1111/anec.12279 · 1.13 Impact Factor
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    ABSTRACT: Purpose To quantitatively determine the population variation and relationship of left ventricular (LV) trabeculation to LV function, structure, and clinical variables. Materials and Methods This HIPAA-compliant multicenter study was approved by institutional review boards of participating centers. All participants provided written informed consent. Participants from the Multi-Ethnic Study of Atherosclerosis with cardiac magnetic resonance (MR) data were evaluated to quantify LV trabeculation as a fractal dimension (FD). Entire cohort participants free of cardiac disease, hypertrophy, hypertension, and diabetes were stratified by body mass index (BMI) into three reference groups (BMI <25 kg/m(2); BMI ≥25 kg/m(2) to <30 kg/m(2); and BMI ≥30 kg/m(2)) to explore maximal apical FD (FDMaxApical). Multivariable linear regression models determined the relationship between FD and other parameters. Results Included were 2547 participants (mean age, 68.7 years ± 9.1 [standard deviation]; 1211 men). FDMaxApical are in arbitrary units. FDMaxApical reference ranges for BMI 30 kg/m(2) or greater (n = 163), 25 kg/m(2) or greater to less than 30 kg/m(2) (n = 206), and less than 25 kg/m(2) (n = 235) were 1.203 ± 0.06 (95% confidence interval: 1.194, 1.212), 1.194 ± 0.06 (95% confidence interval: 1.186, 1.202), and 1.169 ± 0.05 (95% confidence interval: 1.162, 1.176), respectively. In the entire cohort, adjusted for anthropometrics, trabeculation was higher in African American participants (standardized β [sβ] = 0.09; P ≤ .001) and Hispanic participants (sβ = 0.05; P = .013) compared with white participants and was also higher in African American participants compared with Chinese American participants (sβ = 0.08; P = .01), and this persisted after adjustment for hypertension and LV size. Hypertension (sβ = 0.07; P < .001), LV mass (sβ = 0.22; P < .001), and wall thickness (sβ = 0.27; P < .001) were positively associated with FDMaxApical even after adjustment. In the group with BMIs less than 25 kg/m(2), Chinese American participants had less trabeculation than white participants (sβ = -0.15; P = .032). Conclusion Fractal analysis of cardiac MR imaging data measures endocardial complexity, which helps to differentiate normal from abnormal trabecular patterns in healthy versus diseased hearts. Trabeculation is influenced by race and/or ethnicity and, more importantly, by cardiac loading conditions and comorbidities. Clinicians who interpret cine MR imaging data should expect slightly less endocardial complexity in Chinese American patients and more in African American patients, Hispanic patients, hypertensive patients, and those with hypertrophy. (©) RSNA, 2015 Online supplemental material is available for this article.
    Radiology 06/2015; DOI:10.1148/radiol.2015142948 · 6.21 Impact Factor
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    ABSTRACT: Purpose To assess the relationship between total, calcified, and noncalcified coronary plaque burdens throughout the entire coronary vasculature at coronary computed tomographic (CT) angiography in relationship to cardiovascular risk factors in asymptomatic individuals with low-to-moderate risk. Materials and Methods This HIPAA-compliant study had institutional review board approval, and written informed consent was obtained. Two hundred two subjects were recruited to an ongoing prospective study designed to evaluate the effect of HMG-CoA reductase inhibitors on atherosclerosis. Eligible subjects were asymptomatic individuals older than 55 years who were eligible for statin therapy. Coronary CT angiography was performed by using a 320-detector row scanner. Coronary wall thickness and plaque were evaluated in all epicardial coronary arteries greater than 2 mm in diameter. Images were analyzed by using dedicated software involving an adaptive lumen attenuation algorithm. Total plaque index (calcified plus noncalcified plaque) was defined as plaque volume divided by vessel length. Multivariable regression analysis was performed to determine the relationship between risk factors and plaque indexes. Results The mean age of the subjects was 65.5 years ± 6.9 (standard deviation) (36% women), and the median coronary artery calcium (CAC) score was 73 (interquartile range, 1-434). The total coronary plaque index was higher in men than in women (42.06 mm(2) ± 9.22 vs 34.33 mm(2) ± 8.35; P < .001). In multivariable analysis controlling for all risk factors, total plaque index remained higher in men than in women (by 5.01 mm(2); P = .03) and in those with higher simvastatin doses (by 0.44 mm(2)/10 mg simvastatin dose equivalent; P = .02). Noncalcified plaque index was positively correlated with systolic blood pressure (β = 0.80 mm(2)/10 mm Hg; P = .03), diabetes (β = 4.47 mm(2); P = .03), and low-density lipoprotein (LDL) cholesterol level (β = 0.04 mm(2)/mg/dL; P = .02); the association with LDL cholesterol level remained significant (P = .02) after additional adjustment for the CAC score. Conclusion LDL cholesterol level, systolic blood pressure, and diabetes were associated with noncalcified plaque burden at coronary CT angiography in asymptomatic individuals with low-to-moderate risk. (©) RSNA, 2015 Online supplemental material is available for this article.
    Radiology 06/2015; DOI:10.1148/radiol.2015142551 · 6.21 Impact Factor
  • Kihei Yoneyama · João A C Lima
    Circulation Cardiovascular Imaging 06/2015; 8(6). DOI:10.1161/CIRCIMAGING.115.003523 · 6.75 Impact Factor
  • Alban Redheuil · Nadjia Kachenoura · João A C Lima
    Journal of the American College of Cardiology 05/2015; 65(20):2262-4. DOI:10.1016/j.jacc.2015.03.537 · 15.34 Impact Factor
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    ABSTRACT: Aortic size increases with age, but factors related to such dilatation in healthy young adult population have not been studied. We aim to evaluate changes in aortic dimensions and its principal correlates among young adults over a 20-year time period. Reference values for aortic dimensions in young adults by echocardiography are also provided. Healthy Coronary Artery Risk Development in Young Adults (CARDIA) study participants aged 23 to 35 years in 1990-1991 (n=3051) were included after excluding 18 individuals with significant valvular dysfunction. Aortic root diameter (ARD) by M-mode echocardiography at year-5 (43.7% men; age, 30.2±3.6 years) and year-25 CARDIA exams was obtained. Univariable and multivariable analyses were performed to assess associations of ARD with clinical data at years-5 and -25. ARD from year-5 was used to establish reference values of ARD in healthy young adults. ARD at year-25 was greater in men (33.3±3.7 versus 28.7±3.4 mm; P<0.001) and in whites (30.9±4.3 versus 30.5±4.1 mm; P=0.006). On multivariable analysis, ARD at year-25 was positively correlated with male sex, white ethnicity, age, height, weight, 20-year gain in weight, active smoking at baseline, and 20-year increase in diastolic, systolic, and mean arterial pressure. A figure showing the estimated 95th percentile of ARD by age and body surface area stratified by race and sex is provided. This study demonstrates that smoking, blood pressure, and increase in body weight are the main modifiable correlates of aortic root dilation during young adulthood. Our study also provides reference values for ARD in young adults. © 2015 American Heart Association, Inc.
    Hypertension 05/2015; 66(1). DOI:10.1161/HYPERTENSIONAHA.115.05156 · 7.63 Impact Factor
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    ABSTRACT: Background: Smoking has adverse effects on pulmonary vascular function, pulmonary artery pressures, and lung function. Clinically established cigarette-related pulmonary disease may lead to RV dysfunction. However, relations between smoking and early stages of RV dysfunction are still unclear. We investigated the association between smoking status and RV systolic function in a bi-racial cohort of middle aged participants. Methods: CARDIA is a prospective study that enrolled healthy black and white adults (18-30 years) from 4 Field Centers (Birmingham, AL; Oakland, CA; Chicago, IL; Minneapolis, MN) in 1985-86. We assessed participants that underwent echocardiograms at follow-up year 25 exam. RV function was determined by M-Mode: derived tricuspid annular plane systolic excursion (TAPSE) and Tissue Doppler Imaging (TDI): derived tricuspid lateral annular systolic velocity of RV (RVS’). According to the most recent ASE recommendations, abnormally reduced TAPSE (<17 mm) and RVS’ (<9.5 cm/s) were then computed. Multivariable linear regression models assessed the cross-sectional correlation of smoking status (current smoker, former smoker or never smoked) with TAPSE and RVS’, adjusted for age, gender, race, body mass index (BMI), systolic blood pressure, antihypertensive medications, heart rate, diabetes mellitus, alcohol use, glomerular filtration rate and left ventricle ejection fraction (LVEF). Results: Of the 3445 CARDIA participants in the Y25 follow-up, 22% (n=750) were former smokers and 17% (n=589) current smokers. Mean age was 50±3.6 years, 54% were females and 51% were blacks. Mean BMI was 30±7g/m2; LVEF was 61±8%; TAPSE was 13±2.5 mm and RVS’ was 13±2cm/s. Abnormally reduced TAPSE was evidenced in 4.6% (n=147) and RVS’ in 3.6% (n=119) of the participants. As shown in table 1, being a current smoker was significantly related to lower RV systolic function both by TAPSE and RVS’ compared to never smokers. Conclusion: In a middle aged population, being a current smoker was statistically significant related to lower RV function measured by M-mode and TDI echocardiographic methods.
    Journal of the American Society of Echocardiography (ASE 26th Annual Scientific Sessions); 05/2015
  • Boaz D Rosen · João A C Lima
    JACC. Cardiovascular imaging 05/2015; 8(5):550-2. DOI:10.1016/j.jcmg.2015.02.008 · 6.99 Impact Factor
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    ABSTRACT: The relation between glycemic index, glycemic load, and subclinical coronary atherosclerosis is unknown. The aim of the study was to evaluate the associations between energy-adjusted glycemic index, glycemic load, and coronary artery calcium (CAC). This study was cross-sectional analysis of 28,429 asymptomatic Korean men and women (mean age 41.4 years) without a history of diabetes or cardiovascular disease. All participants underwent a health screening examination between March 2011 and April 2013, and dietary intake over the preceding year was estimated using a validated food frequency questionnaire. Cardiac computed tomography was used for CAC scoring. The prevalence of detectable CAC (CAC score >0) was 12.4%. In multivariable-adjusted models, the CAC score ratios (95% confidence intervals) comparing the highest to the lowest quintile of glycemic index and glycemic load were 1.74 (1.08 to 2.81; p trend = 0.03) and 3.04 (1.43 to 6.46; p trend = 0.005), respectively. These associations did not differ by clinical subgroups, including the participants at low cardiovascular risk. In conclusion, these findings suggest that high dietary glycemic index and glycemic load were associated with a greater prevalence and degree of CAC, with glycemic load having a stronger association. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 05/2015; DOI:10.1016/j.amjcard.2015.05.005 · 3.43 Impact Factor
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    ABSTRACT: The Multi-Ethnic Study of Atherosclerosis (MESA), initiated in July 2000, is a six-center longitudinal population-based study that included 6,814 men and women at baseline study. Cardiac MRI was part of the study procedures, representing the first large-scale application of cardiac MRI in a multi-center and multi-ethnic population study in the USA. To date, this is the largest ever MRI study. Such effort would come with a great potential for variability due to the number of professionals involved; therefore, an intensive quality control process was implemented since the very beginning. A workflow for process control was used to match image protocols in different types of MRI scanners, transfer images to the reading center, train technicians, and implement image quality scorecards. This article reviews the influence of research management for quality control and work standardization processes in cardiac magnetic MRI results at the 10th year of follow-up in MESA.
    Current Cardiovascular Imaging Reports 05/2015; 8(5). DOI:10.1007/s12410-015-9329-x
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    ABSTRACT: Background: Chagas disease leads to biventricular heart failure, usually with prominent systemic congestion. Right ventricle (RV) dysfunction has been described as an early finding in chronic Chagas cardiomyopathy (CCC) when radionuclide angiography or magnetic resonance imaging (MRI) were used. However, mixed results were reported from the few small studies that used echocardiography for the assessment of RV function in CCC. We evaluated the accuracy of echocardiographic parameters to detect RV global systolic dysfunction in CCC with MRI as the gold standard comparator. Methods: Included were 56 outpatients with CCC who underwent 2-D echocardiography (GE Healthcare) and MRI. Echocardiographic parameters of RV function were Tricuspid Annular Plane Systolic Excursion (TAPSE), DTI-derived Tricuspid Lateral Annular Systolic Velocity (RVS’), Fractional Area Change, DTI-derived RV Index of Myocardial Performance and RV longitudinal end-systolic strain and systolic strain rate by Speckle Tracking. Strain and strain rate were performed in apical 4 chamber view focused on RV and designated as lateral wall if only from lateral RV wall segments and as global for analysis including lateral RV wall and interventricular septum. RV dysfunction was defined as RV ejection fraction by MRI < 50%, using cine steady-state free precession sequences and analyzed using QMass software (Medis). Receiver Operating Characteristic analysis was used to assess the accuracy of echocardiographic parameters to detect RV global dysfunction. Results: Mean age: 55±14 years, 59% males; mean RV ejection fraction: 55±12%; 30% (n=17) with RV global systolic dysfunction. Period of time between echocardiographic and MRI exams was 23 ± 15 days and no clinical events occurred between the two exams. Receiver Operating Characteristic analysis (Table 1) showed that RV Global Strain had the highest area under the curve (0.826), followed by Lateral Wall RV Strain, Fractional Area Change, RV Global Strain Rate, RVS’, Lateral Wall RV Strain Rate, TAPSE and RV Index of Myocardial Performance. Conclusion: Echocardiography is useful for the assessment of RV global systolic dysfunction in CCC. RV global longitudinal strain and RV longitudinal systolic strain rate were the most accurate parameters for detecting RV global systolic dysfunction in CCC.
    Journal of the American Society of Echocardiography (ASE 26th Annual Scientific Sessions); 05/2015
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    ABSTRACT: Background: Aortic Root Diameter (ARD) predicts cardiovascular disease (CVD) events. Identifying an association between alterations in aortic dimensions, Left Ventricular (LV) remodeling and function may highlight the potential role of vascular-ventricular coupling in the pathogenesis of CVD. We aim to evaluate the relationship between aortic root diameter and myocardial structure and function assessed by 2-Dimensional (2D) echocardiography in middle-aged black and white adults. Method: Included were 3,367 Coronary Artery Risk Development in Young Adults (CARDIA) black and white participants who underwent 2D echocardiography at four field centers in the Year- 25 exam, excluding participants with severe or moderate mitral regurgitation, aortic regurgitation and aortic stenosis. ARD was measured at the level of the Sinuses of Valsalva and indexed by Body Surface Area (BSA) and height. Multivariable linear regression models were used to assess the cross-sectional relationships between ARD and cardiac structure and function, adjusted for demographics and traditional cardiovascular risk factors. Results: Mean age of CARDIA participants was 50.1 ± 3.7 years, 52.3% were female and 48.1% Caucasian. As shown in Table 1, higher ARD/BSA was associated with greater LV mass, smaller LV relative wall thickness, greater LV end diastolic volume and lower ejection fraction. Similarly, higher ARD/height was associated with greater LV mass, smaller LV relative wall thickness, higher LV end diastolic volume and lower ejection fraction. In addition, higher ARD/height was associated with diastolic dysfunction assessed by E/E’ and left atrial volume. Conclusion: Large aortic root diameter in middle aged adults was associated with LV eccentric hypertrophy, reduced systolic and diastolic function.
    Journal of the American Society of Echocardiography (ASE 26th Annual Scientific Sessions); 05/2015
  • Journal of the American Society of Echocardiography (ASE 26th Annual Scientific Sessions); 05/2015

Publication Stats

17k Citations
3,146.56 Total Impact Points


  • 1998–2015
    • Johns Hopkins Medicine
      • • Department of Medicine
      • • Division of Cardiology
      Baltimore, Maryland, United States
  • 1993–2015
    • Johns Hopkins University
      • • Division of Cardiology
      • • Department of Medicine
      • • Department of Radiology
      Baltimore, Maryland, United States
  • 2013
    • National Institutes of Health
      • Radiology and Imaging Sciences Department
      Bethesda, MD, United States
  • 2006–2010
    • Columbia University
      • Department of Medicine
      New York City, NY, United States
    • University of California, Los Angeles
      Los Ángeles, California, United States
  • 2009
    • University of Washington Seattle
      • Department of Biostatistics
      Seattle, Washington, United States
  • 2007
    • Federal University of Rio de Janeiro
      Rio de Janeiro, Rio de Janeiro, Brazil
  • 2004
    • Ethianum Klinik Heidelberg
      Heidelburg, Baden-Württemberg, Germany
    • University of Zurich
      Zürich, Zurich, Switzerland
  • 2002
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Epidemiology
      Baltimore, Maryland, United States
  • 2001
    • Stanford University
      • Department of Radiology
      Stanford, CA, United States
  • 1997
    • University of Baltimore
      Baltimore, Maryland, United States
  • 1996
    • University of Maryland, Baltimore
      • Division of Cardiology
      Baltimore, MD, United States