Daniel Berman

• Cedars-Sinai Medical Center

Importance Accurate assessment of tricuspid regurgitation (TR) is necessary for identification and risk stratification. Objective To design a deep learning computer vision workflow for identifying color Doppler echocardiogram videos and characterizing TR severity. Design, Setting, and Participants An automated deep learning workflow was developed...

Background Myocardial fibrosis is a key healing response after myocardial infarction driven by activated fibroblasts. Gallium-68-labeled fibroblast activation protein inhibitor ([⁶⁸Ga]-FAPI) is a novel positron-emitting radiotracer that binds activated fibroblasts. Objectives The aim of this study was to investigate the intensity, distribution, an...

Computed tomography coronary angiography provides a non-invasive evaluation of coronary artery disease that includes phenotyping of atherosclerotic plaques and the surrounding perivascular adipose tissue (PVAT). Image analysis techniques have been developed to quantify atherosclerotic plaque burden and morphology as well as the associated PVAT atte...

Background: Coronary CT angiography (CCTA) has emerged as a first line tool for detecting CAD and assessing need for invasive coronary angiography (ICA). Historically, women have higher cardiovascular mortality compared to men with similar coronary plaque burden, yet remain undertreated. This study aims to investigate gender differences in ICA rate...

Background: There is increasing interest in predicting heart failure (HF), a major cause of morbidity and mortality that exerts a significant financial burden. The role of coronary artery calcium (CAC), an accessible and inexpensive test, in predicting long-term HF mortality amongst asymptomatic adults remains unknown. Objectives: To determine if C...

Background: After heart transplantation, endomyocardial biopsy (EMBx) is the standard diagnostic modality for acute rejection (AR). However, EMBx is invasive with some limitations to conventional histological interpretation. Non-invasive assessments, such as cardiac magnetic resonance Imaging (MRI) and donor-derived cell-free DNA (dd-cfDNA) assays,...

Background: Plasma donor-derived cell-free DNA (dd-cfDNA) has emerged as a biomarker for acute heart transplant rejection as a potential adjunct to endomyocardial biopsy (EMBx). However, an established threshold for dd-cfDNA in acute cardiac transplant rejection is lacking, with prior studies employing different study specific thresholds. This meta...

Background: Computed tomography attenuation correction (CTAC) scans are routinely obtained during cardiac perfusion imaging, but currently only utilized for attenuation correction and visual calcium estimation. We aimed to develop a novel artificial intelligence (AI)-based approach to obtain volumetric measurements of chest body composition from CT...

Introduction There are sex differences in the extent, severity, and outcomes of coronary artery disease. We aimed to assess the influence of sex on coronary atherosclerotic plaque activity measured using coronary ¹⁸F-sodium fluoride (¹⁸F-NaF) positron emission tomography (PET), and to determine whether ¹⁸F-NaF PET has prognostic value in both women...

Background Heart failure with preserved ejection fraction (HFpEF) is the most common cardiac complication in patients with coronary microvascular dysfunction (CMD), yet its underlying pathways remain unclear. Aortic pulse-wave velocity (aPWV) is an indicator of large artery stiffness and a predictor for cardiovascular disease. However, aPWV in CMD...

Aims Vessel-specific coronary artery calcification (CAC) is additive to global CAC for prognostic assessment. We assessed accuracy and prognostic implications of vessel-specific automated deep learning (DL) CAC analysis on electrocardiogram (ECG) gated and attenuation correction (AC) computed tomography (CT) in a large multi-centre registry. Metho...

Introduction: The purpose of this study was to compare rubidium-82 positron emission tomography ( ⁸² Rb PET) myocardial perfusion imaging (MPI) findings and quantitative image quality measures between the digital silicone photomultipliers (SiPM) scanner and a conventional scanner. Methods: We studied 24 consecutive patients (mean age 71.2±2.2 years...

Background: Non-contrast CT scans are currently not used to assess left ventricular myocardial mass (LV mass), which is usually evaluated with contrast CT or cardiac magnetic resonance (CMR). We aimed to assess the feasibility of LV mass estimation from non-contrast CT calcium scans using an artificial intelligence (AI) approach and compare it to m...

Background: Impaired coronary artery response to isometric handgrip exercise (IHE) has previously been demonstrated to reflect endothelial dysfunction, an important contributor to ischemia with no obstructive coronary arteries (INOCA) and coronary microvascular dysfunction (CMD). Stress perfusion cardiac magnetic resonance (CMR) imaging is typicall...

Introduction: Persons with very-high high-density lipoprotein-cholesterol (HDL-C) may experience an increased mortality risk. However, the predictors of mortality among those with very-high HDL-C remain unknown. Hypothesis: Compared to traditional risk factors, coronary artery calcium (CAC) will more strongly stratify risk among individuals with ve...

Background: Women with SLE have an elevated risk of cardiovascular disease. Many women with SLE frequently report chest pain in the absence of obstructive coronary artery disease (CAD) due to coronary microvascular dysfunction (CMD), a form of ischemia with no obstructive CAD. Echocardiographic studies have shown that SLE patients have reduced left...

Background Coronary microvascular dysfunction (CMD) has differences in prevalence and presentation between women and men; however, we have limited understanding about underlying contributors to sex differences in CMD. Myocardial perfusion reserve index (MPRI), as semi-quantitative measure of myocardial perfusion derived from cardiac magnetic resona...

Background: Coronary CT angiography (CCTA) artery plaque characteristics including low attenuation and positive remodeling are associated with future myocardial infarction. Associations between angina symptoms and plaque characteristics are unknown. Objective: To examine relationships between quantitative plaque characteristics and angina in women...

Introduction: Statins reduce major cardiovascular events, but residual risk remains. The study examined determinants of atherosclerotic statin non-response in patients using statins. Hypothesis: We hypothesized that a comprehensive evaluation of atherosclerosis identifies patients that progress atherosclerosis despite the use of statin therapy. Met...

Introduction: Coronary artery calcification (CAC) is a noninvasive biomarker of atherosclerotic plaque burden in the general population and predicts coronary heart disease and mortality. This study examined whether CAC predicts stroke mortality independent of established traditional cardiovascular risk factors. Methods: We included 66,511 participa...

Introduction: Coronary CT Angiogram (CCTA) has become a powerful tool in the diagnosis and risk stratification of coronary artery disease (CAD), but can also provide unique insight into the effects of pharmacotherapy on the progression of atherosclerosis. Although Renin-Angiotensin-Aldosterone-System (RAAS) inhibitors are indicated in patients with...

Introduction: Coronary anomalies are detected in 0.3-2.3% of patients undergoing coronary computed tomography angiography (CCTA). Data are scarce on atherosclerosis severity in anomalous arteries and relationship to ischemia on stress testing. Hypothesis: High risk features of anomalous coronary arteries are associated with ischemia, even in the ab...

Background Non-obstructive coronary artery disease (CAD) is associated with increased adverse cardiovascular (CV) events. However, it is unclear if functional stenosis, as assessed by FFRCT <0.80, further stratifies risk among patients with non-obstructive CAD and which factors contribute to this anatomic-functional discordance (stenosis <50% and F...

Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developmen...

Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developmen...

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 populati...

Background Respiratory motion correction is of importance in studies of coronary plaques employing ¹⁸F‐NaF; however, the validation of motion correction techniques mainly relies on indirect measures such as test–retest repeatability assessments. In this study, we aim to compare and, thus, validate the respiratory motion vector fields obtained from...

Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developmen...

We present a rare case of a young patient who underwent a bioprosthetic mitral valve replacement and subsequently experienced a left ventricular pseudoaneurysm complicated by valve dehiscence and paravalvular mitral regurgitation, demonstrated by multimodality imaging and confirmed during surgical repair. (Level of Difficulty: Advanced.)

Aim: Women with evidence of ischemia and no obstructive coronary artery disease (INOCA) have an increased risk of major adverse cardiac events, including heart failure with preserved ejection fraction (HFpEF). To investigate potential links between INOCA and HFpEF, we examined pathophysiological findings present in both INOCA and HFpEF. Methods: We...

Introduction: Late sodium channel inhibition with ranolazine may beneficially impact coronary microvascular dysfunction (CMD). We hypothesized that markers of ventricular volume/pressure (N-terminal -pro BNP [NT-proBNP]) and myocardial damage (ultra-high sensitivity cardiac troponin I [u-hs-TnI]) are related to therapeutic response. Methods: We ana...

Introduction: Coronary computed tomography angiography (CCTA) in SCOT-HEART led to increased preventive therapy for coronary artery disease (CAD). We hypothesized that atherosclerosis on CCTA would lead to greater preventive therapy changes compared to invasive coronary angiography (ICA). Methods: We studied 429 consecutive patients with available...

Introduction: Prior work demonstrates up to 50% of patients with acute coronary syndrome are malnourished, as evaluated by the Controlling Nutritional Status (CONUT) score. We investigated the prevalence of malnutrition in stable nonobstructive coronary artery disease (CAD) detected by coronary computed tomography angiography (CCTA) versus invasive...

Aims: Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes is unknown. Methods and results: In this post-hoc analysis, computed tomography (CT) images and 5-year clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary arter...

Objectives The aim of this meta-analysis was to assess the diagnostic performance of various CMR imaging parameters for evaluating acute cardiac transplant rejection. Background Endomyocardial biopsy is the current gold standard for detection of acute cardiac transplant rejection. Cardiac magnetic resonance (CMR) is uniquely capable of myocardial...

(246/250 words) Introduction The degree of stenosis on coronary CT angiography (CCTA) guides referral for CT-derived flow reserve (FFRct). We sought to assess whether semiquantitative assessment of high-risk plaque (HRP) features on CCTA improves selection of studies for FFRct over stenosis assessment alone. Methods Per-vessel FFRct was computed...

Thoracic aortic calcium(TAC) is an important marker of extra-coronary atherosclerosis with established predictive value for all-cause mortality. We sought to explore the predictive value of TAC for stroke mortality, independent of the more established coronary artery calcium(CAC) score. The CAC Consortium is a retrospectively assembled database of...

Aims Recovery of left ventricular ejection fraction (LVEF) after aortic valve replacement has prognostic importance in patients with aortic stenosis (AS). The mechanism by which myocardial fibrosis impacts LVEF recovery in AS is not well characterized. We sought to evaluate the predictive value of extracellular volume fraction (ECV) quantified by...

Introduction: Coronary inflammation may be a factor in developing heart failure with preserved ejection fraction (HFpEF). Epicardial fat volume (EFV) measured using non-contrast computed tomography (CT) and pericoronary adipose tissue (PCAT) attenuation on coronary CT angiography (CCTA) are considered to be inflammatory mediators, which play an imp...

Introduction: Sudden cardiac death (SCD) commonly presents as the initial manifestation of coronary heart disease in the general population. Coronary artery calcium (CAC), a sub-clinical marker of atherosclerosis, is a strong predictor of cardiovascular events. We assessed the ability of CAC to stratify risk of SCD. Methods: We studied 66,636 adult...

Introduction: Thoracic aortic calcium(TAC) is an important marker of extra-coronary atherosclerosis with known predictive value for all-cause mortality. We sought to explore the predictive value of TAC for stroke mortality, independent of the more established coronary artery calcium score. Methods: The Coronary Artery Calcium(CAC) Consortium is a r...

Objectives: We sought to assess characteristics of diffuse coronary artery calcium (CAC) phenotypes and their associations with cause-specific mortality. Background: CAC is a measure of subclinical atherosclerosis and improves risk stratification. CAC characteristics including vessel involvement, number of vessels, volume, and density have been sho...

Objectives: The association between extracellular volume (ECV) measured by computed tomography angiography (CTA) and clinical outcomes was evaluated in low-flow low-gradient (LFLG) aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR). Background: Patients with LFLG AS comprise a high-risk group with respect to c...

Background and aims Statins do not decrease coronary artery calcium (CAC) and may increase existing calcification or its density. Therefore, we examined the prognostic significance of CAC among statin users at the time of CAC scanning. Methods We included 28,025 patients (6151 statin-users) aged 40-75 years from the CAC Consortium. Cox regression...

Increase in left ventricular (LV) mass develops as a compensatory mechanism against pressure overload in aortic valve stenosis. However, long-standing LV geometrical changes are related to poor prognosis. The LV geometrical change occurs after transcatheter aortic valve replacement (TAVR). The present study aimed to investigate the relationship bet...

Background: CT coronary angiography (CTA) with Fractional Flow Reserve as determined by CT (FFRCT) is a safe alternative to invasive coronary angiography. A negative FFRCT has been shown to have low cardiac event rates compared to those with a positive FFRCT. However, the clinical utility of FFRCT according to age is not known. Methods: Patients...

The 2013 ACC/AHA guidelines resulted in broad recommendations for preventive statin therapy allocation among individuals without known cardiovascular disease (CVD). Subsequent studies demonstrated significant heterogeneity of atherosclerotic cardiovascular disease (ASCVD) risk across the primary prevention population. In 2018/2019, the guidelines w...

Background Bicuspid aortic stenosis accounts for almost 50% of patients undergoing surgical aortic valve replacement in the younger patients. Expanding the indication of transcatheter aortic valve replacement (TAVR) toward lower-risk and younger populations will lead to increased use of TAVR for patients with bicuspid aortic valve (BAV) stenosis de...

Background: 18F-Sodium fluoride (18F-NaF) positron emission tomography (PET) provides an assessment of active calcification (microcalcification) across a wide range of cardiovascular conditions including coronary artery disease, carotid and penile atherosclerosis, aortic and mitral valve disease, and abdominal aortic aneurysms. To date the signific...

Objectives This study is to determine the management and clinical outcomes of patients investigated with coronary computed tomography angiography (CCTA)–derived fractional flow reserve (FFRCT) according to sex. Background Women are underdiagnosed with conventional ischemia testing, have lower rates of obstructive coronary artery disease (CAD) at i...

Background To evaluate the impact of respiratory-averaged computed tomography attenuation correction (RACTAC) compared to standard single-phase computed tomography attenuation correction (CTAC) map, on the quantitative measures of coronary atherosclerotic lesions of 18F-sodium fluoride (18F-NaF) uptake in hybrid positron emission tomography and com...

Background. Echocardiographic texture analysis using the signal intensity coefficient (SIC) can identify fibrosis−associated microstructural changes. This approach has not been tested in immune−inflammatory disease states such as myocarditis or transplant rejection. Methods. Retrospective pilot analysis using the SIC was performed in populations in...

Epicardial adipose tissue (EAT) is associated with the development of atrial fibrillation (AF). EAT thickness identified on transthoracic echocardiography (TTE). The relationship between EAT volume and left atrial appendage (LAA) function is not well-known. We aimed to investigate the associations between EAT thickness and LAA emptying flow velocit...

Background and aims We sought to understand the risk factor correlates of very early coronary artery calcium (CAC), and the potential investigational value of CAC phenotyping in adults aged 20–30 years. Methods We studied all participants aged 20–30 years at baseline (N = 373) in the Coronary Artery Calcium Consortium, a large multi-center cohort...

Objectives: This study designed and evaluated an end-to-end deep learning solution for cardiac segmentation and quantification. Background: Segmentation of cardiac structures from coronary computed tomography angiography (CCTA) images is laborious. We designed an end-to-end deep-learning solution. Methods: Scans were obtained from multicenter...

There has been an evolutionary leap in single photon emission computed tomography (SPECT) imaging with the advent of camera systems which utilize solid-state crystals and novel collimator designs configured specifically for cardiac imaging. Solid-state SPECT camera systems have facilitated dramatic reductions in both imaging time and radiation dose...

Aims: Women with evidence of ischaemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD). Although invasively measured coronary flow reserve (CFR) is useful for the diagnosis of CMD, intermediate CFR values are often found of uncertain significance. We investigated myocardial flow reserve and le...

Background Coronary artery fractional flow reserve (FFR) derived from CT angiography (FFTCT) enables functional assessment of coronary stenosis. Prior clinical trials showed 13%-33% of coronary CT angiography studies had insufficient quality for quantitative analysis with FFRCT. Purpose To determine the rejection rate of FFRCT analysis and to deter...

Background: In women with evidence of ischemia and no obstructive coronary artery disease the underlying mechanism is most often attributed to coronary microvascular dysfunction. Higher rates of adverse cardiovascular events, specifically heart failure with preserved ejection fraction, are present in women with coronary microvascular dysfunction,...

Background and aims: LDL-C reduction has been associated with a decrease in noncalcified plaque (NCP) by serial quantitative coronary CT angiography (CTA). We evaluated the effect of LDL-C reduction on specific components of noncalcified plaque (NCP). Methods: We analyzed 154 patients undergoing serial CTAs (118 men, 60 ± 10 years, interval 4 ±...

Background: Coronary computed tomography angiography (CTA) allows quantification of stenosis. However, such quantitative analysis is not part of clinical routine. We evaluated the feasibility of utilizing deep learning for quantifying coronary artery disease from CTA. Methods: A total of 716 diseased segments in 156 patients (66 ± 10 years) who...

Background Women with ischemia and no obstructive coronary artery disease (INOCA) have increased risk of major adverse cardiac events, including heart failure with preserved ejection fraction (HFpEF). To investigate how INOCA may progress to HFpEF we examined pathophysiological findings present in both INOCA and HFpEF. Methods We performed adenosi...

Background: While statins reduce the relative risk for MACE by ~30%, significant residual risk remains. We explored the association of clinical, laboratory and coronary atherosclerotic predictors with statin non-response. Methods: The multi-center PARADIGM registry included 2,252 patients who underwent serial CCTA >2 years apart, with 17-segment co...

Background Transient ischemic dilatation (TID) has been associated with the presence of severe coronary artery disease (CAD). However, its prognostic significance has been questioned in patients with normal perfusion. We assessed the association between TID and major adverse cardiovascular events (MACE) in patients without ischemia and the lower ri...

Background Bioprosthetic aortic valve degeneration is increasingly common, often unheralded, and can have catastrophic consequences. Objectives The authors sought to assess whether ¹⁸F-fluoride positron emission tomography (PET)-computed tomography (CT) can detect bioprosthetic aortic valve degeneration and predict valve dysfunction. Methods Expl...