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Echocardiography. 2021:38(5):798-804.DOI: 10.1111/echo.15021

Two cases of acute endocarditis misdiagnosed as COVID-19 infection

Hayes, Dena E; Rhee, David W; Hisamoto, Kazuhiro; Smith, Deane; Ro, Richard; Vainrib, Alan F; Bamira, Daniel; Zhou, Fang; Saric, Muhamed
The COVID-19 pandemic has presented countless new challenges for healthcare providers including the challenge of differentiating COVID-19 infection from other diseases. COVID-19 infection and acute endocarditis may present similarly, both with shortness of breath and vital sign abnormalities, yet they require very different treatments. Here, we present two cases in which life-threatening acute endocarditis was initially misdiagnosed as COVID-19 infection during the height of the pandemic in New York City. The first was a case of Klebsiella pneumoniae mitral valve endocarditis leading to papillary muscle rupture and severe mitral regurgitation, and the second a case of Streptococcus mitis aortic valve endocarditis with heart failure due to severe aortic regurgitation. These cases highlight the importance of careful clinical reasoning and demonstrate how cognitive errors may impact clinical reasoning. They also underscore the limitations of real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 testing and illustrate the ways in which difficulty interpreting results may also influence clinical reasoning. Accurate diagnosis of acute endocarditis is critical given that surgical intervention can be lifesaving in unstable patients.
PMID: 33715241
ISSN: 1540-8175
CID: 4817282
Critical care medicine. 2021:49(8):1285-1292.DOI: 10.1097/CCM.0000000000004940

Assessing Competence in Critical Care Echocardiography: Development and Initial Results of an Examination and Certification Processes

Panebianco, Nova L; Mayo, Paul H; Arntfield, Robert T; Brown, Sam M; Diaz-Gomez, Jose; Hernandez, Antonio; Koenig, Seth J; Noble, Vicki; Sekiguchi, Hiroshi; Subhiyah, Raja G; Mulvagh, Sharon; Saric, Muhamed; Troianos, Christopher A; Labovitz, Arthur J
OBJECTIVES/OBJECTIVE:To describe the development and initial results of an examination and certification process assessing competence in critical care echocardiography. DESIGN/METHODS:A test writing committee of content experts from eight professional societies invested in critical care echocardiography was convened, with the Executive Director representing the National Board of Echocardiography. Using an examination content outline, the writing committee was assigned topics relevant to their areas of expertise. The examination items underwent extensive review, editing, and discussion in several face-to-face meetings supervised by National Board of Medical Examiners editors and psychometricians. A separate certification committee was tasked with establishing criteria required to achieve National Board of Echocardiography certification in critical care echocardiography through detailed review of required supporting material submitted by candidates seeking to fulfill these criteria. SETTING/METHODS:The writing committee met twice a year in person at the National Board of Medical Examiner office in Philadelphia, PA. SUBJECTS/METHODS:Physicians enrolled in the examination of Special Competence in Critical Care Electrocardiography (CCEeXAM). MEASUREMENTS AND MAIN RESULTS/RESULTS:A total of 524 physicians sat for the examination, and 426 (81.3%) achieved a passing score. Of the examinees, 41% were anesthesiology trained, 33.2% had pulmonary/critical care background, and the majority had graduated training within the 10 years (91.6%). Most candidates work full-time at an academic hospital (46.9%). CONCLUSIONS:The CCEeXAM is designed to assess a knowledge base that is shared with echocardiologists in addition to that which is unique to critical care. The National Board of Echocardiography certification establishes that the physician has achieved the ability to independently perform and interpret critical care echocardiography at a standard recognized by critical care professional societies encompassing a wide spectrum of backgrounds. The interest shown and the success achieved on the CCEeXAM by practitioners of critical care echocardiography support the standards set by the National Board of Echocardiography for testamur status and certification in this imaging specialty area.
PMID: 33730745
ISSN: 1530-0293
CID: 4817862
Journal of clinical ultrasound. 2021:49(7):644-649.DOI: 10.1002/jcu.23002

Aortic closure signal length on doppler echocardiography differentiates aortic patient-prosthesis mismatch from prosthetic stenosis

Ali, Thara; Garshick, Michael S; Saric, Muhamed; Skolnick, Adam H
PURPOSE/OBJECTIVE:The purpose of this study was to investigate the diagnostic potential of the aortic closure (A2) signal length on Doppler echocardiography in distinguishing aortic patient-prosthesis mismatch (PPM) from prosthetic stenosis among patients with elevated gradients over bioprosthetic valves. METHODS:The A2 signal length was retrospectively measured for 150 patients with bioprosthetic aortic valves (50 with PPM, 50 with prosthetic stenosis, and 50 with normally functioning valves) from transthoracic echocardiograms performed at NYU Langone Health between 01/01/2012 and 08/01/2018. RESULTS:Mean A2 signal length was shorter among patients with PPM (11.1 ms ± 5.2 ms), than among those with prosthetic stenosis (21.1 ms ± 6.0 ms), P < .001 and controls (21.7 ms ± 7.4 ms), P < .001. There was no difference in A2 signal length between prosthetic stenosis and controls. The A2 signal length yielded an AUC of 0.89 (95% CI 0.82-0.95) for predicting PPM over prosthetic stenosis. CONCLUSION/CONCLUSIONS:Among patients with bioprosthetic aortic valves, the length of the A2 signal on Doppler echocardiography is shorter in PPM than in prosthetic stenosis and normally functioning valves. The A2 signal length may represent a novel metric to distinguish PPM from prosthetic stenosis.
PMID: 33665868
ISSN: 1097-0096
CID: 4800372
JACC: Cardiovascular interventions. 2021:14(9):1050-1052.DOI: 10.1016/j.jcin.2020.12.023

Novel Computed Tomography Classification for Bioprosthetic Aortic Valve Degeneration: Guiding Trial of Anticoagulation or Reintervention [Letter]

Nakashima, Makoto; Williams, Mathew; He, Yuxin; Du, Run; Saric, Muhamed; Staniloae, Cezar; Querijero, Michael; Pushkar, Illya; Kapitman, Anna; Jilaihawi, Hasan
PMID: 33640385
ISSN: 1876-7605
CID: 4800972
Echocardiography. 2021:38(3):446-449.DOI: 10.1111/echo.14996

Point-of-care ultrasound during the COVID-19 pandemic: A multidisciplinary approach between intensivists and echocardiographers

Yuriditsky, Eugene; Saric, Muhamed; Horowitz, James M
PURPOSE/OBJECTIVE:The coronavirus disease-2019 (COVID-19) led to a large influx of critically ill patients and altered echocardiography laboratory workflow. We developed a point-of-care ultrasound (POCUS) first approach to patients requiring echocardiography and describe our workflow and findings. METHODS:We performed a single-center retrospective analysis of all POCUS studies performed on critically ill patients with COVID-19. Sonography was performed by intensivists, uploaded and archived, and rapidly reviewed by echocardiographers. We evaluated each study based on the number of views obtained. Additionally, we provide a description of the workflow during the COVID-19 surge at a tertiary care hospital in New York City. RESULTS:Fifty patients had POCUS studies performed by intensivists and reviewed by echocardiographers obviating the need for sonographer-performed studies. Of the 48 cardiac POCUS studies, 17% of patients had 4 of 4 standard views available while 53% had 3 of 4 standard views. The parasternal long-axis view was obtained on 81%, subxiphoid view on 79%, apical 4-chamber view on 71%, and parasternal short-axis view on 63% of patients. CONCLUSIONS:Our POCUS workflow allowed intensivists to perform cardiac sonography for rapid bedside diagnosis of pathology with immediate interpretation performed by echocardiographers. At least 3 views were obtained in the majority of cases.
PMID: 33586797
ISSN: 1540-8175
CID: 4786452
CASE : cardiovascular imaging case reports. 2021:5(3):143-146.DOI: 10.1016/j.case.2020.12.003

Clot in Transit in a Patient with COVID-19: Transesophageal Echocardiographic Guidance of Mechanical Cardiopulmonary Resuscitation [Case Report]

Horowitz, James M; Yuriditsky, Eugene; Bakker, Jan; Magda, Gabriela; Teran, Felipe; Saric, Muhamed
•COVID-19 infection is associated with a prothrombotic state•Point of care ultrasound (POCUS) provides prompt bedside diagnosis of covid-19 complications such as clot in transit•Bedside TEE guidance of mechanical CPR arm placement improves the efficiency of chest compressions.
PMCID:7816862
PMID: 33495743
ISSN: 2468-6441
CID: 4767072
Catheterization & cardiovascular interventions. 2021:98(2):319-327.DOI: 10.1002/ccd.29378

Long-term outcomes after transcatheter aortic valve replacement with minimal contrast in chronic kidney disease

Rzucidlo, Justyna; Jaspan, Vita; Paone, Darien; Jilaihawi, Hasan; Xia, Yuhe; Kapitman, Anna; Nakashima, Makoto; He, Yuxin; Ibrahim, Homam; Pushkar, Illya; Neuburger, Peter J; Saric, Muhamed; Bamira, Daniel; Paschke, Sonja; Kalish, Chloe; Staniloae, Cezar; Shah, Binita; Williams, Mathew
BACKGROUND:Patients with renal insufficiency have poor short-term outcomes after transcatheter aortic valve replacement (TAVR). METHODS:Retrospective chart review identified 575 consecutive patients not on hemodialysis who underwent TAVR between September 2014 and January 2017. Outcomes were defined by VARC-2 criteria. Primary outcome of all-cause mortality was evaluated at a median follow-up of 811 days (interquartile range 125-1,151). RESULTS:Preprocedural glomerular filtration rate (GFR) was ≥60 ml/min in 51.7%, 30-60 ml/min in 42.1%, and < 30 ml/min in 6.3%. Use of transfemoral access (98.8%) and achieved device success (91.0%) did not differ among groups, but less contrast was used with lower GFR (23 ml [15-33], 24 ml [14-33], 13 ml [8-20]; p < .001). Peri-procedural stroke (0.7%, 2.1%, 11.1%; p < .001) was higher with lower GFR. Core lab analysis of preprocedural computed tomography scans of patients who developed a peri-procedural stroke identified potential anatomic substrate for stroke in three out of four patients with GFR 30-60 ml/min and all three with GFR <30 ml/min (severe atheroma was the most common subtype of anatomical substrate present). Compared to GFR ≥60 ml/min, all-cause mortality was higher with GFR 30-60 ml/min (HR 1.61 [1.00-2.59]; aHR 1.61 [0.91-2.83]) and GFR <30 ml/min (HR 2.41 [1.06-5.48]; aHR 2.34 [0.90-6.09]) but not significant after multivariable adjustment. Follow-up echocardiographic data, available in 63%, demonstrated no difference in structural heart valve deterioration over time among groups. CONCLUSIONS:Patients with baseline renal insufficiency remain a challenging population with poor long-term outcomes despite procedural optimization with a transfemoral-first and an extremely low-contrast approach.
PMID: 33180381
ISSN: 1522-726x
CID: 4665422
Journal of the American Society of Echocardiography. 2021:34(1):89-96.DOI: 10.1016/j.echo.2020.08.019

Three-Dimensional Imaging and Dynamic Modeling of Systolic Anterior Motion of the Mitral Valve

Vainrib, Alan; Massera, Daniele; Sherrid, Mark V; Swistel, Daniel G; Bamira, Daniel; Ibrahim, Homam; Staniloae, Cezar; Williams, Mathew R; Saric, Muhamed
Left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM) is often caused by systolic anterior motion (SAM) of the mitral valve caused by the interplay between increased left ventricular (LV) wall thickness and an abnormal mitral valve anatomy and geometry. Three-dimensional (3D) echocardiographic imaging of the mitral valve has revolutionized the practice of cardiology, paving the way for new methods to see and treat valvular heart disease. Here we present the novel and incremental value of 3D transesophageal echocardiography (TEE) of SAM visualization. This review first provides step-by-step instructions on acquiring and optimizing 3D TEE imaging of SAM. It then describes the unique and novel findings using standard 3D TEE rendering as well as dynamic mitral valve modeling of SAM from 3D data sets, which can provide a more detailed visualization of SAM features. The findings include double-orifice LVOT caused by the residual leaflet, the dolphin smile phenomenon, and delineation of SAM width. Finally, the review discusses the essential role of 3D TEE imaging for preprocedural assessment and intraprocedural guidance of surgical and novel percutaneous treatments of SAM.
PMID: 33059963
ISSN: 1097-6795
CID: 4641632
JACC: Cardiovascular imaging. 2021:14(1):3-21.DOI: 10.1016/j.jcmg.2019.06.032

Imaging for Patient's Selection and Guidance of LAA and ASD Percutaneous and Surgical Closure

Faletra, Francesco F; Saric, Muhamed; Saw, Jacqueline; Lempereur, Mathieu; Hanke, Thoesten; Vannan, Mani A
This review comprises 2 main subjects: the percutaneous and surgical closure of the left atrial appendage (LAA) and atrial septal defect (ASD). The aim of the authors was to provide a detailed description of: 1) anatomy of LAA, normal interatrial septum, and the various types of ASD as revealed by noninvasive imaging techniques; 2) preprocedure planning of secundum ASD and LAA percutaneous closure; 3) key steps of the procedural guidance emphasizing the role of 2-dimensional/3-dimensional transesophageal echocardiography; and 4) surgical closure of LAA and ASD.
PMID: 32682721
ISSN: 1876-7591
CID: 4531792
New England journal of medicine. 2020:382(15):1395-1407.DOI: 10.1056/NEJMoa1915922

Initial Invasive or Conservative Strategy for Stable Coronary Disease

Maron, David J; Hochman, Judith S; Reynolds, Harmony R; Bangalore, Sripal; O'Brien, Sean M; Boden, William E; Chaitman, Bernard R; Senior, Roxy; López-Sendón, Jose; Alexander, Karen P; Lopes, Renato D; Shaw, Leslee J; Berger, Jeffrey S; Newman, Jonathan D; Sidhu, Mandeep S; Goodman, Shaun G; Ruzyllo, Witold; Gosselin, Gilbert; Maggioni, Aldo P; White, Harvey D; Bhargava, Balram; Min, James K; Mancini, G B John; Berman, Daniel S; Picard, Michael H; Kwong, Raymond Y; Ali, Ziad A; Mark, Daniel B; Spertus, John A; Krishnan, Mangalath N; Elghamaz, Ahmed; Moorthy, Nagaraja; Hueb, Whady A; Demkow, Marcin; Mavromatis, Kreton; Bockeria, Olga; Peteiro, Jesus; Miller, Todd D; Szwed, Hanna; Doerr, Rolf; Keltai, Matyas; Selvanayagam, Joseph B; Steg, P Gabriel; Held, Claes; Kohsaka, Shun; Mavromichalis, Stavroula; Kirby, Ruth; Jeffries, Neal O; Harrell, Frank E; Rockhold, Frank W; Broderick, Samuel; Ferguson, T Bruce; Williams, David O; Harrington, Robert A; Stone, Gregg W; Rosenberg, Yves; Ricci, Joseph; Tello Montoliu, A; Robero Aniorte, A I; Mulder, Abbey; Laddu, Abhay A; Goyal, Abhinav; Dubey, Abhishek; Goyal, Abhishek; Knighton, Abigail; Oomman, Abraham; Jaskowiak, Adam J; Kolodziej, Adam; Witkowski, Adam; Hameed, Adnan; Anesini, Adriana; Hussain, Afshan; Juceviciene, Agne; Urboniene, Agne; Jakal, Agnes; Szramowska, Agnieszka; Khairuddin, Ahmad; Abdel-Latif, Ahmed; Adel, Ahmed; Aljzeeri, Ahmed; Kamal, Ahmed; Talaat, Ahmed; Mann, Aimee; Contreras, Aira; Kumar, Ajit; Kumar, V K; Furukawa, Akemi; Bagai, Akshay; Smigelskaite, Akvile; Furber, Alain; Rheault, Alain; Loehr, Alaine Melanie; Rosen, Alan; Varga, Albert; Qelaj, Albertina; Barioli, Alberto; Russo, Aldo; Moorman, Alec; Gisbert, Alejandro; Fratczak, Aleksandra; Laucevicius, Aleksandras; Kuleshova, Alena; Sionis, Alessandro; Sirker, Alexander A; Chernyavskiy, Alexander M; Craft, Alexandra; Vazquez, Alexandra; Ciappina Hueb, Alexandre; Colafranseschi, Alexandre S; Schaan de Quadros, Alexandre; Tognon, Alexandre; Alghamdi, Ali; Manica Muller, Alice; Nogueira Rabaça, Aline; Peixoto Deiro, Aline; Hallam, Alison; Stone, Allegra; Schley, Allison; Castro, Almudena; Rabelo Ales, Alvaro; Germann, Amanda; O'Malley, Amanda; Uxa, Amar; Ojajuni, Amarachi; Oliveira, Amarino C Jr; Hull, Amber B; Roy, Ambuj; Zarka, Amer; Janmohamed, Amir; Brown, Ammani; Malinay, Ammy; Martinez Monzonis, Amparo; Richards, Amy J; Iskandrian, Amy; Ollinger, Amy; Djordjevic-Dikic, Ana D; Fernández Martínez, Ana; Gomes Almeida, Ana; Batista, Ana Paula; Francisco, Ana Rita; Mladenovic, Ana S; Santana, Ana; Siddiqui, Anam; Kuzmina-Krutetskaya, Anastasia M; Vertes, Andras; Sousa, Andre S; Gabriel, Andre; Schmidt, André; Lundeen, Andrea M; Bartykowszki, Andrea; Lorimer, Andrea; Mortara, Andrea; Pascual, Andrea; Coelho, Andreia; Rocha, Andreia; García-Rincón, Andrés; Howarth, Andrew G; Moriarty, Andrew J; Docherty, Andrew; Starovoytov, Andrew; Zurick, Andrew; Łabyk, Andrzej; Swiatkowski, Andrzej; Lam, Andy; Kawakami, Anelise; Hoye, Angela; Kim, Angela; Smit, Angelique; Nobre, Angelo; Shah, Anil V; Ljubez, Anja; Anand, Anjali; Sachdeva, Ankush; Greenberg, Ann; Luyten, Ann; Ostrander, Ann; Di Donato, Anna; Cichocka-Radwan, Anna; Fojt, Anna; Plachcinska, Anna; Proietti, Anna; Teresinska, Anna; Webb, Anne Marie; Cartwright, Anne; Heath, Anne; Mackin, Anne; Amaritakomol, Anong; Chaiyasri, Anong; Chauhan, Anoop; Mathew, Anoop; Gemignani, Anthony; Andres, Anto Luigi; Vega, Antonia; Hansen, Antonietta; Iglesias, Antonino Ginel; Carvalho, Antonio Carlos; Di Chiara, Antonio; Serra Peñaranda, Antonio; Carvalho, Antonio; Colombo, Antonio; Fiarresga, Antonio; Rao, Anupama; Valdespino-Estrada, Aquiles; Boan, Araceli; Ishani, Areef; Diaz, Ariel; Ghosh, Arijit; Prommintikul, Arintaya; Roberts, Arline; Seto, Arnold H; Good, Arnold P; Quyyumi, Arshed; Labovitz, Arthur J; Kerner, Arthur; Campos-Santaolalla, Arturo S; Misra, Arunima; Mukherjee, Ashok; Seth, Ashok; Seedhom, Ashraf; Cheema, Asim N; Ahmed, Asker; Mathur, Atul; Verma, Atul; Leong, Audrey W; Ã…kerblom, Axel; Fuentes, Axelle; Naher, Aynun; Valaiyapathi, Badhma; Kaur, Baljeet; Guruge, Bandula; BrzeziÅ„ska, Barbara; Nardi, Barbara; Czarniak, Bartosz; Singh, Bebek; Igual, Begoña; Merkely, Bela; Alvarez, Belen Cid; Spooner, Benjamin J; Chow, Benjamin J W; Cheong, Benjamin; Shah, Benoy N; de Bruyne, Bernard; Valecka, Bernardas; Jäger, Bernhard; Archer, Beth A; Abramson, Beth; Jorgenson, Beth; Harvey, Bethany; O'Neal, Betsy; Atkinson, Bev; Bozek, Bev; Lang, Bevin; Sasidharan, Bijulal; Yang, Bin; Zhang, Bin; Kurian, Binoy Mannekkattukudy; Goebel, Bjoern; Hu, Bob; Popescu, Bogdan A; Crnokrak, Bogdan; Zhu, Bolin; Kirby, Bonnie J; Zimbelman, Brandi D; Starks, Brandy; Beleslin, Branko D; Hart, Brenda; Shapiro, Brian P; McCandless, Brian; Wisniewski, Brianna; Smith, Brigham R; Mirrer, Brooks; McManus, Bruce; Rutkin, Bruce; Paulino, Bruna Edilena; Ascoli, Bruna Maria; Smith, Bryn; Allen, Byron J; Gibson, C Michael; Bairey Merz, C Noel; Pop, Calin; Hague, Cameron; Thais de Ormundo, Camila; Gopaul, Candace; Edillo, Candice P; Polanczyk, Carísi A; Krannila, Carita; Vicente, Carla; Gagné, Carl-Éric; Briguori, Carlo; Peña Gil, Carlos; Alvarez, Carlos; Ohmart, Carly; Beladan, Carmen C; Ginghina, Carmen; Kartje, Carol M; Alsweiler, Caroline; Brown, Caroline; Callison, Caroline; Pinheiro, Caroline; Rodgers, Caroline; Spindler, Caroline; Corbett, Carolyn; Drum, Carrie; Riedberger, Casey; Bone, Catherine; Fleming, Catherine; Gordon, Catherine; Jahrsdorfer, Catherine; Lemay, Catherine; Weick, Catherine; Patten, Cathrine; Goletto, Cecilia; Kepka, Cezary; Suvarna, Chandini; Xu, Chang; Mercure, Chantale; Viljoen, Charle A; Wiyarand, Charlene; Jia-Yin Hou, Charles; Lui, Charles Y; Cannan, Charles; Cornet, Charles; Pirro, Charlotte; Rimsukcharoenchai, Chataroon; Wang, Chen; Tsai, Cheng-Ting; Chien, Chen-Yen; Allardyce, Cheryl A; Hedgepeth, Chester M; Patel, Chetan; Attanasio, Chiara; Yen, Chih-Hsuan; Chow, Chi-Ming; Er, Ching Min; Ong, Ching-Ching; Manjunath, Cholenahally Nanjappa; Beck, Chris; Buller, Chris; Vassaliere, Christel; Hamm, Christian; Caldeira, Christiano; Ballantyne, Christie; Björklund, Christina; Hinton, Christine R; Bergeron, Christine; Masson, Christine; Roraff, Christine; Shelley, Christine; Laure, Christophe; Thuaire, Christophe; Kinsey, Christopher; McFarren, Christopher; Spizzieri, Christopher; Travill, Christopher; Liu, Chun-Chieh; Hung, Chung-Lieh; Li, Chunguang; Yun, Chun-Ho; Xia, Chunli; Heard, Ciarra; Schultz, Cidney; Venn-Edmonds, Clare; Hochberg, Claudia P; Wegmayr, Claudia; Cortés, Claudia; Escobar, Claudia; Freixo, Cláudia; Mesquita, Claudio T; Kadalie, Clemens T; Berry, Colin; Philander, Constance; Thobois, Corine; Costantini, Costantino; Page, Courtney; Atkinson, Craig; Barr, Craig; Paterson, Craig; Bare, Cristina; Baumann, Cynthia; Burman, Cynthia; Espinosa, Dalisa; Collison, Damien; Deleanu, Dan; Elian, Dan; Gao, Dan; Oliver, Dana; Vezina, Daniel P; O'Rourke, Daniel; Komar, Daniele; Schade, Danielle; Francis, Darrel P; Malaev, Dastan; Bull, David A; Winchester, David E; Faxon, David P; Booth, David; Cohen, David; DeMets, David; Foo, David; Schlichting, David; Taggart, David; Waters, David; Wohns, David; Vo, Davis; Teodorczyk, Dawid; Shelstad, Dawn; Turnbull, Dawn; Li, Dayuan; Kereiakes, Dean; O'Neill, Deborah; Yip, Deborah; Johnson, Debra K; Dees, Debra; Bhatt, Deepak L; Gopal, Deepika; Kumar, Deepti; Mattina, Deirdre; Murphy, Deirdre; Small, Delano R; Rose, Delsa K; Jiang, Dengke; Phaneuf, Denis Carl; Braganza, Denise; Fine, Denise; Cyr, Derek; Tobin, Desiree; Cukali, Diana; Parra, Diana; Camara, Diane; Minshall Liu, Diane; Vences, Diego Adrián; Franca de Cunha, Diego; Stournaras, Dimitrios; Patel, Dipti; Li, Dongze; Exley, Donna; Grahl, Dorit; Stanojevic, Dragana; Cacela, Duarte; Conway, Dwayne S G; Bermudez, E Pinar; Punnoose, Eapen; Tay, Edgar L; Karanjah, Edgar; Verna, Edoardo; Hernandez-Rangel, Eduardo; Nicol, Edward D; McFalls, Edward O; Martin, Edward T; Kaczmarska, Edyta; Lubinskaya, Ekaterina I; Demchenko, Elena A; Refoyo Salicio, Elena; Feen, Eli; Durán-Cortés, Elihú; Janzen, Elisabeth M; Hannemann, Elise L; Dongen, Elise van; Piloto, Elissa Restelli; Kaplan, Eliza; Srbinovska Kostovska, Elizabeta; Capasso-Gulve, Elizabeth; Congdon, Elizabeth; Ferguson, Elizabeth; Zbyshevskaya, Elizaveta V; Magedanz, Ellen; Fridell, Ellie; Lader, Ellis W; Kedhi, Elvin; Racca, Emanuela; Tachot, Emilie; DeRosa, Emily; Alonso-Álvarez, Encarnación; Nicollet, Eric; Peterson, Eric; Rosas, Erick Alexánderson; Morales, Erick Donato; Orvis, Erin; Moga, Ermina; Montpetit, Estelle; Figueiredo, Estevao; Passamani, Eugene; Nikolsky, Eugenia; Yeoh, Eunice; Kretov, Evgeniy I; Szczerba, Ewa; Wojtala, Ewelina; Ribeiro Silva, Expedito Eustáquio; Ortuño, F Marin; Farias, Fabio R; Fimiani, Fabio; Rolfo, Fabrizio; Yu, Fa-Chang; Hage, Fadi; Matar, Fadi; Haider Jafary, Fahim; Feng, Fang; Liu, Fang; Ranjbaran, Fatima; Rodriguez, Fatima; Pinto, Fausto J; Rashid, Fauzia; Ramani, Federica; Wang, Fei; Igansi, Fernanda; Silva, Filipa; Ottani, Filippo; Haines, Fiona; Al Solaiman, Firas; Egydio, Flávia; Lyra, Flavio; Egger, Florian; Farquharson, Fran; Laube, Frances; Carreras Costa, Francesc; de Micco, Francesca; Bianchini, Francesca; Pezzetta, Francesca; Pietrucci, Francesca; Orso, Francesco; Pisano, Francesco; Burt, Francis; Patuleia Figueiras, Francisca; Fernandez-Aviles, Francisco; Mongeon, Francois Pierre; Van de Werf, Frans; Guenther, Franziska; Witherow, Fraser N; Mohr, Fred; Dall'Orto, Frederico; Otsuka, Fumiyuki; De La Morena, G; Karthikeyan, G; Dekany, Gabor; Kerecsen, Gabor; Galeote, Gabriel; Grossmann, Gabriel; Vorobiof, Gabriel; Sanchez de Souza, Gabriela; Guzman, Gabriela; Zeballos, Gabriela; Gabrielli, Gabriele; Jakl-Kotauschek, Gabriele; Shammas, Gail A; Brandt, Gail; Chen, Gang; Lane, Gary E; Luckasen, Gary J; Sharma, Gautam; Mikolaitiene, Gelmina; Yee, Gennie; Nickenig, Georg; Revtyak, George E; Juang, George J; Fletcher, Gerald; Leonard, Gerald; Devlin, Gerard Patrick; Esposito, Gerard; Ágoston, Gergely; Lamas, Gervasio; Fontos, Geza; Mikhail, Ghada; Cobb, Gia; Perna, Gian Piero; Leone, Gianpiero; Roditi, Giles; Barone-Rochette, Gilles; Mishra, Girish; Tarantini, Giuseppe; Wong, Glenda; Hamroff, Glenn S; Rayos, Glenn; Cheng, Gong; Barge-Caballero, Gonzalo; Davidović, Goran; Stankovic, Goran; Stevanovic, Gordana; Jingyan Wang, Grace; Young, Grace M; Wayser, Graceanne; Scaro, Graciela; Hillis, Graham S; Wong, Graham; Szulczyk, Grazyna Anna; Simonis, Gregor; Kumkumian, Gregory; Peichel, Gretchen Ann; Gajos, Grzegorz; Steinmaurer, Gudrun; Rucatti, Guilherme G; Portugal, Guilherme; Cantinho Lopes, Guilhermina; Pons Lladó, Guillem; Frostfelt, Gunnar; Wander, Gurpreet S; Gulati, Gurpreet; Pucci, Gustavo; Abd Hadi, Hafidz; Zhang, Haibo; Wang, Haitao; Marciniak, Halina; Chen, Han; Kerr, Hanan; Najm, Hani; Douglas, Hanna; Phillips, Hannah; Dai, Hao; Dong, Haojian; Jamil, Haqeel; Sivadasanpillai, Harikrishnan; Suryapranata, Harry; Reda, Hassan; Pomeroy, Hayley; Barrentine, Heather; Golden, Heather; Hurlburt, Heather; Wilson, Heidi; Tucker, Helen C; Abergel, Helene; Siddaram, Hemalata; Osseni, Hermine; Schuchlenz, Herwig; Zeng, Hesong; Skali, Hicham; Solomon, Hilda; Horton, Hollie; Hetrick, Holly; Little, Holly; Park, Holly; Chi, Hongjie; Mahrous, Hossam; Levite, Howard A; Pejkov, Hristo; Li, Huajun; Bloise-Adames, Hugo; Marques, Hugo; Zhong, Hui; Zhang, Hui-Min; Hashim, Humayrah; Yeh, Hung-I; El Fishawy, Hussien; Webb, Ian; Kullo, Iftikhar; Grazhdankin, Igor O; Hamzeh, Ihab; Hassan, Ikraam; Ueda, Ikuko; Pina, Ileana L; Tamasauskiene, Ilona; Bouwhuis, Ilse; Arif, Imran; Wenzelburger, Ina; Zimbarra Cabrita, Inês; Rodrigues, Ines; Robbins, Inga H; Soveri, Inga; Schnittger, Ingela; Karimullah, Iqbal; Dauber, Ira M; Rehman, Iram; Peovska Mitevska, Irena; Marthe Lang, Irene; Subbotina, Irina; Kalibataite-Rutkauskiene, Irma; Yusnida, Irni; Carvajal, Isabel Estela; Palazzo, Isabella C; Hogan, Isabelle; Roy, Isabelle; Syed, Ishba; Tejani, Ishita; Naryshkin, Ivan A; Jankovic, Ivana; Niedzwiecka, Iwona; Knight, J David; Kusmierek, Jacek; White, Jackie M; Chow, Jackie; Udell, Jacob; Tamis-Holland, Jacqueline E; Fannon, Jacqueline; Quin, Jacquelyn A; Do, Jacquelyn; Heo, Jaekyeong; Maksym, Jakub; Davies, James E; O'Keefe, James H Jr; Jang, James J; Cha, James; Harrison, James; Hirsch, James; Stafford, James; Tatoulis, James; Rankin, Jamie; Henzel, Jan; Orga, Jan; Tancredi, Jana; Oliveira, Janaina; Burton, Jane; Eckstein, Jane; Marucci, Jane; Knight, Janet P; Blount, Janet; Halliday, Janet; Kourzenkova, Janetta; Raj, Janitha; Sinning, Jan-Malte; Pozzibon, Jaqueline; Drozdz, Jaroslaw; Karwowski, Jaroslaw; Glover, Jason D; Kwok, Jason Loh; Call, Jason T; Linefsky, Jason; Gomes, Jassira; Anumpa, Jati; Garcia, Javier J; Courtis, Javier; Meisner, Jay; Jayakumar, K; Scales, Jayne; Denaro, Jean E; Juliard, Jean Michel; Ho, Jean; Stansborough, Jeanette K; Juliard, Jean-Michel; Russo, Jeanne; Schoep, Jeannette J M; Thambyrajah, Jeet; Leimberger, Jeff; Breall, Jeffery A; Kohn, Jeffrey A; Milliken, Jeffrey C; Anderson, Jeffrey; Blume, Jeffrey; Kanters, Jeffrey; Lorin, Jeffrey; Moses, Jeffrey; Stepanovic, Jelena J; Celutkiene, Jelena; Djokic, Jelena; Stojkovic, Jelena; Jose, Jenne M; Manchery, Jenne; Mull, Jennifer A; Czerniak, Jennifer H; Stanford, Jennifer L; Gillis, Jennifer; Horst, Jennifer; Isaacs, Jennifer; Langdon, Jennifer; Thomson, Jennifer; Tomfohr, Jennifer; White, Jennifer; Kuo, Jen-Yuan; Rautureau, Jeremy; Fleg, Jerome; Berg, Jessica; Rodriguez, Jessica; Waldron, Jessica; Patro, Jhina; Li, Jia; Mao, Jiajia; Liu, Jiamin; Wang, Jian'an; Li, Jianhua; Zhang, Jianxin; Qi, Jie; Lyo, Jihyun; Marcus, Jill; Blankenship, Jim; Zhang, Jing; Liu, Jingjing; Fan, Jing-Yao; Li, Jiun-Yi; Pradhan, Jiwan; Chen, Jiyan; Rivera Caravaca, J M; Evans, Jo; Garcia Picart, Joan; Hecht, Joan; Jaroch, Joanna; Zalewska, Joanna; Kelly, Joanne; Taaffe, Joanne; Abbud, João Reynaldo; Vitola, João V; Peñafiel, Joaquín V; Benatar, Jocelyne; Bindeman, Jody; Sabik, Joe; Klitch, Joel; Christopher, Johann; Aspberg, Johannes; Friedman, John D; Beltrame, John F; Heitner, John F; Graham, John Joseph; Davies, John R; Doan, John; Kotter, John; Kurian, John; Mukai, John; Pownall, John; Sobolewska, Jolanta; Kobashigawa, Jon; Goldberg, Jonathan L; Bazeley, Jonathan W; Byrne, Jonathan; Himmelfarb, Jonathan; Leipsic, Jonathan; Thorsen, Jonean; Trejo Gutierrez, Jorge F; Escobedo, Jorge; Timmer, Jorik; Ortega-Ramírez, José A; Marin-Neto, José Antonio; Salas, Jose D; Castillo, Jose Enrique; Saraiva, Jose Francisco; Cuenca-Castillo, José J; Diez, Jose L; Narro Villanueva, José Luis; da Vieira, José Luiz; Flores-Palacios, José M; Gonzalez, Jose Ramon; Seijas Amigo, Jose; Fragata, Jose; Padró, Josep Maria; McGarvey, Josheph F X Jr; Hannan, Joseph; Sacco, Joseph; Sweeny, Joseph; Wiesel, Joseph; Abraham, Josephine D; Loh, Joshua P; Burkhardt, Joy; White, Joyce R; Riestenberg-Smith, Joyce; Sebo, Judit; Meadows, Judith L; Wright, Judith; Foltz, Judy Mae; Hung, Judy; Otis, Judy; Stumpf, Juergen; Tsai, Jui-Peng; Dionne, Julia S; de Aveiro Morata, Julia; Bunke, Julie; Morrow, Julie; Figal, Julio César; Fujita, Jun; Jiang, Jun; Li, Junhua; Yang, Junqing; Euathrongchit, Juntima; Garg, Jyotsna; Manjula Rani, K; Preethi, K; Goetschalckx, Kaatje; Eggers, Kai; Surineni, Kamalakar; Hirase, Kanae; Kapilamoorthy, T R; Calfas, Karen; Gratrix, Karen; Hallett, Karen; Hultberg, Karen; Nugent, Karen; Petrosyan, Karen; Swan, Karen; Kryczka, Karolina; Wojtczak-Soska, Karolina; Wojtera, Karolina; Lenk, Karsten; Ramasamy, Karthik; Łuczak, Katarzyna; Malinowska, Katarzyna; Pointon, Kate; Robb, Kate; Martin, Katherine; Claes, Kathleen; Carruthers, Kathryn; Siegel, Kathy E; Drouin, Katia; Fowler-Lehman, Katie; Rawat, Kavita; Rowe, Kay; Fukuda, Keiichi; Fox, Keith A A; Mahaffey, Ken; Unterbrink, Kendra; Giedd, Kenneth; Van Loo, Kerrie; Lee, Kerry; Bonin, Kerstin; Bainey, Kevin R; Harley, Kevin T; Anstrom, Kevin; Chan, Kevin; Croce, Kevin; Landolfo, Kevin; Marzo, Kevin; Patel, Keyur; Abdul-Nour, Khaled; Alfakih, Khaled; Dajani, Khaled; Ziada, Khaled; Baloch, Khaula; Kushniriuk, Khrystyna; Poh, Kian-Keong; Ireland, Kim F; Holland, Kim; Byrne, Kimberly Ann; Halverson, Kimberly E; Elmore, Kimberly; Miller-Cox, Kimberly; Reddy, Kiran; Quiles, Kirsten J; Abercrombie, Kirsty; Matschke, Klaus; Szymczyk, Konrad; Chan, Koo Hui; Preethi, Kotiboinna; Sokhon, Kozhaya; Meemuk, Krissada; Thygesen, Kristian; Salmi, Kristin M; Newby, Kristin; Wippler, Kristina; Arges, Kristine; Teoh, Kristine; Etherington, Krystal; Łoboz-GrudzieÅ„, Krystyna; Reczuch, Krzysztof W; Bury, Krzysztof; Drzymalski, Krzysztof; KukuÅ‚a, Krzysztof; Sung, Kuo-Tzu; Huber, Kurt; Douangvila, Ladda; Sullenberger, Lance; Trama, Larissa Miranda; Matics, Laszlone; Drew, Laura; Flint, Laura; Keinaite, Laura; Sarti, Laura; Kolakaluri, Laurel; Phillips, Lawrence M; Friedman, Lawrence; Phillips, Lawrence; Velicki, Lazar; Howell, Leah; Maranan, Leandro C; Cox, Leanne; Daba, Ledjalem; Zhang, Lei; Dharmarajan, Lekshmi; Bockeria, Leo; Pizzol Caetano, Leonardo; Bridi, Leonardo; Bershtein, Leonid L; Sokalski, Leszek; Yan, Li Hai; Li, Li; Nijmeijer, Lia; Sousa, Lidia; Xu, Lihong; Zhang, Lihua; Zhang, Lili; Schiavi, Lilia; Barbosa, Lilian Mazza; Khor, Lillian L; Felix-Stern, Lina; Hall, Linda L; Hollenweger, Linda M; Arcand, Linda; Davidson-Ray, Linda; Schwarz, Linda; Sikora, Lindsey N; Chi, Lingping; Patricio, Lino; Zhang, Liping; Chaytor, Lisa; Hatch, Lisa; McCloy, Lisa; Wong, Lisa; Persson, Liselotte; Jiang, Lixin; Low, Liz; Pupic, Ljiljana; Bière, Loïc; Monti, Lorenzo; Christensen, Lori; Pritchard, Lori; Black, Loriane; Desimone, Lori-Ann; Larmand, Lori-Ann; McGregor, Lorraine; Morby, Louise; Thomson, Louise; Harvey, Luc; de Pádua Baptista, Luciana; Garcia, Lucilla; Eliahou, Ludivine; Helmer, Ludmila; Smidt, Luis F; Bernanrdes, Luis; Guzman, Luis; Carvalho, Luiz A; Xiong, Luyang; Teo, Lynette L; Neeson, Lynn M; Winstanley, Lynne; Srichai-Parsia, M Barbara; Quintana Giner, M; Sowjanya Reddy, M; Valdés Chávarri, M; Grazia Rossi, M; Simoons, Maarten; Konigstein, Maayan; Lesiak, Maciej; Olsowka, Maciej; Selas, Mafalda; Corfias, Magalie; Madero Rovalo, Magdalena; Łanocha, Magdalena; Miller, Magdalena; Misztal-Teodorczyk, Magdalena; Rantinella, Magdalena; Abdelhamid, Magdy; Jimenez, Magnolia; Alam, Mahboob; Mylarappa, Mahevamma; El Shahawy, Mahfouz; Mohamed, Mahmoud; Al-Bustami, Mahmud; Joseph, Majo X; Frach, Malgorzata; CeliÅ„ska-Spodar, MaÅ‚gorzta; Helm, Malte; Chacko, Manas; Murphy, Mandy; Vinod, Manitha; Rani, Manjula; Dhawan, Manu; Mombelli, Manuela; Weber, Marcel; Galvani, Marcello; Rodrigues, Marcelo Jamus; Dubin, Marcia F; Werner Bayer, Marcia F; Szkopiak, Marcin; Monsalve, Marco Antonio; Santos, Marco Bizzaro; Magnoni, Marco; Marini, Marco; Sicuro, Marco; Zenati, Marco; Coimbra Resende, Marcos Valério; Roik, Marek; Bentzvi, Margalit; Gilsenan, Margaret; Iraola, Margaret; Quinn, Margot C; Alfonso, Maria A; Pereira Moraes, Maria Antonieta; Martínez-Ruíz, María Dolores; Canales, María Fernanda; Caetano, Maria Inês; Corral, Maria P; Pérez García, Maria; Actis, Maria Victoria; Aguirre, Maria; Andreasson, Maria; Aprile, Maria; Colton, Maria; Martin, Maria Eugenia; Lasala, Maria; Lorenzo, Maria; Posada, Maria; Shier, Maria; Thottam, Maria; Furtado, Mariana V; Okada, Mariana Yumi; Dracoulakis, Marianna D A; De Andrade, Marianne; Rubio, Mariano; Essermark, Marie; Scherrer-Crosbie, Marielle; Petrovic, Marija T; Zdravkovic, Marija; Black, Marilyn; Garcia, Marina; Garcia, Mario J; Szulik, Mariola; Orgera, Marisa; de Belder, Mark A; Harbinson, Mark; Hyun, Mark; Peterson, Mark; Xavier, Mark; Mosley, Marlowe; Capinha, Marta; Marcinkiewicz-Siemion, Marta; Swiderek, Marta; Meyer, Martha; Ceseri, Martina; Tricoli, Martina; Kronenberg, Marvin; Williams, Mary; Champagne, Mary Ann; Rogge, Mary Colleen; Soltau, Mary R; Streif, Mary; Villella, Massimo; Leesar, Massoud; Claudia, Matei; Solecki, Mateusz; Mungo, Matías Nicolás; Wall, Matthew Jr; Budoff, Matthew; Jezior, Matthew; Luckie, Matthew; Friedrich, Matthias; Haeffner, Mauren P; Tscharre, Maximilian; Winter, Max-Paul; Almeida, Mayana; Krishnam, Mayil S; Patel, Mayuri; Mishra, Meenakshi; Manocchia, Megan; Kakade, Meghana; Munro, Melanie J; Chaplin, Melissa D; LeFevre, Melissa; Andiapen, Mervyn; Gibson, Michael A; Rubens, Michael B; Turner, Michael C; Shapiro, Michael D; Lee, Michael W; Berlowitz, Michael; Davidson, Michael; Mack, Michael; McDaniel, Michael; Mumma, Michael; Wlodarczyk, Michal; Khouri, Michel G; Slama, Michel S; Rawlins, Michele; Bonner, Michelle M; Seib, Michelle M; Chang, Michelle; Crowder, Michelle; Dixon, Michelle; Mayon, Michelle; McEvoy, Michelle; Yee, Michelle; Fernandes, Miguel M; Nobre Menezes, Miguel; Souto Bayarri, Miguel; Barrero, Miguel; Torosoff, Mikhail T; Dobric, Milan R; Dobric, Milan; Dekleva, Milica Nikola; Gadkari, Milind Avdhoot; Gomez, Millie; Kyaw, Min Tun; Brooks, Miriam; Stevo Martinovic, Miroslav; Lustre, Mitchel B; Vakani, Mohammad Tariq; El-Hajjar, Mohammad; Al-Amoodi, Mohammed; Hussain, Mohammed; Saleem, Mohammed; Blanco-Calvo, Moisés; Jiménez-Santos, Moisés; Bhatia, Mona; Rosca, Monica; Laukyte, Monika; Gracida Blanca, Montserrat; Vila Perales, Montserrat; Al-Mallah, Mouaz H; de Oliveira Filho, Moysés; Ntsekhe, Mpiko; Saric, Muhamed; Chen, Mulei; Brousseau, Myriam; Takiuti, Myrthes Emy; Cemerlic-Adjic, Nada; Asif, Nadia; Gakou, Nadia; Hussain, Nafisa; Katamadze, Nana O; Clapp, Nancy L; Aedy, Nancy; Nataraj, Nandita; Wenger, Nanette K; Uchida, Naomi; Ismail, Nasrul; Oliveira, Natalia S; de Carvalho Maffei, Natalia; Spitzer, Natalie; Putnam, Natasha C; Aslam, Naved; Mowafy, Neamat; Pandit, Neeraj; Parakh, Neeraj; Garcevic, Nevena; Meadows, Ngaire; Tran, Nhi N; Danchin, Nicholas; Lakeman, Nicki; Johnston, Nicola; Shammas, Nicolas W; Saint Vrestil, Nicole; Deming, Nicole; Zhong, Nier; Patel, Niket; Boskovic, Nikola N; Karogiannis, Nikolaos; Werner, Nikos; Johnston, Nina; Zhang, Ning; Zhou, Ning; Hindoyan, Niree; Kumar, Nirmal; Chadha, Nitika; Naik, Nitish; Aripova, Nodira; Mtana, Noloyiso; Eskelson, Nona A; Mokhtar, Noor Syamira; Taksaudom, Noppon; Basri, Nor Asiah; Marchelletta, Nora; Hogg, Norma; Jungla, Nungshi; Ferreira, Nuno; Lubyanaya, Oksana A; Nikolaeva, Olga B; Cañavate, Olga; Sobrino, Olga; Walesiak, Olga; Walter, Olga; ZdoÅ„czyk, Olga; Lim, Olivia J; Anaya, Olivia; Mancilla, Olivia; Dubourg, Olivier; Bello, Olugbenga; Almousalli, Omar; Thompson, Omar; Olurinde, Oni; Harel, Or; Raheem, Osama; Méndiz, Oscar; Prada-Delgado, Óscar; Shapira, Oz; Schulze, P Christian; Panpunuan, Pachara; Maurovich-Horvat, Pal; Garg, Pallav; Moraga, Paloma; Singh, Pam; Julian, Pamela; Ouyang, Pamela; Sigel, Pamela; Woodard, Pamela; Zhou, Panpan; Poggio, Paola Emanuela; Smanio, Paola; Calabro, Paolo; Jeetley, Paramjit; Goube, Pascal; Nguyen, Patricia K; Alarie, Patricia; Arakelian, Patricia; Arsenault, Patricia; Blaise, Patricia; Brito, Patricia; Cowper, Patricia; Endsley, Patricia; Mieses, Patricia; Alexander, Patrick B; Donnelly, Patrick; Wilmot, Patrick; Lebioda, Patrycja; Gordon, Paul C; Mesropian, Paul Der; Galiwango, Paul; Hauptman, Paul; Kennedy, Paul; Beardsley, Paula; García-González, Paula; Rezende, Paulo Cury; Caramori, Paulo Ricardo; Kozlov, Pavel S; Canas Silva, Pedro; Melo Barros E Silva, Pedro Gabriel; Píccaro de Oliveira, Pedro; Carvalho, Pedro; Modas, Pedro; Rio, Pedro; Jain, Peeyush; He, Peiyu; McCullough, Peter A; Stone, Peter H; Pollak, Peter M; Douglass, Peter; Henriksen, Peter; OKane, Peter; Ong, Peter; Jones, Philip; Rogal, Philip; Généreux, Philippe; Menasche, Philippe; Rheault, Philippe; Goold, Phoebe; Gervais, Pierre; Michaud, Pierre; Calvillo, Pilar; Chai, Ping; Jakubowski, Piotr; Pruszczyk, Piotr; Slomka, Piotr; Sritara, Piyamitr; Loh, Poay-Huan; Sonawane, Poonam; Samadi, Pouneh; Parikh, Pragnesh P; Deedwania, Prakash; Patel, Pranav M; Polamuri, Praneeth; Sharma, Pratiksha; Vasquez, Precilia; Kamath, Preeti; Thomas, Prince; Arambam, Priyadarshani; Mehta, Puja K; Grant, Purvez; Naik, Pushpa; Zhong, Qi; Zhao, Qian; Zhou, Qiang; Yuan, Qianqian; Yu, Qin; Li, Qingxian; Xie, Qiulan; Zeng, Qiutang; Vindhya, R J; Gerlach, R James; King, Rachel; Vučić, Rada; Lyubarova, Radmila; Pracon, Radoslaw; Fisher, Raewyn; Beyar, Rafael; Diaz, Rafael; Selgas, Rafael; Bugiardini, Raffaele; Fanelli, Raffaele; Kavalakkat, Raisa; Rajalekshmi, V S; Barua, Rajat S; Menon, Rajeev; Nair, Rajesh Gopalan; Francis, Rajesh; Narang, Rajiv; Yadav, Rakesh; Huston, Ralph Alan; Ramakrishnan, T; de Silva, Ramesh; Mahmoud, Rami El; Carvalho, Ramiro; de Jesús-Pérez, Ramon; Stevens, Ramona; Leng, Ran; Kachru, Ranjan; Nath, Ranjit Kumar; Sanchez, Raquel; Dwyer, Raven R; Lee, Raven; Wyman, Ray; Wong, Raymond C; Little, Raymond W; Ocaranza Sanchez, Raymundo; Wimmer, Rebecca J; Bariciano, Rebecca; Otis, Rebecca; Herrmann, Rebekah R; Yunis, Reem; Hampson, Reinette; Karam, Renato Abdala; Hessian, Renee C; Kaneshiro, Renee; Ravindran, Reshma; Gamma, Reto Andreas; Bhandari, Reyna; Arsanjani, Reza; Lopes, Ricardo L; Mendes Oliveira, Ricardo; Costa, Ricardo; Bhatt, Richa; Davies, Richard F; Trimlett, Richard H J; Goldweit, Richard; Hermanides, Rik; Nakanishi, Rine; Sidh, Rinu R; Patel, Risha; Coram, Rita; Siddiqui, Rizwan A; Beanlands, Rob S; Hamburger, Robert J; Riezebos, Robert K; Donnino, Robert M; Bojar, Robert; Chilton, Robert; Guyton, Robert; Henderson, Robert; Kornberg, Robert; Leber, Robert; Mao, Robert; Stenberg, Robert; Santos, Roberta P; Favaloro, Roberto René; Amati, Roberto; Lima, Rodolfo G S D; Cerci, Rodrigo J; Tumelero, Rogerio; Tandon, Rohit; Tewari, Roma; Miranda-Peats, Romalisa; Wald, Ron; Mastouri, Ronald A; Morford, Ronald G; Schwartz, Ronald G; Pedalino, Ronald P; Hu, Rongrong; Hansen, Ronnell A; Cohen, Ronny A; Hachamovitch, Rory; Homem, Rosa; Sandonato, Rosa; Laimer, Rosane; Gans, Rosann; Yost, Roxanne; Mathew, Roy; Baleón-Espinosa, Rubén; Ramos, Ruben; Gevorgyan, Rubine; Ferreira, Rui; Jing, Rui; Pérez-Fernández, Ruth; Dwivedi, S K; Ramakrishnan, S; Khan, Saadat; Bokhari, Sabahat; Thomas, Sabu; Lubna, Sadath; Khan, Sajeeda Parveen; Govindan, Sajeev Chakanalil; Girotra, Saket; Kassam, Saleem; Canada, Sallie; Cruz-Flores, Salvador; Mohamed, Samaa; Ly, Samantha; El Kaffas, Sameh; Massalha, Samia; Setty, Sampoornima; Nwosu, Samuel; Seth, Sandeep; Singh, Sandeep; Niehe, Sander R; Rivest, Sandra M; Zier, Sandra S; Ahoud, Sandra; Carr, Sandy; Ganapathi, Sanjay; Shetty, Sanjay; Sharma, Sanjeev; Jimenez, Santa; Satheesh, Santhosh; Garcia, Santiago A; Fernandez, Sara; Karlsson, Sara; Salkind, Sara; Temiyasathit, Sara; Medina Rodriguez, Sarah; Beaudry, Sarah; Hadjih, Sarah; Williams, Sarah; Zahrani, Sarah; Ralhan, Sarju; Hinic, Sasa; Kedev, Sasko; Singh, Satinder; Yasuda, Satoshi; Manjunath, Satvic Cholenahally; Lee, Sau; Kaczkowski, Scott M; Kinlay, Scott; Hayes, Sean W; Sobczak, Sebastian; Asier, Senait; Sayganov, Sergey A; Sokol, Seth I; Pandie, Shaheen; Yahaya, Shaiful Azmi; Mehta, Shamir; Nie, Shao-Ping; Chandra, Sharad; Islam, Sharder; Tai, Sharon; Karwa, Sheetal Rupesh; Ussery, Sheri; Bajaj, Sheromani; Crook, Sherron C; Nishimura, Shigeyuki; Nakano, Shintaro; Heydari, Shirin; Choudhary, Shiv Kumar; Patel, Shivali; Ganesan, Shobana; Pandey, Shruti; Zhang, Shuyang; Hande, Shweta; Gadage, Siddharth; Tan, Sik-Yin V; Zottis Poletti, Silvia; Riera, Silvia; Valbuena, Silvia; Walsh, Simon; Maspoli, Simona; Savaris, Simone; Feng, Si-Ting; Cho, So Yang; Yakubov, Solomon; Zhu, Songlin; Wang, Songtao; Guerrero, Sonia; Gupta, Sonika; Salinger Martinovic, Sonja; Brons, Sonya; Brener, Sorin; Gurunathan, Sothinathan; Saba, Souheil; Nayak, Soundarya; Reddy, Sowjanya; Potluri, Srinivasa; Sudarshan, Sriram; Kuanprasert, Srun; Van Oosterhout, Stacie; Lerakis, Stamatios; Cobos, Stanley E; Bertog, Stefan C; Simović, Stefan M; Weikl, Stefan; Di Marco, Stefano; Provasoli, Stefano; Tirado, Stephanie A; Boer, Stephanie C; Lane, Stephanie M; Ferket, Stephanie; Kelly, Stephanie; Wasmiller, Stephanie; McKellar, Stephen H; Hoole, Stephen P; Fremes, Stephen; Preston, Stephen; Leung, Steve; Fein, Steven A; Lindsay, Steven J; Sedlis, Steven P; Giovannone, Steven; Michael, Steven; Weitz, Steven; van Vugt, Stijn; Banerjee, Subhash; Naik, Sudhir; Hosino, Suellen; Desire, Sukie; Yamwong, Sukit; Thambar, Suku T; Mookherjee, Sulagna; Singh, Suman; Mishra, Sundeep; Verma, Sunil Kumar; Kulthawong, Supap; Khwakhong, Supatchara; Naik, Surendra; Babu, Suresh; Woragidpoonpol, Surin; Narayanappa, Suryaprakash; Derbyshire, Susan; Gent, Susan; Mathus, Susan; Milbrandt, Susan; Moore, Susan; Regan, Susan; Stinson, Susan; Webber, Susan; Silva, Susana; Stevens, Susanna; Gruensfelder, Susanne; Aramcharoen, Suthara; Kolhe, Suvarna; Tavares, Suzana; Arnold, Suzanne; Welsh, Suzanne; Apostolovic, Svetlana; Kunhunny, Swapna; Hung, Ta-Chuan; Zappernick, Taissa; Sharir, Tali; Silva, Talita; Soares, Tamara Colaiácovo; Pillay, Tapan Umesh; Mittal, Tarun K; Trifonova, Tatiana; Duarte, Tauane Bello; Huk, Tauqir; Dutoiu, Téodora; Chua, Terrance; Weyand, Terry; Charles, Thabitha; Kofidis, Theodoros; McCreary, Theresa; Lefevre, Thierry; Arumairajah, Thippeekaa; Tepsuwan, Thitipong; Mulhearn, Thomas J; Meyer, Thomas M; Rocco, Thomas P; Downes, Thomas R; Crain, Thomas; Haldis, Thomas; Mathew, Thomas; Redick, Thomas; Devi, Thounaojam Indira; Nageh, Thuraia; Cauthren, Tia; Silva, Tiago; Little, Tiffany; Andric, Tijana; Harding, Tina; Lau, Titus; Formisano, Tiziana; Moccetti, Tiziano; Ciurus, Tomasz; Mazurek, Tomasz; Tarchalski, Tomasz; Nagai, Toshiyuki; Tran, Tri; Youn, Tricia; Tucker, Trish; Milner, Trudie; Bose, Tuhina; Kotecha, Tushar; Sechtem, Udo; Valeti, Uma S; Cucchini, Umberto; Badami, Umesh; Kaul, Upendra; Bahl, V K; Narain, V S; Casali, Valentina; Godoy, Valeria; Robesyn, Valerie; Priya, Vamshi P; Yadav, Vandana; McKinney, Vera; De Lenges, Veronica; Tinnirello, Veronica; Miro, Vicente; Navarro, Victor; Gumerova, Victoria; Hernandez, Victoria; Seeratan, Vidya; Kumar, Vijay; Kozulin, Vikentiy Y; Bulkley, Viktoria; Veiga, Vilmar Jr; Setang, Vincent; Vineeth, C P; Pubull Nuñez, Virginai; Fernández-Figares, Virginia; Gomes, Vitor; Gabriel, Viviana; Dos Santos, Viviane; Almeida, Viviane; Iliescu, Vlad A; Mudrenovic, Vladan; Dzavik, Vladimir; Giga, Vojislav L; Mogrovejo, Walter Enrique; Chan, Wan Xian; Marfori, Wanda C; Parker, Wanda; Mekara, Warangkana; Nona, Wassim; Old, Wayne; Pennachi, Wayne; Nawarawong, Weerachai; Chen, Wei; Su, Wei; Xing, Weibing; Lan, Wei-Ren; Crawford, Wenda; Stewart, Wendy L; Drewes, Wendy; Lin, Wenhua; Abernethy, William B; Salerno, William D; Fearon, William F; Vergoni, William; Weintraub, William; Sia, Winnie C; Musial, Wlodzimierz J; Flores-Ríos, Xacobe; Garcia-Moll Marimon, Xavier; Su, Xi; Ma, Xiang; Gu, Xiangqiong; Wang, Xiao; Li, Xiaomei; Yao, Xiaowei; Fu, Xin; Su, Xin; Zeng, Xin; Yang, Xinchun; Li, Xiuhong; Fang, Xuehua; Wang, Xutong; Geng, Yaming; Yan, Yan; Pépin-Dubois, Yanek; Wang, Yanfu; Wang, Yang; Tian, Yanmeng; Huang, Yaping; Han, Yechen; Zambrano, Yesenia; Yang, Yi-Hsuan; Sia, Ying Tung; Yang, Yining; Ma, Yitong; Peralta, Yolayfi; Wu, Yongjian; Kunwu, Yu; Zhao, Yu; Peng, Yudong; Lin, Yueh-Hung; Zhao, Yulan; Dong, Yumei; Zhao, Yunhai; Wannasopha, Yutthaphan; Taul, Yvonne; Sahul, Zakir; Kudzoeva, Zalina; Kalarus, Zbigniew; Markovic, Zeljko Z; Huang, Zhen; Ji, Zheng; Liu, Zhenyu; Yue, Zhou; Zhang, Zhulin; Li, Zhuxi; Singh Meharwal, Zile; Bai, Ziliang; Yu, Zixiang; Huda, Zohra; Davidovits, Zoltan
BACKGROUND:Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS:We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS:Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS:Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
PMID: 32227755
ISSN: 1533-4406
CID: 5451242