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News Article | May 5, 2017

Highmark Health today announced the appointment of Tony Farah, MD, to the newly created position of Executive Vice President, Chief Medical and Clinical Transformation Officer for the organization. “It is with great pride that I welcome Tony to our leadership team, as he has proven to be invaluable in accelerating Allegheny Health Network’s and Highmark Health’s collective efforts to reinvent the healthcare model and support long-term enterprise growth,” said Highmark Health President and Chief Executive Officer, David Holmberg. “Tony is a highly respected physician-leader who is passionate about changing the way health care is delivered, and he is the right person to take Highmark Health and Allegheny Health Network to the next level when it comes to transforming clinical care to achieve the best patient experience and best outcomes at an affordable cost.” Dr. Farah has been a leading clinician, physician educator and health care executive in the western Pennsylvania region for more than three decades. As a noted cardiologist at Allegheny General Hospital and former longtime director of the institution’s cardiac catheterization laboratory, he and his team have played a pivotal role in the development of many of the field’s breakthrough therapies for cardiovascular disease, including disease fighting medications and plaque clearing technologies. The same leadership qualities that have driven Dr. Farah’s success in the clinical setting throughout his career have defined his many accomplishments as a physician executive as well. He has served in numerous high-level positions over the past 15 years, including chief medical officer of AGH, West Penn Allegheny Health System and Allegheny Health Network, and as a Trustee of one of his field’s most prestigious scientific organizations, the Society for Cardiovascular Angiography and Interventions. For the last four years, Dr. Farah has also served as President of Allegheny Clinic, AHN’s employed physician organization. Under his leadership, the Clinic has doubled in size to now more than 1,200 members. Dr. Farah played a critical role in the formation of AHN in 2013, and in his new capacity with Highmark Health he will oversee clinical transformation, deploying innovative models to create more value for Highmark members and all of the patients AHN serves by way of enhanced experience, access, clinical outcomes and affordable cost in every care setting. “I am extremely grateful for and excited about this unique opportunity to help further redefine the delivery of health care in western Pennsylvania and across Highmark Health’s vast and diverse footprint,” said Dr. Farah. “By leveraging the clinical knowledge at AHN with the financing expertise and population health insights of Highmark Health, we are well positioned to create a high-quality, value-based care model that will set a new standard, locally and nationally, for the experience it affords.” In order to effect a seamless transition to new leadership in the roles of Chief Medical Officer for AHN and President of Allegheny Clinic, Dr. Farah will continue to provide oversight of those areas as part of his responsibilities for Highmark Health. Once the positions are filled, they will report dually to Dr. Farah and AHN President and CEO, Cynthia Hundorfean. “For many years, Dr. Farah has been a tireless advocate for patients and for his colleagues at AHN,” Hundorfean said. “We expect that advocacy to only grow stronger in his important new role at Highmark Health and congratulate him on his well-deserved promotion. It is yet more evidence that AHN and Highmark Health are committed to creating and sustaining an integrated health care delivery and financing system that is both patient-centered and clinician-led.” About Allegheny Health Network Allegheny Health Network (, part of Highmark Health, is an integrated health care delivery system serving the greater Western Pennsylvania region. The Network is composed of eight hospitals, including Allegheny General Hospital, its flagship academic medical center in Pittsburgh, Allegheny Valley Hospital in Natrona Heights, Canonsburg Hospital in Canonsburg, Forbes Hospital in Monroeville, Jefferson Hospital in Jefferson Hills, Saint Vincent Hospital in Erie, West Penn Hospital in Pittsburgh and Westfield Memorial Hospital in Westfield, NY. The Network provides patients with access to a complete spectrum of medical services, including nationally recognized programs for primary and emergency care, cardiovascular disease, cancer care, orthopedic surgery, neurology and neurosurgery, women’s health, diabetes and more. It also is home to a comprehensive research institute; Health + Wellness Pavilions; an employed physician organization, home and community based health services and a group purchasing organization. The Network employs approximately 17,000 people, has more than 2,400 physicians on its medical staff and serves as a clinical campus for Drexel University College of Medicine, Temple University School of Medicine, and the Lake Erie College of Osteopathic Medicine. About Highmark Health Highmark Health, a Pittsburgh, PA based enterprise that employs more than 40,000 people nationwide and serves nearly 50 million Americans in all 50 states, is the second largest integrated health care delivery and financing network in the nation based on revenue. Highmark Health is the parent company of Highmark Inc., Allegheny Health Network, and HM Health Solutions. Highmark Inc. and its subsidiaries and affiliates provide health insurance to nearly 5 million members in Pennsylvania, West Virginia and Delaware as well as dental insurance, vision care and related health products through a national network of diversified businesses that include United Concordia Companies, HM Insurance Group, Davis Vision and Visionworks. Allegheny Health Network is the parent company of an integrated delivery network that includes eight hospitals, more than 2,800 affiliated physicians, ambulatory surgery centers, an employed physician organization, home and community-based health services, a research institute, a group purchasing organization, and health and wellness pavilions in western Pennsylvania. HM Health Solutions focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge and integrated cloud-based platforms. To learn more, please visit

LA JOLLA, CA - February 22, 2017 - The MagnaSafe Registry, a new multicenter study led by scientists at The Scripps Research Institute (TSRI), has demonstrated that appropriately screened and monitored patients with standard or non-MRI-conditional pacemakers and defibrillators can undergo MRI at a field strength of 1.5 tesla without harm. These devices are not presently approved by the U.S. Food and Drug Administration (FDA) for MRI scanning. The researchers observed no patient deaths, device or lead failures, losses of pacing function or ventricular arrhythmias in 1,500 patients who underwent MRI using a specific protocol for device interrogation, device programming, patient monitoring and follow-up designed to reduce the risk of patient harm from MRI effects. The research will be published as an Original Article in the February 23, 2017 issue of The New England Journal of Medicine. The use of MRI poses potential safety concerns for patients with an implanted cardiac device. These concerns are a result of the potential for magnetic field-induced cardiac lead heating, which could result in cardiac injury and damage to an implanted device. As a result, it has long been recommended that patients with a pacemaker or defibrillator not undergo MRI scanning, even when MRIs are considered the most appropriate diagnostic imaging method for their care. Despite the development of devices designed to reduce the potential risks associated with MRI, a large number of patients have devices that have not been shown to meet these criteria and are considered "non-MRI-conditional." At least half these patients are predicted to have the need for MRI after a device has been implanted. Researchers established the MagnaSafe Registry to determine the frequency of cardiac device-related events among patients with non-MRI-conditional devices, as well as to define a simplified protocol for screening, monitoring and device programming before MRI. "Given the great clinical demand for MRI for patients with a standard pacemaker or defibrillator, we wanted to determine the risk," said study leader Dr. Robert Russo, an adjunct professor at TSRI and director of The La Jolla Cardiovascular Research Institute. In the MagnaSafe Registry, researchers at 19 U.S. institutions tested 1,000 cases with a non-MRI-conditional pacemaker (one not approved for use in an MRI) and 500 cases of patients with a non-MRI-conditional implantable cardioverter defibrillator (ICD), a device that can shock the heart in response to a potentially fatal cardiac rhythm. They scanned regions other than the chest, such as the brain, spine or extremities--where MRI is traditionally the best option for imaging. The researchers tested the devices at an MRI field strength of 1.5 tesla, a standard strength for MRI scanners and reprogrammed some devices according to a prespecified protocol for the MRI examination. "If the patient was not dependent upon their pacemaker, the device was turned off," explained Russo. "If they could not tolerate having the device turned off, it was set to a pacing mode that did not sense cardiac activity. The reason was that the pacemaker could sense the electrical activity (radiofrequency energy) from the MRI scanner and the function of the device could be inhibited, which could be catastrophic if you depend upon your pacemaker for your heartbeat." Russo and his co-investigators did observe adverse effects in a small group of patients. Six patients had a brief period of atrial fibrillation, and in six additional cases pacemaker partial reset (a loss of stored patient information) was noted. But in no cases did the researchers observe device failure or a failure in the leads that connect the device to the heart when the protocol was followed. "One ICD generator could not be interrogated after MRI and required immediate replacement; the device had not been appropriately programmed per protocol before the MRI," explained Russo. These findings led the researchers to conclude that "device removal and replacement seem unlikely to be safer than proceeding with scanning for patients with a pacemaker or an ICD who require a nonthoracic MRI," provided a protocol similar to the MagnaSafe protocol was followed. "Patients with a standard or non-MRI-conditional pacemaker can undergo clinically indicated MRI without harm if a protocol such as the 'MagnaSafe' protocol used in this study is followed and patients are screened and monitored as described," said Russo. The researchers also noted that their results may not be predictive of findings with all device and lead combinations, higher MRI field strengths, patients younger than 18 years of age and MRI examinations of the chest or cardiac resynchronization devices (those designed to increase the function of a failing heart). The researchers plan to follow up by studying the risk for patients in need of a chest scan at scanner field strength of 1.5 tesla, as well as an MRI of any anatomic area at a higher field strength (3.0 tesla). The study, "Assessing the Risks Associated with MRI in Patients with a Pacemaker or Defibrillator," also included authors from the University of California, San Diego; Scripps Memorial Hospital; the University of California, Los Angeles; Providence St. Joseph Medical Center; the University of Arizona; Intermountain Medical Center; Inova Heart and Vascular Institute; Allegheny General Hospital; Abington Memorial Hospital; Yale University School of Medicine; Providence Heart Institute; Oklahoma Heart Institute; the University of Mississippi Medical Center; the Medical College of Wisconsin; Bassett Medical Center; Carnegie Hill Radiology; Methodist DeBakey Heart and Vascular Center and Baptist Health. The study was supported by grants from St. Jude Medical, Biotronik, Boston Scientific and the Hewitt Foundation for Medical Research, and by philanthropic gifts from Mr. and Mrs. Richard H. Deihl, Evelyn F. and Louis S. Grubb, Roscoe E. Hazard, Jr. and the Shultz Steel Company. The Scripps Research Institute (TSRI) is one of the world's largest independent, not-for-profit organizations focusing on research in the biomedical sciences. TSRI is internationally recognized for its contributions to science and health, including its role in laying the foundation for new treatments for cancer, rheumatoid arthritis, hemophilia, and other diseases. An institution that evolved from the Scripps Metabolic Clinic founded by philanthropist Ellen Browning Scripps in 1924, the institute now employs more than 2,500 people on its campuses in La Jolla, CA, and Jupiter, FL, where its renowned scientists--including two Nobel laureates and 20 members of the National Academies of Science, Engineering or Medicine--work toward their next discoveries. The institute's graduate program, which awards PhD degrees in biology and chemistry, ranks among the top ten of its kind in the nation. In October 2016, TSRI announced a strategic affiliation with the California Institute for Biomedical Research (Calibr), representing a renewed commitment to the discovery and development of new medicines to address unmet medical needs. For more information, see http://www. .

News Article | February 23, 2017

The results of a major study on the safety of magnetic resonance imaging (MRI) as a diagnostic procedure for patients with implantable cardiac devices were published today in the prestigious New England Journal of Medicine. Robert Biederman, MD, Medical Director of the Cardiovascular MRI Center at Allegheny General Hospital’s Cardiovascular Institute, co-authored the study. AGH, part of Allegheny Health Network (AHN), was one of just 19 medical centers nationwide to participate in the study – and the only hospital in western Pennsylvania. The study, performed from 2009 to 2014, examined a total of 1,000 pacemaker and 500 implantable cardioverter defibrillator (ICD) cases using MRI. Researchers reported no deaths, lead failures or ventricular arrhythmias. “MRI is simply too important a diagnostic tool not to be able to have it in our arsenal to evaluate and help determine the best treatment for patients who have implanted devices,” said Dr. Biederman. “For years, we had what are essentially two life-saving technologies – MRI and implantable devices – that could not be in the same room together. The findings of this study, though, should help solve this critical dilemma. Hospitals like AGH with advanced capabilities can safely perform MRI on this patient population.” The New England Journal of Medicine article states that an estimated 2 million people in the U.S. and additional 6 million worldwide have implantable cardiac devices that, until now, would have been considered incompatible with MRI because of concerns that the powerful magnetic and radio frequency fields generated during MRI might damage the implanted device and harm the patient. The study also notes that at least half of those patients are expected to require an MRI at some point during their lifetime. Patients with implanted cardiac devices who are referred for MRI undergo an extensive evaluation of their cardiovascular health and level of device dependence. Once a patient is cleared to undergo MRI at AGH, Dr. Biederman and his team perform a baseline device interrogation and then convert the pacemaker to a safer mode of operation for the length of the test. If patients are determined to be non-pacemaker dependent under baseline conditions, the device may be turned off completely while the imaging takes place. During the procedure, a patient’s heart rhythm is monitored in real-time in the MRI suite and the entire process is closely supervised by Dr. Biederman, a cardiovascular physicist and the Cardiovascular MRI Center’s team of nurses and technologists. Once the MRI is completed, the implanted device is reprogrammed to its original settings. In a subsequent study conducted at AGH, Dr. Biederman found that MRI is not just safe for patients with implantable cardiac devices, but also effective. The research, believed to be the first ever focused solely on the value of MRI in this patient population, was presented last year at the annual Society of Cardiovascular MRI Scientific Sessions meeting in Los Angeles. “This ongoing study has shown that using MRI on patients with implanted pacemakers and defibrillators has added substantial clinical value to patient diagnosis and subsequent patient management, justifying the risk of the procedure,” said Dr. Biederman. AGH specialists evaluated 157 patients, including 114 neurology/neurosurgery cases, 36 cardiovascular cases and seven musculoskeletal cases. For 88 percent of the neurology/neurosurgery cases, the MRI scan added value to the final diagnoses – with 18 percent of those cases seeing a change to the original diagnoses thanks to the use of MRI. And 92 percent of the cardiac cases saw a benefit from the use of MRI, while 100 percent of the musculoskeletal cases realized a benefit from using MRI. Additionally, Dr. Biederman reported, there were no adverse clinical events associated with it for any of the patients studied. Allegheny Health Network, part of Highmark Health, is an integrated healthcare delivery system serving the Western Pennsylvania region. The Network is comprised of eight hospitals, including its flagship academic medical center Allegheny General Hospital, Allegheny Valley Hospital, Canonsburg Hospital, Forbes Hospital, Jefferson Hospital, Saint Vincent Hospital, Westfield Memorial Hospital and West Penn Hospital; a research institute; Health + Wellness Pavilions; an employed physician organization, home and community based health services and a group purchasing organization. The Network employs approximately 17,000 people and has more than 2,400 physicians on its medical staff. The Network also serves as a clinical campus for Temple University School of Medicine, Drexel University College of Medicine and the Lake Erie College of Osteopathic Medicine.

News Article | February 15, 2017

Continuing its tradition of being at the forefront of cardiac care in the region, Allegheny General Hospital (AGH), part of Allegheny Health Network (AHN), is the only medical center in western Pennsylvania participating in a clinical trial to see if a less-invasive technique called transcatheter aortic valve replacement (TAVR) is as effective as open heart surgery for patients with severe aortic stenosis at low-risk for surgery. The Edwards Lifesciences PARTNER 3 trial will include approximately 1,200 patients at up to 65 sites across the country, including AGH. Patients who qualify will receive the SAPIEN 3 valve via TAVR or undergo open heart surgical valve replacement, which is currently the standard of care. “This trial has the potential to change the standard of care in low-risk patients,” said Stephen Bailey, MD, Director of Cardiac Surgery at AGH and the hospital’s principal investigator for the trial. “If TAVR is found to be an effective treatment alternative in this new subset of patients, it could expand its utilization considerably across the country. Patients will be followed for 10 years to help ensure that this newer approach has comparable, exceptional, long-term performance.” Aortic stenosis – a severe narrowing of the aortic valve of the heart – forces the heart to work harder to push blood through the damaged aortic valve, eventually weakening the heart muscle. Aortic stenosis can cause fainting, chest pain, heart failure, irregular heart rhythms (arrhythmias), and cardiac arrest. TAVR is a less-invasive treatment for heart valve disease that involves replacing the damaged aortic valve with a new one while the heart continues to beat on its own. The U.S. Food and Drug Administration (FDA) originally approved TAVR in 2011, providing a new viable option for patients with severe aortic stenosis at high-risk for undergoing open heart surgery. Last year, the FDA approved TAVR for patients with severe aortic stenosis at intermediate-risk for undergoing open heart surgery. According to organizers of the PARTNER 3 trial, nearly 80 percent of all surgical aortic valve replacements (SAVR) are currently done in patients with severe aortic stenosis at low-risk for surgery. “TAVR means no major chest incision, less pain, a shorter hospital stay and a quicker return to normal activity,” said David Lasorda, DO, Director of Interventional Cardiology at AGH. “It could become the new preferred approach for patients.” In October, doctors at AGH performed the hospital’s 500th TAVR procedure, and in 2015 they were the first in western Pennsylvania to implant the latest-generation SAPIEN 3 transcatheter heart valve (THV), which includes a major design change to minimize leakage around the valve. AGH was among the first medical centers in the country to offer two varieties of the minimally invasive valve replacement technique. In transfemoral TAVR, the femoral artery serves as a conduit to access the heart. Surgeons make a small incision in the groin and use a catheter to guide the replacement valve through the femoral artery to the heart. With transapical or transaortic TAVR, a catheter is inserted through a small chest incision that provides direct access into the heart, providing a new option for patients with smaller or diseased peripheral blood vessels who may not be candidates for the transfemoral approach. For more information about the trial at AGH, please contact Kenneth Rayl at kenneth.rayl(at) or call 412.359.6860. Allegheny Health Network, part of Highmark Health, is an integrated healthcare delivery system serving the Western Pennsylvania region. The Network is comprised of eight hospitals, including its flagship academic medical center Allegheny General Hospital, Allegheny Valley Hospital, Canonsburg Hospital, Forbes Hospital, Jefferson Hospital, Saint Vincent Hospital, Westfield Memorial Hospital and West Penn Hospital; a research institute; Health + Wellness Pavilions; an employed physician organization, home and community based health services and a group purchasing organization. The Network employs approximately 17,000 people and has more than 2,400 physicians on its medical staff. The Network also serves as a clinical campus for Temple University School of Medicine, Drexel University College of Medicine and the Lake Erie College of Osteopathic Medicine.

Post C.,Allegheny General Hospital
Advances in Oto-Rhino-Laryngology | Year: 2011

There is a growing body of evidence, both from animal and human studies, that host genetic factors can influence the risk of developing otitis media (OM). The role of genetics in OM has been elucidated through studies with monozygotic and dizygotic twins, analyses linking genetic polymorphisms to OM susceptibility, and genome scans. Several twin studies have shown a strong genetic component to middle ear effusion risk, with the estimate of the role of heredity for the proportion of time with middle ear effusions being around 0.7. Genetic polymorphisms in plasminogen activator inhibitor-1, interleukin-6, tumor necrosis factor-α, human leukocyte antigen, and mannose-binding lectin have been variously linked with OM and upper respiratory infection susceptibility. Several genome linkage studies have identified chromosomal regions associated with chronic OM, including 3p, 10q, 10q22.3, 17q12 and 19q. A number of candidate genes are associated with these sites. Given the current state of understanding of the role of genetics in OM, a family history of OM should be as certained for all patients. Children with a strong family history of OM should be considered as candidates for a more aggressive early treatment of OM, particularly if other risk factors are present. These children may be earlier candidates for the placement of tympanostomy tubes and/or adenoidectomy. Existing data do not support routine genetic testing to determine a child's susceptibility to OM; however, given the advances in whole genome sequencing, such testing may someday play a role in the management of the OM patient. Copyright © 2011 S. Karger AG, Basel.

Krishnamurti U.,Allegheny General Hospital | Silverman J.F.,Allegheny General Hospital
Advances in Anatomic Pathology | Year: 2014

HER2 (human epidermal growth factor receptor 2) receptor is a membrane tyrosine kinase and when activated affects cell proliferation and survival. The HER2 oncogene is located on chromosome 17q12. HER2 amplification is the primary pathway of HER2 receptor overexpression and is a major driver of tumor development and progression in a subset of breast cancers. HER2 is amplified in about 15% to 20% of breast cancers. The overexpressed HER2 receptor is a valuable therapeutic target. The 2007 ASCO guidelines mandate that HER2 should be evaluated in every invasive breast cancer, either at the time of diagnosis or recurrenceto guide therapy. Currently HER2 testing is carried out by several methods. It is crucial to standardize testing techniques to accuratelyassess HER2 status. The aim of this review on HER2 in breast cancer is to discuss the important aspects of HER2 biology, its significance in breast cancer, and the current standards for its detection. © 2014 by Lippincott Williams & Wilkins.

Daffner R.H.,Allegheny General Hospital
American Journal of Roentgenology | Year: 2015

OBJECTIVE. The purpose of this article is to share the views of an experienced expert witness in medical malpractice cases on the use of CT scout images. CONCLUSION. The medical literature has resurrected issues regarding viewing of CT scout images. Scout images are an integral part of any CT examination and should be carefully reviewed for findings that may or may not be included in the FOV of the study. © American Roentgen Ray Society.

BACKGROUND: We have shown that glucagon-like peptide-1 (GLP-1[7-36] amide) stimulates myocardial glucose uptake in dilated cardiomyopathy (DCM) independent of an insulinotropic effect. The cellular mechanisms of GLP-1-induced myocardial glucose uptake are unknown. METHODS AND RESULTS: Myocardial substrates and glucoregulatory hormones were measured in conscious, chronically instrumented dogs at control (n=6), DCM (n=9) and DCM after treatment with a 48-hour infusion of GLP-1 (7-36) amide (n=9) or vehicle (n=6). GLP-1 receptors and cellular pathways implicated in myocardial glucose uptake were measured in sarcolemmal membranes harvested from the 4 groups. GLP-1 stimulated myocardial glucose uptake (DCM: 20+/-7 nmol/min/g; DCM+GLP-1: 61+/-12 nmol/min/g; P=0.001) independent of increased plasma insulin levels. The GLP-1 receptors were upregulated in the sarcolemmal membranes (control: 98+/-2 density units; DCM: 256+/-58 density units; P=0.046) and were expressed in their activated (65 kDa) form in DCM. The GLP-1-induced increases in myocardial glucose uptake did not involve adenylyl cyclase or Akt activation but was associated with marked increases in p38alpha MAP kinase activity (DCM+vehicle: 97+/-22 pmol ATP/mg/min; DCM+GLP-1: 170+/-36 pmol ATP/mg/min; P=0.051), induction of nitric oxide synthase 2 (DCM+vehicle: 151+/-13 density units; DCM+GLP-1: 306+/-12 density units; P=0.001), and GLUT-1 translocation (DCM+vehicle: 21+/-3% membrane bound; DCM+GLP-1: 39+/-3% membrane bound; P=0.005). The effects of GLP-1 on myocardial glucose uptake were blocked by pretreatment with the p38alpha MAP kinase inhibitor or the nonspecific nitric oxide synthase inhibitor nitro-l-arginine. CONCLUSIONS: GLP-1 stimulates myocardial glucose uptake through a non-Akt-1-dependent mechanism by activating cellular pathways that have been identified in mediating chronic hibernation and the late phase of ischemic preconditioning.

Carlin B.W.,Allegheny General Hospital
Postgraduate Medicine | Year: 2012

Health care utilization and costs associated with chronic obstructive pulmonary disease (COPD) continue to increase, notwithstanding evidence-based management strategies described by major respiratory societies. Cardiovascular diseases, asthma, diabetes and its precursors (obesity and metabolic syndrome), depression, cognitive impairment, and osteoporosis are examples of common comorbidities that can affect or be affected by COPD. Appropriate diagnosis and management (from a pharmacologic and nonpharmacologic perspective) of COPD and its associated comorbidities are important to ensure optimal patient care. An evolving understanding of COPD as a multimorbid disease that affects an aging population, rather than just a lung-specific disease, necessitates an integrated, tailored disease-management approach to improve prognoses and reduce costs. © Postgraduate Medicine.

The purpose of this study was to assess the prognostic value of global magnetic resonance (MR) myocardial perfusion imaging (MPI) in women with suspected myocardial ischemia and no obstructive (stenosis <50%) coronary artery disease (CAD). The prognostic value of global MR-MPI in women without obstructive CAD remains unknown. Women (n = 100, mean age 57 ± 11 years, age range 31 to 76 years), with symptoms of myocardial ischemia and with no obstructive CAD, as assessed by coronary angiography, underwent MR-MPI and standard functional assessment. During follow-up (34 ± 16 months), time to first adverse event (death, myocardial infarction, or hospitalization for worsening anginal symptoms) was analyzed using global MPI and left ventricular ejection fraction (EF) data. Adverse events occurred in 23 (23%) women. Using univariable Cox proportional hazards regression modeling, variables found to be predictive of adverse events were global MR-MPI average uptake slope (p < 0.05), the ratio of MR-MPI peak signal amplitude to uptake slope (p < 0.05), and EF (p < 0.05). Two multivariable Cox models were formed, 1 using variables that were performance site dependent: ratio of MR-MPI peak amplitude to uptake slope together with EF (chi square: 13, p < 0.005); and a model using variables that were performance site independent: MR-MPI slope and EF (chi square: 12, p < 0.005). Each of the 2 multivariable models remained predictive of adverse events after adjustment for age, disease history, and Framingham risk score. For each of the Cox models, patients were categorized as high risk if they were in the upper quartile of the model and as not high risk otherwise. Kaplan-Meier analysis of time to event was performed for high risk versus not high risk for site-dependent (log rank: 15.2, p < 0.001) and site-independent (log rank: 13.0, p < 001) models. Among women with suspected myocardial ischemia and no obstructive CAD, MR-MPI-determined global measurements of normalized uptake slope and peak signal uptake, together with global functional assessment of EF, appear to predict prognosis. Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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