Evaluation of ferroelectricity in a distorted wurtzite-type structure of Sc-doped LiGaO2.

Since the discovery of ferroelectricity in a wurtzite-type structure, this structural type has gathered much attention as a next-generation ferroelectric material due to its high polarization value combined with its high breakdown strength. However, the main targets of wurtzite-type ferroelectrics have been limited thus far to simple nitride/oxide compounds. The investigation of new ferroelectric materials with wurtzite-type structures is important for understanding ferroelectricity in such structures. We therefore focus on ß-LiGaO2 in this study. Although AlN and ZnO possess well-known wurtzite-type structures (P63mc), ß-LiGaO2 has a distorted wurtzite-type structure (Pna21), and there are no reports of ferroelectricity in LiGaO2. In this study, we have revealed that LiGaO2 exhibits relatively high barrier height energy for polarization switching, however, Sc doping effectively reduces that energy. Then, we conducted thin film preparation and evaluation for Sc-doped LiGaO2 to observe its ferroelectric properties. We successfully observed ferroelectric behavior by using piezoresponse force microscopy measurements for LiGa0.8Sc0.2O2/SrRuO3/(111)SrTiO3.

Achieving High Piezoelectric Performance across a Wide Composition Range in Tetragonal (Bi,Na)TiO3-BaTiO3 Films for Micro-electromechanical Systems.

Tetragonal (1-x)(Bi,Na)TiO3-xBaTiO3 films exhibit enhanced piezoelectric properties due to domain switching over a wide composition range. These properties were observed over a significantly wider composition range than the morphotropic phase boundary (MPB), which typically has a limited composition range of 1-2%. The polarization axis was found to be along the in-plane direction for the tetragonal composition range x = 0.06-1.0, attributed to the tensile thermal strain from the substrate during cooling after the film formation. A "two-step increase" in remanent polarization against an applied maximum electric field was observed at the high-field region due to the domain switching, and a very high piezoelectric response (effective d33 value, denoted as d33,f) over 220 pm/V was achieved for a wide composition range of x = 0.2-0.5 with high tetragonality, exceeding previously reported values for bulk ceramics. Moreover, a transverse piezoelectric coefficient, e31,f, of 19 C/m2 measured using a cantilever structure was obtained for a composition range of at least 10 atom % (for both x = 0.2 and 0.3). This value is the highest reported for Pb-free piezoelectric thin films and is comparable to the best data for Pb-based thin films. Reversible domain switching eliminates the need for conventional MPB compositions, allowing an improvement in the piezoelectric properties over a wider composition range. This strategy could provide a guideline for the development of environmentally acceptable lead-free piezoelectric films with composition-insensitive piezoelectric performance to replace Pb-based materials with MPB composition, such as PZT.

Unconventional polarization fatigue in van der Waals layered ferroelectric ionic conductor CuInP2S6.

Recent progress in two-dimensional ferroelectrics greatly expands the versatility and tunability in van der Waals heterostructure based electronics. However, the switching endurance issue that widely plagues conventional ferroelectrics in practical applications is hitherto unexplored for van der Waals layered ferroelectrics. Herein, we report the observation of unusual polarization fatigue behaviors in van der Waals layered CuInP2S6, which also possesses finite ionic conductivity at room temperature. The strong intertwinement of the short-range polarization switching and long-range ionic movement in conjunction with the van der Waals layered structure gives rise to unique morphological and polarization evolutions under repetitive electric cycles. With the help of concerted chemical, structural, lattice vibrational and dielectric analyses, we unravel the critical role of the synergy of ionic migration and surface oxidation on the anomalous polarization enhancement and the eventual polarization degradation. This work provides a general insight into the polarization fatigue characteristics in ionically-active van der Waals ferroelectrics and delivers potential solutions for the realization of fatigue-free capacitors.

Impact of proteinuria on long-term prognosis in patients with coronary artery disease.

BACKGROUND: This study aimed to investigate the association between proteinuria and long-term prognosis in patients with coronary artery disease. METHODS: This was a single-center observational study. A total of 1351 patients were identified who underwent percutaneous coronary intervention, and whose urine data were available. Patients were divided into two groups according to the presence (n = 245) or absence (n = 1106) of proteinuria. All-cause and cardiovascular deaths were primarily evaluated. RESULTS: The prevalence rates of hypertension and diabetes were significantly higher, and the baseline estimated glomerular filtration rate (eGFR) was lower in patients with proteinuria than in those without proteinuria. During the median follow-up of 4.1 years (interquartile range, 1.7-6.8 years), the occurrences of all-cause and cardiovascular deaths were significantly higher in patients with proteinuria. Multivariable Cox regression analysis indicated that the presence of proteinuria was a significant predictor of cardiovascular death as well as age, BMI, reduced eGFR, and left ventricular ejection fraction. When stratified into four groups based on eGFR category (eGFR <60 or ≥60 ml/min/1.73 m2) and absence or presence of proteinuria, the incidence rates of all-cause and cardiovascular deaths were highest in patients with proteinuria and eGFR less than 60 ml/min/1.73 m2. Furthermore, the incidence rates of all-cause and cardiovascular deaths were significantly higher in patients with proteinuria among both diabetic and nondiabetic patients. CONCLUSION: Proteinuria is associated with the long-term prognosis, and all-cause and cardiovascular deaths in patients with coronary artery disease, regardless of eGFR and the presence or absence of diabetes mellitus.

Heterogeneous Carotid Plaque Predicts Cardiovascular Events after Percutaneous Coronary Intervention.

AIM: The relationship between carotid artery ultrasound findings and clinical outcomes in patients who undergo percutaneous coronary intervention (PCI) has not been completely elucidated. METHODS: This single-center retrospective study investigated 691 patients who underwent PCI and carotid ultrasound testing. Maximum carotid intima-media thickness (CIMT) was defined as the greatest CIMT at the maximally thick point among the common carotid artery, carotid bulb, and internal carotid artery. A carotid plaque was defined as vessel wall thickening with a CIMT ≥ 1.5 mm. The characteristics of carotid plaque (heterogeneity, calcification, or irregular/ulcerated surface) were evaluated visually. Patients were divided into those with and without heterogeneous carotid plaque (maximum CIMT ≥ 1.5 mm and heterogeneous texture). The endpoint was the incidence of a major adverse cardiovascular event (MACE) defined as a composite of cardiovascular (CV) death, myocardial infarction, and ischemic stroke. RESULTS: Among 691 patients, 309 were categorized as having a heterogeneous plaque. Patients with heterogeneous plaques were at a higher risk of MACE than those without (p=0.002). A heterogeneous plaque was independently associated with MACE after adjusting for covariates (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.01-2.90; p=0.046). Calcified or irregular/ulcerated plaques were correlated with a higher incidence of MACE, but both were not independently associated with MACE (HR, 1.35; 95% CI, 0.69-2.64, p=0.38 and HR, 0.98; 95% CI, 0.57-1.69; p=0.95, respectively). CONCLUSION: The presence of a heterogeneous carotid plaque in patients who underwent PCI predicted future CV events. These patients may require more aggressive medical therapy and careful follow-up.

On the switching dynamics of epitaxial ferroelectric CeO2-HfO2 thin film capacitors.

Epitaxial layers of ferroelectric orthorhombic HfO2 are frequently investigated as model systems for industrially more relevant polycrystalline films. The recent success in stabilizing the orthorhombic phase in the solid-solution cerium oxide - hafnium oxide system allows detailed investigations of external influences during fabrication. This report analyzes the ferroelectric properties of two thin film capacitors, which were post-deposition annealed in N2 and O2 atmospheres to achieve the orthorhombic phase after room temperature deposition. The samples, which exhibit very similar constituent phase, appear identical in conventional polarization-field hysteresis measurements. However, a significant switching speed difference is observed in pristine devices. Continued field cycling reduces the difference. Deeper analysis of switching transients based on the Nucleation Limited Switching model suggests that the O2 heat treatment atmosphere results in an altered oxygen vacancy profile, which is reverted during ferroelectric cycling.

Quantification of the Electromechanical Measurements by Piezoresponse Force Microscopy.

Piezoresponse force microscopy (PFM) is widely used for characterization and exploration of the nanoscale properties of ferroelectrics. However, quantification of the PFM signal is challenging due to the convolution of various extrinsic and intrinsic contributions. Although quantification of the PFM amplitude signal has received considerable attention, quantification of the PFM phase signal has not been addressed. A properly calibrated PFM phase signal can provide valuable information on the sign of the local piezoelectric coefficient-an important and nontrivial issue for emerging ferroelectrics. In this work, two complementary methodologies to calibrate the PFM phase signal are discussed. The first approach is based on using a standard reference sample with well-known independently measured piezoelectric coefficients, while the second approach exploits the electrostatic sample-cantilever interactions to determine the parasitic phase offset. Application of these methodologies to studies of the piezoelectric behavior in ferroelectric HfO2 -based thin-film capacitors reveals intriguing variations in the sign of the longitudinal piezoelectric coefficient, d33,eff . It is shown that the piezoelectric properties of the HfO2 -based capacitors are inherently sensitive to their thickness, electrodes, as well as deposition methods, and can exhibit wide variations including a d33,eff sign change within a single device.

Automated Experiments of Local Non-Linear Behavior in Ferroelectric Materials.

An automated experiment in multimodal imaging to probe structural, chemical, and functional behaviors in complex materials and elucidate the dominant physical mechanisms that control device function is developed and implemented. Here, the emergence of non-linear electromechanical responses in piezoresponse force microscopy (PFM) is explored. Non-linear responses in PFM can originate from multiple mechanisms, including intrinsic material responses often controlled by domain structure, surface topography that affects the mechanical phenomena at the tip-surface junction, and the presence of surface contaminants. Using an automated experiment to probe the origins of non-linear behavior in ferroelectric lead titanate (PTO) and ferroelectric Al0.93 B0.07 N films, it is found that PTO shows asymmetric nonlinear behavior across a/c domain walls and a broadened high nonlinear response region around c/c domain walls. In contrast, for Al0.93 B0.07 N, well-poled regions show high linear piezoelectric responses, when paired with low non-linear responses regions that are multidomain show low linear responses and high nonlinear responses. It is shown that formulating dissimilar exploration strategies in deep kernel learning as alternative hypotheses allows for establishing the preponderant physical mechanisms behind the non-linear behaviors, suggesting that automated experiments can potentially discern between competing physical mechanisms. This technique can also be extended to electron, probe, and chemical imaging.

Preferential growth of (001)-oriented Bi2SiO5 thin films deposited on (101)-oriented rutile substrates and their ferroelectric and dielectric properties.

Ferroelectric thin films are important because of their great potential for use in various electric devices such as ferroelectric random-access memory. It was expected that Bi2SiO5, a Si-containing ferroelectric material, would show improved ferroelectricity by targeting a film with the (001)-orientation (polar-axis) on the substrate. Although there was a narrow process window for the deposition of the (010)/(001)-oriented Bi2SiO5 thin film, it was successfully prepared on a (101)-oriented TiO2 single substrate using the pulsed layer deposition technique. The optimum film deposition conditions and film thickness were found, and in this material, the volume fraction of the (001)-oriented domain reached about 70%. By controlling film orientation to the polar axis, the remanent polarization value of this film was 4.8 µC cm-2, which is the highest value among reported Bi2SiO5.

Exploring Physics of Ferroelectric Domain Walls in Real Time: Deep Learning Enabled Scanning Probe Microscopy.

The functionality of ferroelastic domain walls in ferroelectric materials is explored in real-time via the in situ implementation of computer vision algorithms in scanning probe microscopy (SPM) experiment. The robust deep convolutional neural network (DCNN) is implemented based on a deep residual learning framework (Res) and holistically nested edge detection (Hed), and ensembled to minimize the out-of-distribution drift effects. The DCNN is implemented for real-time operations on SPM, converting the data stream into the semantically segmented image of domain walls and the corresponding uncertainty. Further the pre-defined experimental workflows perform piezoresponse spectroscopy measurement on thus discovered domain walls, and alternating high- and low-polarization dynamic (out-of-plane) ferroelastic domain walls in a PbTiO3 (PTO) thin film and high polarization dynamic (out-of-plane) at short ferroelastic walls (compared with long ferroelastic walls) in a lead zirconate titanate (PZT) thin film is reported. This work establishes the framework for real-time DCNN analysis of data streams in scanning probe and other microscopies and highlights the role of out-of-distribution effects and strategies to ameliorate them in real time analytics.

Suppression of Pressure-Induced Phase Transitions in a Monoclinically Distorted LiNbO3-Type CuNbO3 by Preference for a CuO3 Triangular Coordination Environment.

Pressure-induced phase transitions in a monoclinically distorted LiNbO3-type CuNbO3 with triangularly coordinated Cu and octahedrally coordinated Nb were experimentally and computationally investigated. Phase transitions into GdFeO3-type or NaIO3-type structures generally observed in LiNbO3-type compounds below 30 GPa were not detected in CuNbO3 even at the maximum experimental pressure, 32.4 GPa. Our density functional theory calculations revealed that the phase transition is suppressed by the preference for the CuO3 triangular coordination environment, which reduces the total internal energy. This study clarifies that the change in the coordination environment of given ions can affect the pressure-induced phase transition.

Comparative study of fractional flow reserve and diastolic pressure ratio using a guidewire with a sensor for measuring intravascular pressure.

PURPOSE: This study aimed to evaluate the correlation and diagnostic agreement between diastolic pressure ratio (dPR) and fractional flow reserve (FFR) in a Japanese real-world setting. DESIGN: Prospective multicenter observational study. METHODS: This study included 100 patients with intermediate coronary artery stenosis at 4 Japanese hospitals. For these lesions, FFR and dPR were measured using a guidewire with a sensor and a monitor to measure intravascular pressure. The correlation and diagnostic agreement between FFR and dPR were assessed. When both FFR and dPR were negative or positive, the results were considered to be concordant. When one was positive and the other was negative, the result was regarded as discordant (positive discordance, FFR > 0.80 and dPR ≤ 0.89; negative discordance, FFR ≤ 0.80 and dPR > 0.89). RESULTS: Overall, the FFR and dPR were well-correlated (R = 0.841). FFR and dPR were concordant in 89% of cases (concordant normal, 43%; concordant abnormal, 46%) and discordant in 11% (positive discordance, 7%; negative discordance, 4%). No significant difference was observed in the rate of concordant results between patients with and without diabetes mellitus. The diagnostic concordance rate was significantly different among the 3 coronary arteries (right coronary artery, 93.3%; left anterior descending artery, 93.2%; and left circumflex artery, 58.3%; P = .001). Additionally, the rate of concordant results tended to be higher when using intravenous administration of adenosine than when using intracoronary bolus injection of nicorandil (adenosine, 95.1%; nicorandil, 84.7%; P = .103). CONCLUSION: We found that dPR was highly correlated with FFR, and diagnostic discordance was observed in 11% of the lesions. Several factors, including lesion location and medication for hyperemia, may cause the diagnostic discordance between dPR and FFR.

Large Piezoelectric Response in Lead-Free (Bi0.5Na0.5)TiO3-Based Perovskite Thin Films by Ferroelastic Domain Switching: Beyond the Morphotropic Phase Boundary Paradigm.

Strong electromechanical coupling is observed in tetragonal Pb-free 0.7(Bi0.5Na0.5)TiO3-0.3BaTiO3 films, which is far from the morphotropic phase boundary, prepared by pulsed laser deposition on a Si substrate. The tensile strain induced during cooling causes in-plane polarization in an oriented film on a Si substrate, while an epitaxial film grown on a SrTiO3 substrate exhibits out-of-plane polarization. S-E curve analysis reveals that the obtained piezoelectric coefficient for the film on the Si substrate (d33,f ≈ 275 pm/V) is approximately eight times higher than that for the epitaxial film on the SrTiO3 substrate (d33,f ≈ 34 pm/V). In situ X-ray diffraction analysis confirms the occurrence of domain switching under an electric field from in-plane to out-of-plane polarization. An effective piezoelectric stress coefficient, e31,eff, of ∼19 C/m2 is obtained from a Si cantilever sample, which is the highest among the reported values for Pb-free piezoelectric films and is comparable to those for Pb-based films. The significant piezoelectric response produced by domain switching in the Pb-free materials with the composition far from the morphotropic phase boundary will expand future applications due to their both outstanding properties and environmental sustainability.

Autonomous Experiments in Scanning Probe Microscopy and Spectroscopy: Choosing Where to Explore Polarization Dynamics in Ferroelectrics.

Polarization dynamics in ferroelectric materials are explored via automated experiment in piezoresponse force microscopy/spectroscopy (PFM/S). A Bayesian optimization (BO) framework for imaging is developed, and its performance for a variety of acquisition and pathfinding functions is explored using previously acquired data. The optimized algorithm is then deployed on an operational scanning probe microscope (SPM) for finding areas of large electromechanical response in a thin film of PbTiO3, with results showing that, with just 20% of the area sampled, most high-response clusters were captured. This approach can allow performing more complex spectroscopies in SPM that were previously not possible due to time constraints and sample stability. Improvements to the framework to enable the incorporation of more prior information and improve efficiency further are modeled and discussed.

The Influence of Eicosapentaenoic Acid to Arachidonic Acid Ratio on Long-term Cardiovascular Events Following Percutaneous Coronary Intervention.

Objective The relationship between cardiovascular disease and the serum polyunsaturated fatty acid parameters has been reported. The aim of the present study was to investigate the association between the eicosapentaenoic acid and arachidonic acid (EPA/AA) ratio and long-term cardiovascular events in patients with coronary artery disease. Methods We identified a total of 831 patients who underwent percutaneous coronary intervention and whose EPA/AA ratio was available. The patients were divided into two groups according to their serum EPA/AA ratio (median, 0.29; interquartile range 0.19-0.47): those in the lower quartile of EPA/AA ratios (Low EPA/AA group; n=231) and all other subjects (High EPA/AA group; n=600). The primary endpoints included a composite of cardiovascular death, myocardial infarction, and ischemic stroke. Results Patients in the Low EPA/AA group were significantly younger (66.0±12.6 years vs. 69.9±9.3 years, p<0.001), current smokers (33.3% vs. 22.7%, p=0.002), and had a history of myocardial infarction (20.3% vs. 12.3%, p=0.003). During the follow-up (median, 1,206 days; interquartile range, 654-1,910 days), the occurrence of the primary endpoint was significantly higher in the Low EPA/AA group than in the High EPA/AA group. Of note, the rate of cardiovascular death was significantly higher in the Low EPA/AA group, and the rates of myocardial infarction and stroke tended to be higher. Conclusion A low EPA/AA ratio was associated with long-term adverse cardiovascular events in Japanese patients with coronary artery disease.

Relationship between epicardial adipose tissue volume and coronary artery spasm.

BACKGROUND: Epicardial adipose tissue (EAT) is considered to play a critical role in vascular endothelial function. Coronary artery spasm has been postulated to be a causal factor in vascular endothelial abnormalities and atherosclerosis. This study aimed to investigate the relationship between coronary artery spasm and EAT volume, total abdominal adipose tissue (AAT) area, and abdominal visceral adipose tissue (AVAT) area. METHOD: Among patients undergoing coronary computed tomography (CT) to evaluate coronary artery disease, we identified 110 patients who did not have significant coronary artery stenosis and underwent a coronary spasm provocation test with cardiac catheterization. They were divided into two groups according to the results of the spasm provocation test: spasm-positive and spasm-negative. EAT volume, total AAT area, and AVAT area were evaluated using CT images. RESULTS: Seventy-seven patients were included in the spasm-positive group and 33 patients in the spasm-negative group. There were no significant differences in baseline clinical characteristics between the two groups, except for the prevalence of current smoking (48% vs. 27%, p = 0.04). EAT volume was significantly higher in the spasm-positive group (108 ±â€¯38 mL vs. 87 ±â€¯34 mL, p = 0.007), while no significant difference was seen in total AAT area (280 ±â€¯113 cm2 vs. 254 ±â€¯128 cm2, p = 0.32) or AVAT area (112 ±â€¯54 cm2 vs. 98 ±â€¯55 cm2, p = 0.27). Multivariate logistic analysis indicated that EAT volume (per 10 cm3) (odds ratio, 1.198; 95% confidence interval, 1.035-1.388; p = 0.016) was a significant predictor of coronary artery spasm. CONCLUSION: Our results suggest that EAT has a strong association with coronary artery spasm, while AAT may not.

Dynamic Manipulation in Piezoresponse Force Microscopy: Creating Nonequilibrium Phases with Large Electromechanical Response.

Domain walls and topological defects in ferroelectric materials have emerged as a powerful tool for functional electronic devices including memory and logic. Similarly, wall interactions and dynamics underpin a broad range of mesoscale phenomena ranging from giant electromechanical responses to memory effects. Exploring the functionalities of individual domain walls, their interactions, and controlled modifications of the domain structures is crucial for applications and fundamental physical studies. However, the dynamic nature of these features severely limits studies of their local physics since application of local biases or pressures in piezoresponse force microscopy induce wall displacement as a primary response. Here, we introduce an approach for the control and modification of domain structures based on automated experimentation, whereby real-space image-based feedback is used to control the tip bias during ferroelectric switching, allowing for modification routes conditioned on domain states under the tip. This automated experiment approach is demonstrated for the exploration of domain wall dynamics and creation of metastable phases with large electromechanical response.

Electric-Field-Driven Nanosecond Ferroelastic-Domain Switching Dynamics in Epitaxial Pb(Zr,Ti)O_{3} Film.

Epitaxial oxide ferroelectric films exhibit emerging phenomena arising from complex domain configurations even at pseudoequilibrium, including the creation of domain states unfavored in nature and abrupt piezoelectric coefficients around morphotropic phase boundaries. The nanometer-sized domain configurations and their domain switching dynamics under external stimuli are directly linked to the ultrafast manipulation of ferroelectric thin films; however, complex domain switching dynamics under homogeneous electric fields has not been fully explored, especially at the nanosecond timescale. This Letter reports the nanosecond dynamics of ferroelastic-domain switching from the 90° to 180° direction using time-resolved x-ray microdiffraction under homogeneous electric fields onto an epitaxial Pb(Zr_{0.35},Ti_{0.65})O_{3} film capacitor. It is found that the application of electric fields induces spatially heterogeneous domain switching processes via intermediate domain structures with rotated polarization vectors. In addition, the domain switching time is shown to be inversely proportional to the magnitude of the applied electric field, and electric fields higher than 480 kV/cm are found to complete the ferroelastic switching within nanoseconds.

Origin of giant negative piezoelectricity in a layered van der Waals ferroelectric.

Recent research on piezoelectric materials is predominantly devoted to enhancing the piezoelectric coefficient, but overlooks its sign, largely because almost all of them exhibit positive longitudinal piezoelectricity. The only experimentally known exception is ferroelectric polymer poly(vinylidene fluoride) and its copolymers, which condense via weak van der Waals (vdW) interaction and show negative piezoelectricity. Here we report quantitative determination of giant intrinsic negative longitudinal piezoelectricity and electrostriction in another class of vdW solids-two-dimensional (2D) layered ferroelectric CuInP2S6. With the help of single crystal x-ray crystallography and density-functional theory calculations, we unravel the atomistic origin of negative piezoelectricity in this system, which arises from the large displacive instability of Cu ions coupled with its reduced lattice dimensionality. Furthermore, the sizable piezoelectric response and negligible substrate clamping effect of the 2D vdW piezoelectric materials warrant their great potential in nanoscale, flexible electromechanical devices.

Clinical Characteristics of Nonobese Patients with Acute Coronary Syndrome and Increased Epicardial Fat Volume.

AIM: Increased epicardial fat volume (EFV) is an independent risk factor for acute coronary syndrome (ACS). Although EFV increases with body mass index (BMI), some ACS patients have an increased EFV but normal BMI. We here investigated the clinical characteristics of nonobese ACS patients with an increased EFV. METHODS: A total of 197 Japanese patients hospitalized for ACS was evaluated for EFV, abdominal visceral fat area (VFA), and lipid and glucose profiles. Control subjects comprised 141 individuals who were suspected of having ACS but whose coronary computed tomography findings were normal. RESULTS: EFV was increased in ACS patients compared with control subjects (120±47 versus 95±45 mL, P＜0.01). ACS patients were divided into four groups based on average EFV (120 mL) and a BMI obesity cutoff of 25 kg/m2. For the 30 nonobese ACS patients with an above-average EFV, EFV was positively correlated with VFA (r=0.23, P=0.031). These individuals were significantly older (74±10 years) and tended to have a higher homeostasis model assessment-insulin resistance value (5.5±3.8) compared with other ACS patients. Among nonobese study subjects, EFV was independently associated with ACS (odds ratio=2.01, P=0.021) and correlated with abdominal circumference (r=0.26, P=0.017). CONCLUSION: Nonobese ACS patients with an increased EFV were elderly and tended to manifest insulin resistance. Measurement of EFV may prove informative for evaluation of ACS risk among elderly nonobese individuals with an increased abdominal girth.