Wednesday, March 11, 2015

Usefulness of Regional Distribution of Coronary Artery Calcium to Improve the Prediction of All-Cause Mortality.

The prognostic ability of the Agatston score was found to be improved by determining how many vessels had coronary artery calcium (CAC). Compared with single vessel involvement, 2-vessel CAC increased mortality (HR=1.6) and 3-vessel involvement even more (HR=1.99). Left main CAC and diffuse CAC were also associated with increased mortality.  (Am J Cardiol. 2015 Feb 12)
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Wednesday, February 11, 2015

Atherosclerotic Plaque Characteristics by CT Angiography Identify Coronary Lesions That Cause Ischemia: A Direct Comparison to Fractional Flow Reserve.

Percent vessel stenosis of the coronary arteries is not a uniform predictor of myocardial ischemia. Other important factors include the atherosclerotic plaque characteristics of aggregate plaque volume percent, positive remodeling, low attenuation, and spotty calcification.  (JACC Cardiovasc Imaging. 2015 Jan;8(1):1-10)
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Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort. The MESA Study.

The presence of coronary artery calcium is an independent predictor of cerebrovascular events.  (JACC Cardiovasc Imaging. 2014 Nov;7(11):1108-15.)
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Sunday, December 14, 2014

Myocardial perfusion imaging in diabetes

Myocardial perfusion imaging for evaluation of suspected ischemia and its relationship with glycemic control in South African subjects with diabetes mellitus.
This study found that diabetics were more likely to have abnormal myocardial perfusion than non-diabetics. In addition, a HgbA1c > = 7.0% was associated with a greater risk of having an abnormal perfusion scan compared to diabetics with a HgbA1c of < 7.0%.

Diabetes Metab Syndr Obes. 2014;7:545-552

Direct Imaging of Ischemia

Direct Myocardial Ischemia Imaging: a New Cardiovascular Nuclear Imaging Paradigm.
This review article discusses in depth how to image myocardial ischemia directly as an alternative to stress-rest myocardial perfusion imaging. Techniques include the use of radiolabeled fatty acids and 18F-FDG. Read More

Thursday, November 20, 2014

Long-term mortality after a normal nuclear SPECT exam

Long-term mortality following normal exercise myocardial perfusion SPECT according to coronary disease risk factors.
QUESTION: does a normal SPECT study carry the same prognosis among different patient sub-groups according to risk factors?

METHODS: 12,232 patients with a normal exercise SPECT-MPI scan were evaluated.

RESULTS: The all cause morality rate overall was 0.8%/year, but varied according the the presence of risk factors. Hypertension, smoking, diabetes, exercise capacity, dyspnea, obesity, higher resting heart rate, an abnormal ECG, LVH, atrial fibrillation, and LVEF < 45% were all predictors of increased mortality.

  • 0.2% per year among non-smokers exercising for >9 minutes with no hypertension or diabetes
  • 1.6% per year among patients exercising <6 minutes at least 2 of the following: hypertension, diabetes, or smoking.

CONCLUSIONS: Mortality risk varies with comorbidities and is not exclusively dependent upon nuclear SPECT imaging results. 

J Nucl Cardiol. 2014 Apr;21(2):341-50

COMMENT: isn't it great that we are able to modify at least one of the primary risk factors (smoking)? 

Friday, October 31, 2014

Is Appropriate Use Similar for Cardiology and Non-Cardiology Providers?

Utilization patterns of single-photon emission cardiac tomography myocardial perfusion imaging studies in a rural tertiary care setting.
BACKGROUND: Appropriate use criteria (AUC) for single-photon emission computed tomographic myocardial perfusion imaging (SPECT MPI) were revised in 2009 to include 15 new clinical scenarios.

OBJECTIVE: are the appropriate utilization rates of SPECT MPI imaging similar for cardiology and non cardiology providers?

METHODS: all SPECT MPI studies performed for over a 6-month period at our center were reviewed.

RESULTS: 88% of studies were classified as appropriate, 5.5% as inappropriate,  and 7% as uncertain. The ordering provider specialty did not show any relation with appropriateness of the test (P = 0.46).

CONCLUSIONS: A great majority of MPI studies are performed for appropriate indications regardless of ordering provider specialty.

Clin Cardiol. 2014 Feb;37(2):67-72