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Bradley SM, Maddox TM, Stanislawski MA, O’Donnell CI, Grunwald GK, Tsai TT, Ho PM, Peterson ED, Rumsfeld JS. Normal Coronary Rates for Elective Angiography in the Veterans Affairs Healthcare System. J Am Coll Cardiol 2014; 63:417-26. [DOI: 10.1016/j.jacc.2013.09.055] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/22/2013] [Accepted: 09/10/2013] [Indexed: 11/29/2022]
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Sadick V, Trinh L, Fernandes G, Pau P, Spiteri M, Vu LA, Gurunathan P, Shoy VL, Robinson J. Does biplane imaging reduce contrast load, procedural and screening time compared to single-plane imaging in routine diagnostic coronary angiography? ACTA ACUST UNITED AC 2013. [DOI: 10.1002/j.2051-3909.2008.tb00079.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Victoria Sadick
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Linda Trinh
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Ginella Fernandes
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Pedro Pau
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Michael Spiteri
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Lan Ahn Vu
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Pratheesh Gurunathan
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Victoria Lee Shoy
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - John Robinson
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
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Danad I, Raijmakers PG, Knaapen P. Diagnosing coronary artery disease with hybrid PET/CT: it takes two to tango. J Nucl Cardiol 2013; 20:874-90. [PMID: 23842709 DOI: 10.1007/s12350-013-9753-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The noninvasive diagnosis of coronary artery disease (CAD) is a challenging task. Although a large armamentarium of imaging modalities is available to evaluate the functional consequences of the extent and severity of CAD, cardiac perfusion positron emission tomography (PET) is considered the gold standard for this purpose. Alternatively, noninvasive anatomical imaging of coronary atherosclerosis with coronary computed tomography angiography (CCTA) has recently been successfully implemented in clinical practice. Although each of these diagnostic approaches has its own merits and caveats, functional and morphological imaging techniques provide fundamentally different insights into the disease process and should be considered to be complementary rather than overlapping. Hybrid imaging with PET/CT offers the possibility to evaluate both aspects nearly simultaneously, and studies have demonstrated that such a comprehensive assessment results in superior diagnostic accuracy, better prognostication, and helps in guiding clinical patient management. The aim of this review is to discuss the value of stand-alone CCTA and PET in CAD, and to summarize the available data on the surplus value of hybrid PET/CT including its strengths and limitations.
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Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Cost-effectiveness of a novel blood-pool contrast agent in the setting of chest pain evaluation in an emergency department. AJR Am J Roentgenol 2013; 201:710-9. [PMID: 24059359 DOI: 10.2214/ajr.12.9946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We evaluated three diagnostic strategies with the objective of comparing the current standard of care for individuals presenting acute chest pain and no history of coronary artery disease (CAD) with a novel diagnostic strategy using an emerging technology (blood-pool contrast agent [BPCA]) to identify the potential benefits and cost reductions. MATERIALS AND METHODS A decision analytic model of diagnostic strategies and outcomes using a BPCA and a conventional agent for CT angiography (CTA) in patients with acute chest pain was built. The model was used to evaluate three diagnostic strategies: CTA using a BPCA followed by invasive coronary angiography (ICA), CTA using a conventional agent followed by ICA, and ICA alone. RESULTS The use of the two CTA-based triage tests before ICA in a population with a CAD prevalence of less than 47% was predicted to be more cost-effective than ICA alone. Using the base-case values and a cost premium for BPCA over the conventional CT agent (cost of BPCA ≈ 5× that of a conventional agent) showed that CTA with a BPCA before ICA resulted in the most cost-effective strategy; the other strategies were ruled out by simple dominance. The model strongly depends on the rates of complications from the diagnostic tests included in the model. In a population with an elevated risk of contrast-induced nephropathy (CIN), a significant premium cost per BPCA dose still resulted in the alternative whereby CTA using BPCA was more cost-effective than CTA using a conventional agent. A similar effect was observed for potential complications resulting from the BPCA injection. Conversely, in the presence of a similar complication rate from BPCA, the diagnostic strategy of CTA using a conventional agent would be the optimal alternative. CONCLUSION BPCAs could have a significant impact in the diagnosis of acute chest pain, in particular for populations with high incidences of CIN. In addition, a BPCA strategy could garner further savings if currently excluded phenomena including renal disease and incidental findings were included in the decision model.
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Danad I, Raijmakers PG, Harms HJ, van Kuijk C, van Royen N, Diamant M, Lammertsma AA, Lubberink M, van Rossum AC, Knaapen P. Effect of cardiac hybrid ¹⁵O-water PET/CT imaging on downstream referral for invasive coronary angiography and revascularization rate. Eur Heart J Cardiovasc Imaging 2013; 15:170-9. [PMID: 23839653 DOI: 10.1093/ehjci/jet125] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS This study evaluates the impact of hybrid imaging on referral for invasive coronary angiography (ICA) and revascularization rates. METHODS AND RESULTS A total of 375 patients underwent hybrid (15)O-water positron emission tomography (PET)/computed tomography (CT)-based coronary angiography (CTCA) imaging for the evaluation of coronary artery disease (CAD). Downstream treatment strategy within a 60-day period after hybrid PET/CTCA imaging for ICA referral and revascularization was assessed. CTCA examinations were classified as showing no (obstructive) CAD, equivocal (borderline test result), or obstructive CAD, while the PET perfusion images were classified into normal or abnormal. On the basis of CTCA imaging, 182 (49%) patients displayed no (obstructive) CAD. Only 10 (5%) patients who showed no (obstructive) CAD on CTCA were referred for ICA, which were all negative. An equivocal CT study was observed in 80 (21%) patients, among whom 56 (70%) showed normal myocardial perfusion imaging (MPI), resulting in referral rates for ICA of 18% for normal MPI and 71% for abnormal MPI, respectively. No revascularizations were performed in the presence of normal MPI, while 59% of those with abnormal MPI were revascularized. CTCA indentified obstructive CAD in 113 (30%) patients accompanied in 59 (52%) patients with abnormal MPI. Referral rate for ICA was 57% for normal MPI and 88% for those with abnormal MPI, resulting in revascularization rates of 26% and 72%, respectively. CONCLUSION Hybrid (15)O-water PET/CTCA imaging impacts clinical decision-making with regard to referral for ICA and revascularization procedures. Particularly, in the presence of an equivocal or abnormal CTCA, MPI could guide in the decision to refer for ICA and revascularization.
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Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
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Smith IR, Cameron J, Brighouse RD, Ryan CM, Foster KA, Rivers JT. Impact of quantitative feedback and benchmark selection on radiation use by cardiologists performing cardiac angiography. RADIATION PROTECTION DOSIMETRY 2013; 155:32-41. [PMID: 23081936 DOI: 10.1093/rpd/ncs273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Audit of and feedback on both group and individual data provided immediately after the point of care and compared with realistic benchmarks of excellence have been demonstrated to drive change. This study sought to evaluate the impact of immediate benchmarked quantitative case-based performance feedback on the clinical practice of cardiologists practicing at a private hospital in Brisbane, Australia. The participating cardiologists were assigned to one of two groups: Group 1 received patient and procedural details for review and Group 2 received Group 1 data plus detailed radiation data relating to the procedures and comparative benchmarks. In Group 2, Linear-by-Linear Association analysis suggests a link between change in radiation use and initial radiation dose category (p=0.014) with only those initially 'challenged' by the benchmarks showing improvement. Those not 'challenged' by the benchmarks deteriorated in performance compared with those starting well below the benchmarks showing greatest increase in radiation use. Conversely, those blinded to their radiation use (Group 1) showed general improvement in radiation use throughout the study compared with those performing initially close to the benchmarks showing greatest improvement. This study shows that use of non-challenging benchmarks in case-based radiation risk feedback does not promote a reduction in radiation use; indeed, it may contribute to increased doses. Paradoxically, cardiologists who are aware of performance monitoring but blinded to individual case data appear to maintain, if not reduce, their radiation use.
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Affiliation(s)
- Ian R Smith
- St Andrew's Medical Institute, 457 Wickham Terrace, Spring Hill, QLD 4001, Australia
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Borges Santos M, Ferreira AM, de Araújo Goncalves P, Raposo L, Campante Teles R, Almeida M, Mendes M. Diagnostic yield of current referral strategies for elective coronary angiography in suspected coronary artery disease—An analysis of the ACROSS registry. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Borges Santos M, Ferreira AM, Araújo Gonçalves PD, Raposo L, Campante Teles R, Almeida M, Mendes M. Diagnostic yield of current referral strategies for elective coronary angiography in suspected coronary artery disease—An analysis of the ACROSS registry. Rev Port Cardiol 2013; 32:483-8. [DOI: 10.1016/j.repc.2012.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/01/2012] [Indexed: 10/26/2022] Open
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Scaglione M, Ebrille E, Caponi D, Blandino A, DI Donna P, Siboldi A, Bertero G, Anselmino M, Raimondo C, Sardi D, Gabbarini F, Marasini M, Gaita F. Single center experience of fluoroless AVNRT ablation guided by electroanatomic reconstruction in children and adolescents. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1460-7. [PMID: 23713835 DOI: 10.1111/pace.12183] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/26/2013] [Accepted: 04/02/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anatomical considerations and risks related to x-ray exposure make atrioventricular nodal reentrant tachycardia (AVNRT) ablation in pediatric patients a concerning procedure. We aimed to evaluate the feasibility, safety, and efficacy of performing fluoroless slow-pathway cryoablation guided by the electroanatomic (EA) mapping in children and adolescents. METHODS Twenty-one consecutive patients (mean age 13.5 ± 2.4 years) symptomatic for AVNRT were prospectively enrolled to right atrium EA mapping and electrophysiological study prior to cryoablation. Cryoablation was guided by slow-pathway potential and performed using a 4-mm-tip catheter. RESULTS Sustained slow-fast AVNRT was inducible in all the patients with a dual AV nodal physiology in 95%. Acute success was achieved in 100% of the patients with a median of two cryo-applications. Fluoroless ablation was feasible in 19 patients, while in two subjects 50 seconds and 45 seconds of x-ray were needed due to difficult progression of the catheters along the venous system. After a mean follow-up of 25 months, AVNRT recurred in five patients. All the recurrences were successfully treated with a second procedure. In three patients, a fluoroless cryoablation with a 6-mm-tip catheter was successfully performed, while in the remaining two patients, a single pulse of 60 seconds of radiofrequency energy was applied under fluoroscopic monitoring. No complications occurred. CONCLUSIONS Combination of EA mapping systems and cryoablation may allow to perform fluoroless slow-pathway ablation for AVNRT in children and adolescents in the majority of patients. Fluoroless slow-pathway cryoablation showed a high efficacy and safety comparable to conventional fluoroscopy guided procedures.
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Affiliation(s)
- Marco Scaglione
- Cardiology Department, Cardinal Massaia Hospital, Asti, Italy
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Carr JJ, Hendel RC, White RD, Patel MR, Wolk MJ, Bettmann MA, Douglas P, Rybicki FJ, Kramer CM, Woodard PK, Shaw LJ, Yucel EK. 2013 Appropriate Utilization of Cardiovascular Imaging. J Am Coll Cardiol 2013; 61:2199-206. [DOI: 10.1016/j.jacc.2013.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Society for Vascular Nursing clinical practice guideline (CPG) for carotid artery stenting. JOURNAL OF VASCULAR NURSING 2013; 31:32-55. [PMID: 23481879 DOI: 10.1016/j.jvn.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 11/30/2012] [Accepted: 12/03/2012] [Indexed: 02/07/2023]
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Byrd JB, Vigen R, Plomondon ME, Rumsfeld JS, Box TL, Fihn SD, Maddox TM. Data quality of an electronic health record tool to support VA cardiac catheterization laboratory quality improvement: the VA Clinical Assessment, Reporting, and Tracking System for Cath Labs (CART) program. Am Heart J 2013; 165:434-40. [PMID: 23453115 DOI: 10.1016/j.ahj.2012.12.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 12/17/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electronic health records (EHRs) have been identified as a key tool for quality improvement (QI) in health care. However, EHR data must be of sufficient quality to support QI efforts. In 2005, the Department of Veterans Affairs (VA) began using a novel EHR tool-the CART Program-to support QI in cardiac catheterization laboratories. We evaluated whether data collected by the CART Program were of sufficient quality to support QI. METHODS We evaluated the data validity, completeness, and timeliness of CART Program data using a random sample of 200 coronary procedures performed in 10 geographically diverse VA medical centers. RESULTS Of 1690 observations in the CART Program data repository, 1664 (98.5%) were valid, as compared to the VA medical record. The CART Program reports were more complete than cardiac catheterization laboratory reports generated prior to CART Program implementation (79% vs. 63.1%, P < .001). Finally, there was a trend toward earlier availability of completed procedure reports to treating providers after CART Program implementation, with 75% of CART Program reports available within 1 day compared to 4 days for reports generated prior to CART Program implementation (P = .06). CONCLUSIONS Cardiac catheterization reports generated by the VA's CART Program demonstrate excellent data validity, superior completeness, and a trend toward more timely availability to referring providers relative to cardiac catheterization laboratory reports generated prior to CART Program implementation. This demonstration of data quality is a key step in realizing CART Program's aim of supporting QI efforts in VA catheter laboratories.
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Affiliation(s)
- James Brian Byrd
- Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
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Silent coronary artery disease in Japanese patients undergoing carotid artery stenting. J Stroke Cerebrovasc Dis 2013; 22:1163-8. [PMID: 23352686 DOI: 10.1016/j.jstrokecerebrovasdis.2012.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 11/25/2012] [Accepted: 12/21/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The aim of this retrospective study was to determine the prevalence of silent coronary artery disease (CAD) and the risk factors associated with concomitant CAD in Japanese patients undergoing carotid artery stenting (CAS). METHODS The records of 112 consecutive patients (99 men and 13 women; mean age 70 ± 8 years) who underwent elective CAS at our institution for extracranial carotid artery stenosis between January 2006 and January 2011 were reviewed retrospectively. During this period, preoperative CAD screening by coronary angiography was performed in all patients. Patients were diagnosed with CAD when ≥ 1 coronary arteries had stenosis ≥ 75% and were classified into 2 groups: (1) a group with CAD that was based on preoperative coronary angiography or a history of percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG), and (2) a group without CAD that had no angiographically documented stenosis ≥ 75%. RESULTS Sixteen (14.3%) patients had CAD that had already been treated by PCI and/or CABG. Silent CAD was detected in 39 (34.8%) of 112 patients. Taken together, 55 (49.1%) patients had clinically significant CAD. The patients with CAD were more likely to have diabetes mellitus (DM; P = .001), dyslipidemia (P = .013), and bilateral carotid disease (P = .033). Multivariate analysis revealed that DM (odds ratio 3.07; 95% confidence interval 1.25-7.53) and bilateral carotid stenosis (odds ratio 2.72; 95% confidence interval 1.10-6.75) were independent variables associated with concomitant CAD. CONCLUSIONS Perioperative CAD screening revealed that silent CAD was frequently diagnosed in Japanese patients scheduled for CAS, particularly in those with DM and/or bilateral carotid stenosis.
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Wray C, Scovotti JC, Tobis J, Niemann CU, Planinsic R, Walia A, Findlay J, Wagener G, Cywinski JB, Markovic D, Hughes C, Humar A, Olmos A, Sierra R, Busuttil R, Steadman RH. Liver transplantation outcome in patients with angiographically proven coronary artery disease: a multi-institutional study. Am J Transplant 2013; 13:184-91. [PMID: 23126562 DOI: 10.1111/j.1600-6143.2012.04293.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 08/01/2012] [Accepted: 08/22/2012] [Indexed: 01/25/2023]
Abstract
Over the last decade the age of liver transplant (LT) recipients and the likelihood of coronary artery disease (CAD) in this population have increased. There are no multicenter studies that have examined the impact of CAD on LT outcomes. In this historical cohort study, we identified adult LT recipients who underwent angiography prior to transplantation at seven institutions over a 12-year period. For each patient we recorded demographic data, recipient and donor risk factors, duration of follow-up, the presence of angiographically proven obstructive CAD (≥50% stenosis) and post-LT survival. Obstructive CAD was present in 151 of 630 patients, the CAD(+) group. Nonobstructive CAD was found in 479 patients, the CAD(-) group. Patient survival was similar for the CAD(+) group (adjusted HR 1.13, CI = [0.79, 1.62], p = 0.493) compared to the CAD(-) group. The CAD(+) patients were further stratified into severe (CADsev, >70% stenosis, n = 96), and moderate CAD (CADmod, 50-70% stenosis, n = 55) groups. Survival for the CADsev (adjusted HR = 1.26, CI = [0.83, 1.91], p = 0.277) and CADmod (adjusted HR = 0.93, CI = [0.52, 1.66], p = 0.797) groups were similar to the CAD(-) group. We conclude that when current CAD treatment strategies are employed prior to transplant, post-LT survival is not significantly different between patients with and without obstructive CAD.
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Affiliation(s)
- C Wray
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Orsini E, Antoncecchi E, Carbone V, Dato A, Monducci I, Nistri S, Zito GB. Indications, Utility and Appropriateness of Echocardiography in Outpatient Cardiology. J Cardiovasc Echogr 2013; 23:24-32. [PMID: 28465880 PMCID: PMC5353437 DOI: 10.4103/2211-4122.117982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Respect of "appropriateness" is considered an essential requirement, both on the clinical and the economic profile, and also as it helps to shorten the waiting list. However, only a few studies have dealt with the control of appropriateness in clinical practice, and most of them have focused only on hospital admissions and invasive procedures. MATERIALS AND METHODS INDICARD-out is a prospective, multicenter study carried out by A.R.C.A. (Associazioni Regionali Cardiologi Ambulatoriali) cardiologists from 13 Italian Regions, providing information on indications, utility and appropriateness of echocardiography in outpatient cardiology. RESULTS A total of 2110 prescriptions for echocardiogram were evaluated. Hypertension (23%) and the screening of asymptomatic subjects (17%) by far were the most frequent indications to echocardiography. Overall, 54% of the tests resulted appropriate, 30% were of uncertain appropriateness and 16% were inappropriate. Besides, 31% of the echocardiograms were not useful, and 28% were non pertinent for patient management. The vast majority of prescriptions (72%) came from non-cardiologist physicians (54% from general practitioners). The echocardiograms prescribed by cardiologists were significantly more appropriate, more useful and more pertinent than the tests prescribed by non-cardiologists. CONCLUSIONS The appropriateness, utility and pertinence of the echocardiography are still suboptimal in practice cardiology, especially when indicated by non-cardiologists. The cardiologist, from mere executor of tests prescribed and managed by other physicians, should gain the role of the clinician who takes care of all the cardiologic needs of the patient community.
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Affiliation(s)
| | - Enrico Orsini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Italy
| | | | | | - Achille Dato
- Cardiovascular Diagnostic Centre, Paternò (CT), Italy
| | - Igor Monducci
- Cardiology, Private Medical Centre Lazzaro Spallanzani, Reggio Emilia, Italy
| | - Stefano Nistri
- Outpatient Cardiology, CMSR-Veneto Medica, Altavilla Vicentina (VI), Italy
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Multislice computed tomography to rule out coronary allograft vasculopathy in heart transplant patients. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Jug B, Gupta M, Papazian J, Li D, Tsang J, Bhatia H, Karlsberg R, Budoff M. Diagnostic performance of 64-slice multidetector coronary computed tomographic angiography in women. J Nucl Cardiol 2012; 19:1154-61. [PMID: 23065417 DOI: 10.1007/s12350-012-9630-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 09/17/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnostic approach to chest pain in women is challenging, but still under-investigated. The purpose of this study was to assess the diagnostic performance of 64-slice multidetector coronary computed tomographic angiography (CCTA) in women with chest pain. METHODS AND RESULTS We included 606 patients--255 women and 351 men (mean age 61 ± 12 years for both)--who had been referred for a CCTA and an invasive coronary angiography (diagnostic standard) because of chest pain, either as part of clinical work-up in two urban medical centers or as part of the multicenter ACCURACY trial. On a patient-based model, the sensitivity, specificity, and positive predictive value (PPV) and negative predictive value to detect ≥50% and ≥70% stenosis were 98%, 84%, 87%, and 97% and 96%, 83%, 77%, and 97%, respectively, for women and 97%, 83%, 89%, and 95% and 94%, 91%, 90%, and 94%, respectively, for men. There were no statistically significant differences between men and women in diagnostic performance measures except for the PPV of detecting a ≥70% stenosis (P = .007). CONCLUSION In women with chest pain, 64-slice multidetector CCTA is at least as sensitive and specific as in men. Our findings suggest that CCTA is a promising diagnostic tool for timely detection and/or exclusion of CAD in symptomatic intermediate-risk female populations.
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Affiliation(s)
- Borut Jug
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, 1124 W Carson St, Torrance, CA 90502, USA
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Stone PA, Campbell JE. Complications Related to Femoral Artery Access for Transcatheter Procedures. Vasc Endovascular Surg 2012; 46:617-23. [DOI: 10.1177/1538574412457475] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Percutaneous-based procedures continue to increase as endovascular techniques improve and provide a less morbid approach than the open vascular procedures. The most common complications associated with either cardiac interventions or peripheral interventions involve the access point of the procedure. The retrograde femoral access has and is currently the most frequently used arterial access. Vascular surgeons have been responsible for management of complications following femoral-based procedures and now are a significant contributor to catheter-based diagnostic and interventional procedures. This review provides in-depth review of the literature on specific complications encountered during percutaneous femoral artery puncture. This review includes access complications related to the method of obtaining access (ie, best pulse fluoroscopic guided), direction of access either retrograde or antegrade, risk factors and incidence of complications based on best literature sources, and management strategies for specific complications.
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Affiliation(s)
- Patrick A. Stone
- Division of Vascular & Endovascular Surgery, WVU, Charleston, WV, USA
| | - John E. Campbell
- Division of Vascular & Endovascular Surgery, WVU, Charleston, WV, USA
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Anuradha S, Subramanyan R, Agarwal R, Pezzella AT, Cherian KM. Hybrid stage I palliation for hypo-plastic left heart condition without a hybrid suite: suggestions for developing nations. Indian Heart J 2012; 64:333-7. [PMID: 22929813 DOI: 10.1016/j.ihj.2012.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 03/31/2012] [Accepted: 05/28/2012] [Indexed: 11/17/2022] Open
Abstract
Cardiac hybrid procedures are performed in modern, spacious, and highly equipped hybrid suites in developed countries. Organizing such expensive suites in countries with an emerging economy is difficult from both a financial and logistics point of view. We share our experience of safely performing a Hybrid stage I palliation procedure for Aortic atresia with ventricular septal defect on a 2-month-old infant weighing 3.35 kg using minimal resources in a conventional catheterization laboratory.
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Affiliation(s)
- S Anuradha
- Department of Pediatric Cardiology, Dr. K. M. Cherian Heart Foundation, Chennai, India.
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Estornell-Erill J, Igual-Muñoz B, Monmeneu-Menadas JV, Soriano-Navarro C, Valle-Muñoz A, Vilar-Herrero JV, Perez-Bosca L, Paya-Serrano R, Martinez-Alzamora N, Ridocci-Soriano F. Diagnóstico etiológico de la disfunción ventricular izquierda con tomografía computarizada: comparación con coronariografía y cardiorresonancia. Rev Esp Cardiol 2012; 65:517-24. [DOI: 10.1016/j.recesp.2011.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 07/11/2011] [Indexed: 11/16/2022]
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Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, Hermiller JB, Kinlay S, Landzberg JS, Laskey WK, McKay CR, Miller JM, Moliterno DJ, Moore JWM, Oliver-McNeil SM, Popma JJ, Tommaso CL. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol 2012; 59:2221-305. [PMID: 22575325 DOI: 10.1016/j.jacc.2012.02.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, Hermiller JB, Kinlay S, Landzberg JS, Laskey WK, McKay CR, Miller JM, Moliterno DJ, Moore JW, Oliver-McNeil SM, Popma JJ, Tommaso ACL, Harrington RA, Bates ER, Bhatt DL, Bridges CR, Eisenberg MJ, Ferrari VA, Fisher JD, Gardner T, Gentile F, Gilson MF, Hlatky MA, Jacobs AK, Kaul S, Moliterno DJ, Mukherjee D, Rosenson RS, Weitz HH, Wesley DJ. 2012 American college of cardiology foundation/society for cardiovascular angiography and interventions expert consensus document on cardiac catheterization laboratory standards update: American college of cardiology foundation task force on expert consen. Catheter Cardiovasc Interv 2012; 80:E37-49. [DOI: 10.1002/ccd.24466] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Naidu SS, Rao SV, Blankenship J, Cavendish JJ, Farah T, Moussa I, Rihal CS, Srinivas VS, Yakubov SJ. Clinical expert consensus statement on best practices in the cardiac catheterization laboratory: Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2012; 80:456-64. [PMID: 22434598 DOI: 10.1002/ccd.24311] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 11/30/2011] [Accepted: 12/24/2011] [Indexed: 11/09/2022]
Affiliation(s)
- Srihari S Naidu
- Division of Cardiology, Winthrop University Hospital, Mineola, New York, USA.
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Tavakol M, Ashraf S, Brener SJ. Risks and complications of coronary angiography: a comprehensive review. Glob J Health Sci 2012; 4:65-93. [PMID: 22980117 PMCID: PMC4777042 DOI: 10.5539/gjhs.v4n1p65] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 12/29/2011] [Indexed: 12/17/2022] Open
Abstract
Coronary angiography and heart catheterization are invaluable tests for the detection and quantification of coronary artery disease, identification of valvular and other structural abnormalities, and measurement of hemodynamic parameters. The risks and complications associated with these procedures relate to the patient’s concomitant conditions and to the skill and judgment of the operator. In this review, we examine in detail the major complications associated with invasive cardiac procedures and provide the reader with a comprehensive bibliography for advanced reading.
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Evaluation of coronary allograft vasculopathy using multi-detector row computed tomography: a systematic review. Eur J Cardiothorac Surg 2011; 41:415-22. [PMID: 21820912 DOI: 10.1016/j.ejcts.2011.06.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Coronary allograft vasculopathy (CAV) is a significant cause of morbidity and mortality after cardiac transplantation and requires frequent surveillance with catheter-based coronary angiography (CCA). Multi-detector row computed tomography (MDCT) has been shown to be effective in assessing atherosclerosis in native coronary arteries. This article systematically reviews the literature to determine the accuracy of MDCT in CAV assessment. An English-language literature search was performed using EMBASE, OVID, PubMed, and Cochrane Library databases. Studies that directly compared MDCT with CCA and/or IVUS for the detection of coronary artery stenosis or significant intimal thickening in cardiac transplant patients were analyzed. Data were pooled to obtain weighted sensitivities, specificities, and diagnostic accuracies. Negative and positive predictive values (NPV/PPV) were calculated. A total of seven studies with a sum of 272 patients were included in this review. There were three studies examining 16-slice MDCT and four studies looking at 64-slice MDCT in CAV. Using per-segment analysis, MDCT assessed between 91% and 96% of all coronary segments when evaluating for stenosis. Pooled estimates for sensitivity and specificity for MDCT ranged from 82% to 89% and 89% to 99%, respectively, while NPV was 99%. Per-patient analysis revealed a sensitivity of 87-100% and NPV of 96-100%. PPV was less than 50% for 64-slice MDCT in both per-segment and per-patient analysis. When compared with IVUS, MDCT had a sensitivity of 74-96% and specificity of 88-92% in assessment of intimal thickening. NPV and PPV were 80-81% and 84-98%, respectively. The high sensitivity and NPV of MDCT suggest that it may be a useful, noninvasive screening tool to rule out CAV.
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Abstract
PURPOSE OF REVIEW To review the recent literature on the implications of occupational radiation exposure in anesthesia practice. RECENT FINDINGS Wide variation and lack of reduction in operator doses of medical radiation strongly suggests that more attention must be paid to the factors influencing radiation dose exposure. The eye is likely the most sensitive organ for radiation injury. Radiation-related cataract formation might be a stochastic effect. Operators are strongly advised to use eye protection at all times. Safe medical radiation ophthalmic dose limits are currently under review and are likely to be lowered. Current data do not suggest a significant risk to the fetus for pregnant women working in the interventional radiology suite as long as proper monitoring and radiation safety measures are implemented. SUMMARY Radiation is increasingly utilized in medicine for diagnostic and therapeutic procedures. Anesthesia providers may become exposed to unsafe doses while providing high-quality patient care. Understanding of the physical principles, the sources of radiation exposure, the potential risks, and safe practices helps to minimize the exposure risk and its potential deleterious effects to the anesthesia team.
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Alamri H, Almoghairi A, Almasood A, Alotaibi M, Alonazi S. Do We Need Premedication Before Coronary Angiography? A Controlled Clinical Trial. Cardiol Res 2011; 2:224-228. [PMID: 28357010 PMCID: PMC5358282 DOI: 10.4021/cr68w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2011] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Premedication with benzodiazepines has been thought to reduce patient anxiety, pain perception, and non-catheter-induced coronary spasms and may increase procedure-related complications. We used to routinely provide premedication with diazepam and chlorpheniramine before cardiac catheterization procedures. However the benefits of such a treatment are not well established here. Therefore, we designed this study to test whether the routine use of premedication during coronary angiography is needed. METHODS A total of 200 consecutive patients scheduled to undergo either diagnostic or therapeutic coronary angiographic procedures were randomized to receive either premedication with diazepam (5 mg) and chlorpheniramine (4 mg) 60 minutes prior to their procedures (n = 100) or no premedication (n = 100). The administration of intravenous midazolam during the procedures was permitted at the operator's discretion. The primary endpoints were anxiety and pain perception during the procedure. RESULTS A total of 200 patients with similar baseline characteristics were randomized into two groups. The first group received oral premedication with diazepam (5 mg) and chlorphenamine (4 mg) 60 minutes prior to their procedures, and the other group did not receive premedication. We observed no differences in periprocedural pain perception (31% in the premedicated group versus 29% in the non-premedicated group; P = 0.75) or anxiety (59% in the premedicated group versus 50% in the non-premedicated group; P = 0.2). Interestingly, local pain was more pronounced in the premedicated patients than in the non-premedicated patients (30% versus 16%, respectively; P = 0.018). There were no contrast-related reactions reported in either group. CONCLUSION Treatment with oral diazepam and chlorphenamine prior to cardiac catheterization and percutaneous coronary intervention does not alter rates of anxiety, periprocedural pain.
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Affiliation(s)
- Hussein Alamri
- Adult Cardiology Department, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | | | - Ali Almasood
- Adult Cardiology Department, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Mohamed Alotaibi
- Adult Cardiology Department, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Sami Alonazi
- Adult Cardiology Department, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
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Douglas PS, Patel MR, Bailey SR, Dai D, Kaltenbach L, Brindis RG, Messenger J, Peterson ED. Hospital Variability in the Rate of Finding Obstructive Coronary Artery Disease at Elective, Diagnostic Coronary Angiography. J Am Coll Cardiol 2011; 58:801-9. [DOI: 10.1016/j.jacc.2011.05.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 04/26/2011] [Accepted: 05/03/2011] [Indexed: 12/27/2022]
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Smith IR, Foster KA, Brighouse RD, Cameron J, Rivers JT. The role of quantitative feedback in coronary angiography radiation reduction. Int J Qual Health Care 2011; 23:342-8. [PMID: 21504958 DOI: 10.1093/intqhc/mzr014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate the benefits of radiation education with and without feedback reporting in altering clinician radiation use behaviour in performing coronary angiography (CA). DESIGN A retrospective review of radiation use (fluoroscopy time) in coronary angiograms performed between July 1996 and December 2005 by 10 cardiologists to assess the impact of various interventions aimed at minimizing radiation risk. The impact of interventions such as education and audit/feedback was correlated against radiation use using cumulative sum and cumulative expected minus observed charts. SETTING Private Hospital in Brisbane, Australia. PARTICIPANTS Ten cardiologists. INTERVENTION Education and audit/feedback. RESULTS Baseline radiation use subject to standard guidelines was stable. Group performance charts show a modest transient improvement in radiation use associated with an education intervention alone. However, regular detailed personalized feedback comparing an individual's radiation use to group and external benchmarks was successful in achieving sustained reduction in overall radiation use. For individual participants, significant improvement was noted in 7 of 10 cardiologists. CONCLUSION Although an improved theoretical understanding of effective radiation hygiene strategies might contribute to reduced radiation use, this study suggests that regular detailed quantitative feedback supporting education is an effective tool in altering radiation use in CA. Understanding triggers that stimulate change in clinician behaviour is critical to the design of systems to optimize clinical performance. Confidentially reported benchmarking systems may be a useful tool to alter clinician behaviour.
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Affiliation(s)
- Ian R Smith
- St Andrew's Medical Institute, 457 Wickham Terrace, Spring Hill, Queensland 4000, Australia
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81
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Scaglione M, Biasco L, Caponi D, Anselmino M, Negro A, Di Donna P, Corleto A, Montefusco A, Gaita F. Visualization of multiple catheters with electroanatomical mapping reduces X-ray exposure during atrial fibrillation ablation. Europace 2011; 13:955-62. [PMID: 21421574 DOI: 10.1093/europace/eur062] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
AIMS Atrial fibrillation (AF) ablation still requires long procedural time and high radiation exposure with its related risk for the patient and the operators. This study was designed to compare three different approaches of AF ablation to verify the hypothesis that image integration with electroanatomic mapping allows minimal use of fluoroscopy. Therefore, we evaluated the procedure and fluoroscopy times of ablation using three imaging modalities: conventional fluoroscopy, image integration electroanatomic mapping, and a new electroanatomic mapping system that provides visualization of multiple catheters. METHODS AND RESULTS One hundred and twenty patients with symptomatic refractory AF were enrolled in the study. Patients were randomly assigned to fluoroscopy alone (Group A, 40 patients), electroanatomic integration (Cartomerge®, Group B, 40 patients), and electroanatomic integration plus catheters visualization (Carto® 3 System, Group C, 40 patients) guided procedures. The ablation procedure aimed at isolating the pulmonary veins and creating lesion lines at the left atrial roof and left isthmus. Procedure and fluoroscopy parameters were recorded in all patients. Total procedure time and skin to catheter positioning time did not significantly differ between the groups. Total fluoroscopy time was statistically different between all three groups (Group A, 18'09″±5'00″; Group B, 9'48″±3'41″; Group C, 2'28″±1'40″; P<0.001). A significant difference was noted in ablation fluoroscopy time between all groups (P<0.001), mainly due to shortened fluoroscopy time in Group B (7'34″±3'15″) and Group C (0'21″±0'31″) when compared with Group A (16'07″±5'04″). CONCLUSION Image integration and, to a larger extent, visualization of multiple catheters allowed a minimal use of fluoroscopy in transcatheter AF ablation.
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Affiliation(s)
- Marco Scaglione
- Cardiology Department, Cardinal Massaia Hospital, Asti, Italy.
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82
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Smith I, Rivers J, Mengersen K, Cameron J. Performance monitoring in interventional cardiology: application of statistical process control to a single-site database. EUROINTERVENTION 2011; 6:955-62. [DOI: 10.4244/eijv6i8a166] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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83
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Radiation exposure to the surgeon during open lumbar microdiscectomy and minimally invasive microdiscectomy: a prospective, controlled trial. Spine (Phila Pa 1976) 2011; 36:255-60. [PMID: 20736891 DOI: 10.1097/brs.0b013e3181ceb976] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a prospective in vivo study comparing radiation exposure to the surgeon during 10 minimally invasive lumbar microdiscectomy cases with 10 traditional open discectomy cases as a control. OBJECTIVE Radiation exposure to the eye, chest, and hand of the operating surgeon during minimally invasive surgery (MIS) and open lumbar microdiscectomy were measured. The Occupational Exposure Guidelines were used to calculate the allowable number of cases per year from the mean values at each of the 3 sites. SUMMARY OF BACKGROUND DATA Fluoroscopy is a source of ionizing radiation and as such, is a potential health hazard with continued exposure during surgery. Presently, radiation exposure to the surgeon during MIS lumbar microdiscectomy is unknown. METHODS Radiation exposure to the surgeon (millirads [mR]) per case was measured by digital dosimeters placed at the level of the thyroid/eye, chest, and dominant forearm. Other data collected included operative side and level, side of the surgeon, side of the x-ray source, total fluoroscopy time, and energy output. RESULTS The average radiation exposure to the surgeon during open cases was thyroid/eye 0.16 ± 0.22 mR, chest 0.21 ± 0.23 mR, and hand 0.20 ± 0.14 mR. During minimally invasive cases exposure to the thyroid/eye was 1.72 ± 1.52 mR, the chest was 3.08 ± 2.93 mR, and the hand was 4.45 ± 3.75 mR. The difference between thyroid/ eye, chest, and hand exposure during open and minimally invasive cases was statistically significant (P = 0.010, P = 0.013, and P = 0.006, respectively). Surgeons standing in an adjacent substerile room during open cases were exposed to 0.2 mR per case. CONCLUSION MIS lumbar microdiscectomy cases expose the surgeon to significantly more radiation than open microdiscectomy. One would need to perform 1623 MIS microdiscectomies to exceed the exposure limit for whole-body radiation, 8720 cases for the lens of the eye, and 11,235 cases for the hand. Standing in a substerile room during x-ray localization in open cases is not fully protective.
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Rolley JX, Salamonson Y, Wensley C, Dennison CR, Davidson PM. Nursing clinical practice guidelines to improve care for people undergoing percutaneous coronary interventions. Aust Crit Care 2011; 24:18-38. [DOI: 10.1016/j.aucc.2010.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 07/14/2010] [Accepted: 08/03/2010] [Indexed: 11/26/2022] Open
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Application of serum protein fingerprint in diagnosis of coronary artery disease. Clin Biochem 2011; 44:185-91. [DOI: 10.1016/j.clinbiochem.2010.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 10/04/2010] [Accepted: 10/06/2010] [Indexed: 11/24/2022]
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Schulz O, Reinicke M, Krämer J, Berghöfer G, Bensch R, Schimke I, Jaffe A. Pregnancy-associated plasma protein A values in patients with stable cardiovascular disease: use of a new monoclonal antibody-based assay. Clin Chim Acta 2011; 412:880-6. [PMID: 21238442 DOI: 10.1016/j.cca.2011.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 01/05/2011] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND PAPP-A is promising in improving risk stratification and invasive treatment decisions in stable cardiovascular patients. We evaluated the prognostic value of pregnancy-associated plasma protein A (PAPP-A) measured by a novel assay in stable cardiovascular patients. METHODS We investigated 228 stable cardiovascular outpatients. Blood was drawn for PAPP-A measurement after echocardiography and ergometry prior to heart catheterization. Angiographically we determined severity as well as qualitative characteristics suspect for vulnerability of coronary lesions. After 1108±297 days, follow-up information was obtained by questionnaire mailings and interviews by phone. RESULTS 104 patients had coronary stenosis≥70%, 75 had B-type lesions≥50%, 46 showed complex lesions, and 68 were suspected to have vulnerable lesions. Median PAPP-A was 1.76 (interquartile range 1.21, 2.63) μIU/ml in the entire cohort. PAPP-A concentrations did not differ in dependence on coronary artery findings. A cutpoint of 2.7 μIU/ml was derived from receiver-operator characteristics for outcome measures. For this cutoff, Cox proportional hazard models with 19 further clinical variables showed that PAPP-A was predictive for all-cause death (HR 4.73, 95% CI 1.46-15.31, p=0.01), all-cause death or nonfatal infarction (HR 4.01, 95% CI 1.58-10.13, p=0.003) and all-cause death, nonfatal myocardial infarction or hospitalization (HR 1.96, 95% CI 1.03-3.70, p=0.04). The predictive value of PAPP-A did not change substantially after correction for values of cardiac troponin, using a highly sensitive cardiac troponin I research assay. CONCLUSIONS PAPP-A, measured by a new, monoclonal antibody-based assay is a promising prognostic marker in patients with stable cardiovascular disease and an indication for heart catheterization.
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Affiliation(s)
- Olaf Schulz
- Interventionelle Kardiologie Spandau, Berlin, Germany
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87
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De Cecco C, Buffa V, Fedeli S, Vallone A, Ruopoli R, Luzietti M, Miele V, Maurizi Enrici M, Musumeci F, David V. Dual-source CT coronary angiography: prospective versus retrospective acquisition technique. Radiol Med 2010; 116:178-88. [DOI: 10.1007/s11547-010-0584-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 11/25/2009] [Indexed: 12/14/2022]
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Delgado K, Williams M. REVIEW: Diagnostic accuracy for coronary artery disease of multislice CT scanners in comparison to conventional coronary angiography: An integrative literature review. ACTA ACUST UNITED AC 2010; 22:496-503. [DOI: 10.1111/j.1745-7599.2010.00501.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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89
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The Diagnostic Accuracy of 64-Detector Cardiac Computed Tomography Compared With Stress Nuclear Imaging in Patients Undergoing Invasive Cardiac Catheterization. J Comput Assist Tomogr 2010; 34:645-51. [DOI: 10.1097/rct.0b013e3181e3d0b1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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90
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Brainerd EL, Baier DB, Gatesy SM, Hedrick TL, Metzger KA, Gilbert SL, Crisco JJ. X-ray reconstruction of moving morphology (XROMM): precision, accuracy and applications in comparative biomechanics research. ACTA ACUST UNITED AC 2010; 313:262-79. [PMID: 20095029 DOI: 10.1002/jez.589] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
X-Ray Reconstruction of Moving Morphology (XROMM) comprises a set of 3D X-ray motion analysis techniques that merge motion data from in vivo X-ray videos with skeletal morphology data from bone scans into precise and accurate animations of 3D bones moving in 3D space. XROMM methods include: (1) manual alignment (registration) of bone models to video sequences, i.e., Scientific Rotoscoping; (2) computer vision-based autoregistration of bone models to biplanar X-ray videos; and (3) marker-based registration of bone models to biplanar X-ray videos. Here, we describe a novel set of X-ray hardware, software, and workflows for marker-based XROMM. Refurbished C-arm fluoroscopes retrofitted with high-speed video cameras offer a relatively inexpensive X-ray hardware solution for comparative biomechanics research. Precision for our biplanar C-arm hardware and analysis software, measured as the standard deviation of pairwise distances between 1 mm tantalum markers embedded in rigid objects, was found to be +/-0.046 mm under optimal conditions and +/-0.084 mm under actual in vivo recording conditions. Mean error in measurement of a known distance between two beads was within the 0.01 mm fabrication tolerance of the test object, and mean absolute error was 0.037 mm. Animating 3D bone models from sets of marker positions (XROMM animation) makes it possible to study skeletal kinematics in the context of detailed bone morphology. The biplanar fluoroscopy hardware and computational methods described here should make XROMM an accessible and useful addition to the available technologies for studying the form, function, and evolution of vertebrate animals.
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Affiliation(s)
- Elizabeth L Brainerd
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island 02912, USA.
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91
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Schulz O, Reinicke M, Berghoefer GH, Bensch R, Kraemer J, Schimke I, Jaffe AS. High-sensitive cardiac troponin I (hs-cTnI) values in patients with stable cardiovascular disease: An initial foray. Clin Chim Acta 2010; 411:812-7. [DOI: 10.1016/j.cca.2010.02.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 02/18/2010] [Accepted: 02/19/2010] [Indexed: 10/19/2022]
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92
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Cost-effectiveness of coronary CT angiography in evaluation of patients without symptoms who have positive stress test results. AJR Am J Roentgenol 2010; 194:1257-62. [PMID: 20410412 DOI: 10.2214/ajr.09.3209] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Patients without symptoms who have positive stress test results are often referred for diagnostic catheter angiography in an evaluation for coronary artery disease (CAD). The purpose of this study was to use decision tree analysis to determine the cost-effectiveness and radiation dose that would result from performing coronary CT angiography (CTA) before catheterization. MATERIALS AND METHODS A decision tree was constructed to compare the false-negative rates, false-positive rates, costs, and radiation exposure of direct referral of patients for cardiac catheterization with the values associated with performing coronary CTA before catheterization. We assumed that patients referred for coronary CTA proceed to catheterization only when significant disease is identified. Costs for coronary CTA and diagnostic catheterization were obtained from the 2009 physician Medicare fee schedule. Sensitivity, specificity, and radiation dose were obtained by literature review. RESULTS Cost reduction with coronary CTA depends on the prevalence of coronary artery disease, but overall costs are reduced as long as the prevalence is less than 85%. At a 50% prevalence of coronary artery disease, performing coronary CTA before cardiac catheterization results in an average cost saving of $789 per patient with a false-negative rate of 2.5% and average additional radiation exposure of 1-2 mSv. CONCLUSION Performing coronary CTA before cardiac catheterization is a cost-effective strategy in the care of patients without symptoms who have positive stress test results when the probability that the patient has significant coronary artery disease is less than 50%. The false-negative rate with this strategy compares favorably with the false-negative rate of stress testing. The use of coronary CTA in this role can avoid many unnecessary cardiac catheterization procedures.
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Chen HW, Fang XM, Hu XY, Bao J, Hu CH, Chen Y, Yang ZY, Alexander L, Wu XQ. Efficacy of dual-source CT coronary angiography in evaluating coronary stenosis: initial experience. Clin Imaging 2010; 34:165-71. [DOI: 10.1016/j.clinimag.2009.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 05/05/2009] [Indexed: 11/15/2022]
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Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, Brindis RG, Douglas PS. Low diagnostic yield of elective coronary angiography. N Engl J Med 2010; 362:886-95. [PMID: 20220183 PMCID: PMC3920593 DOI: 10.1056/nejmoa0907272] [Citation(s) in RCA: 1177] [Impact Index Per Article: 84.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Guidelines for triaging patients for cardiac catheterization recommend a risk assessment and noninvasive testing. We determined patterns of noninvasive testing and the diagnostic yield of catheterization among patients with suspected coronary artery disease in a contemporary national sample. METHODS From January 2004 through April 2008, at 663 hospitals in the American College of Cardiology National Cardiovascular Data Registry, we identified patients without known coronary artery disease who were undergoing elective catheterization. The patients' demographic characteristics, risk factors, and symptoms and the results of noninvasive testing were correlated with the presence of obstructive coronary artery disease, which was defined as stenosis of 50% or more of the diameter of the left main coronary artery or stenosis of 70% or more of the diameter of a major epicardial vessel. RESULTS A total of 398,978 patients were included in the study. The median age was 61 years; 52.7% of the patients were men, 26.0% had diabetes, and 69.6% had hypertension. Noninvasive testing was performed in 83.9% of the patients. At catheterization, 149,739 patients (37.6%) had obstructive coronary artery disease. No coronary artery disease (defined as <20% stenosis in all vessels) was reported in 39.2% of the patients. Independent predictors of obstructive coronary artery disease included male sex (odds ratio, 2.70; 95% confidence interval [CI], 2.64 to 2.76), older age (odds ratio per 5-year increment, 1.29; 95% CI, 1.28 to 1.30), presence of insulin-dependent diabetes (odds ratio, 2.14; 95% CI, 2.07 to 2.21), and presence of dyslipidemia (odds ratio, 1.62; 95% CI, 1.57 to 1.67). Patients with a positive result on a noninvasive test were moderately more likely to have obstructive coronary artery disease than those who did not undergo any testing (41.0% vs. 35.0%; P<0.001; adjusted odds ratio, 1.28; 95% CI, 1.19 to 1.37). CONCLUSIONS In this study, slightly more than one third of patients without known disease who underwent elective cardiac catheterization had obstructive coronary artery disease. Better strategies for risk stratification are needed to inform decisions and to increase the diagnostic yield of cardiac catheterization in routine clinical practice.
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Affiliation(s)
- Manesh R Patel
- Duke Clinical Research Institute, Duke University, Durham, NC 27715, USA.
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Buffa V, De Cecco C, Cossu L, Fedeli S, Vallone A, Ruopoli R, Luzietti M, Angelica G, David V, Musumeci F. Preoperative coronary risk assessment with dual-source CT in patients undergoing noncoronary cardiac surgery. Radiol Med 2010; 115:1028-37. [DOI: 10.1007/s11547-010-0543-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 09/17/2009] [Indexed: 10/19/2022]
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Abstract
Contrast-induced nephropathy, also referred to as contrast-induced acute kidney injury (CIAKI), is among the most common causes of AKI, especially in patients with underlying chronic kidney disease. In addition to the increased cost engendered by the development of CIAKI, several studies have suggested the occurrence of AKI after cardiac procedures is associated with an increase in both morbidity and mortality. This increase in morbidity and mortality occurs after both intravenous and intra-arterial studies. This review focuses on relevant proposed pathophysiological mechanisms, risk factors, and current prophylactic strategies, which may reduce the incidence of CIAKI during cardiac angiographic imaging studies.
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98
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Wake R, Iwata S, Nakagawa M, Doi A, Sugioka K, Otsuka R, Hozumi T, Takemoto Y, Ehara S, Hanatani A, Muro T, Yoshiyama M. Usefulness of Cardiac Computed Tomography in the Diagnosis of Prosthetic Coronary Artery Graft with Interposition Procedure. CLINICAL MEDICINE INSIGHTS: CARDIOLOGY 2010; 4:95-8. [PMID: 21079753 PMCID: PMC2978934 DOI: 10.4137/cmc.s5806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An 80-year-old Japanese man was admitted with orthopnea and pitting edema of both lower legs. We diagnosed congestive heart failure (CHF) on the basis of a chest X-ray and an echocardiogram. An electrocardiogram showed a heart rate of 120 beats/min with atrial fibrillation rhythm (Af). The patient developed aortic valve failure and destruction of the base of right coronary artery (RCA) due to infectious endocarditis at 71 years of age. The patient underwent aortic valve replacement and coronary artery bypass grafting with an interposed graft with polyester vascular graft to RCA. The patient recovered from CHF after the 6 days of treatment with diuretics and verapamil. We confirmed the patency of coronary arteries and bypass grafts using a 64-slice cardiac computed tomography scan (CT) and diagnosed CHF due to Af. Here we describe the estimation of the prosthetic coronary artery graft patency with the interposition procedure using 64-slice cardiac CT.
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Affiliation(s)
- Ryotaro Wake
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinichi Iwata
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masashi Nakagawa
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Doi
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenichi Sugioka
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ryo Otsuka
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Hozumi
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiko Takemoto
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shoichi Ehara
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akihisa Hanatani
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takashi Muro
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
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99
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Impact of biplane versus single-plane imaging on radiation dose, contrast load and procedural time in coronary angioplasty. Br J Radiol 2009; 83:379-94. [PMID: 20019175 DOI: 10.1259/bjr/21696839] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Coronary angioplasties can be performed with either single-plane or biplane imaging techniques. The aim of this study was to determine whether biplane imaging, in comparison to single-plane imaging, reduces radiation dose and contrast load and shortens procedural time during (i) primary and elective coronary angioplasty procedures, (ii) angioplasty to the main vascular territories and (iii) procedures performed by operators with various levels of experience. This prospective observational study included a total of 504 primary and elective single-vessel coronary angioplasty procedures utilising either biplane or single-plane imaging. Radiographic and clinical parameters were collected from clinical reports and examination protocols. Radiation dose was measured by a dose-area-product (DAP) meter intrinsic to the angiography system. Our results showed that biplane imaging delivered a significantly greater radiation dose (181.4+/-121.0 Gycm(2)) than single-plane imaging (133.6+/-92.8 Gycm(2), p<0.0001). The difference was independent of case type (primary or elective) (p = 0.862), vascular territory (p = 0.519) and operator experience (p = 0.903). No significant difference was found in contrast load between biplane (166.8+/-62.9 ml) and single-plane imaging (176.8+/-66.0 ml) (p = 0.302). This non-significant difference was independent of case type (p = 0.551), vascular territory (p = 0.308) and operator experience (p = 0.304). Procedures performed with biplane imaging were significantly longer (55.3+/-27.8 min) than those with single-plane (48.9+/-24.2 min, p = 0.010) and, similarly, were not dependent on case type (p = 0.226), vascular territory (p = 0.642) or operator experience (p = 0.094). Biplane imaging resulted in a greater radiation dose and a longer procedural time and delivered a non-significant reduction in contrast load than single-plane imaging. These findings did not support the commonly perceived advantages of using biplane imaging in single-vessel coronary interventional procedures.
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Wagdi P, Alkadhi H. The impact of cardiac CT on the appropriate utilization of catheter coronary angiography. Int J Cardiovasc Imaging 2009; 26:333-44. [PMID: 19936961 DOI: 10.1007/s10554-009-9541-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 11/10/2009] [Indexed: 01/30/2023]
Abstract
The purpose of this study was to evaluate the impact of computed tomography coronary angiography (CTCA) on the appropriate utilization of catheter angiography (CA). This observational trial analyzed all patients undergoing CA in 2006 and 2007 in one hospital. In 2007, patients having a low to intermediate cardiovascular risk and suspicion of coronary artery disease (CAD) and those with suspicion of progression of known organic heart disease (OHD) underwent CTCA either prior to CA or as the sole imaging modality. Appropriate utilization of CA was defined as: (1) percentage of patients showing normal or non-significant findings at CA, (2) percentage of self-referred patients to CA, and (3) percentage of patients with known OHD undergoing CA without immediate operative or interventional consequences. Use of CTCA resulted in a significant drop in the percentage of CA examinations in patients with suspected CAD showing normal or non-significant findings (19% in 2006, 10% in 2007, P < 0.001). The percentage of self-referred CA significantly dropped (29% in 2006, 10% in 2007, P < 0.001). CT ruled-out CAD in 74/151 (49%) patients, obviating subsequent CA. During a follow-up of 15 +/- 4 months, CA and percutaneous interventions was considered necessary in 2/74 patients. CT ruled-out progression of known OHD in 53/60 (90%) patients, while one patient underwent CA and percutaneous intervention during a follow-up period of 16 +/- 4 months. No reduction of CA examinations without immediate consequences was found in patients with known OHD (13% in 2006, 27% in 2007). In patients with suspicion of CAD, CTCA improved the appropriate utilization of CA without jeopardizing patient safety, along with a decrease of self-referred patients for CA. CTCA did not influence the appropriate utilization of CA in patients with known OHD.
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