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Villines TC, Rodriguez-Lozano P, Mallawaarachchi I, Williams MC, Hirschfeld C, Better N, Shaw LJ, Vitola JV, Cerci RJ, Dorbala S, Bucciarelli-Ducci C, Karthikeyan G, Cohen YA, Malkovskiy E, Randazzo MJ, Choi AD, Pascual TNB, Pynda Y, Dondi M, Paez D, Einstein AJ. Disparities in Noninvasive Traditional and Advanced Testing for Coronary Artery Disease: Findings from the INCAPS-COVID 2 Study. Am J Cardiol 2024; 214:85-93. [PMID: 38218393 DOI: 10.1016/j.amjcard.2023.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/10/2023] [Accepted: 12/24/2023] [Indexed: 01/15/2024]
Abstract
The COVID-19 pandemic disrupted the delivery of cardiovascular care, including noninvasive testing protocols and test selection for the evaluation of coronary artery disease (CAD). Trends in test selection in traditional versus advanced noninvasive tests for CAD during the pandemic and in countries of varying income status have not been well studied. The International Atomic Energy Agency conducted a global survey to assess the pandemic-related changes in the practice of cardiovascular diagnostic testing. Site procedural volumes for noninvasive tests to evaluate CAD from March 2019 (prepandemic), April 2020 (onset), and April 2021 (initial recovery) were collected. We considered traditional testing modalities, such as exercise electrocardiography, stress echocardiography, and stress single-photon emission computed tomography, and advanced testing modalities, such as stress cardiac magnetic resonance, coronary computed tomography angiography, and stress positron emission tomography. Survey data were obtained from 669 centers in 107 countries, reporting the performance of 367,933 studies for CAD during the study period. Compared with 2019, traditional tests were performed 14% less frequently (recovery rate 82%) in 2021 versus advanced tests, which were performed 15% more frequently (128% recovery rate). Coronary computed tomography angiography, stress cardiac magnetic resonance, and stress positron emission tomography showed 14%, 25%, and 25% increases in volumes from 2019 to 2021, respectively. The increase in advanced testing was isolated to high- and upper middle-income countries, with 132% recovery in advanced tests by 2021 compared with 55% in lower income nations. The COVID-19 pandemic exacerbated economic disparities in CAD testing practice between wealthy and poorer countries. Greater recovery rates and even new growth were observed for advanced imaging modalities; however, this growth was restricted to wealthy countries. Efforts to reduce practice variations in CAD testing because of economic status are warranted.
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Affiliation(s)
- Todd C Villines
- University of Virginia Health System, Charlottesville, Virginia.
| | | | | | - Michelle C Williams
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Cole Hirschfeld
- Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Nathan Better
- Department of Cardiology and Nuclear Medicine, Cabrini Health, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Leslee J Shaw
- Blavatnik Family Women'S Health Research Institute, Mount Sinai Medical Center, New York, New York
| | | | | | | | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Trust and King's College London, London, United Kingdom
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Yosef A Cohen
- Department of Epidimiology, Columbia-Mailman School of Public Health, New York, New York
| | - Eli Malkovskiy
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York; Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York
| | - Michael J Randazzo
- Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Andrew D Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, District of Columbia
| | | | - Yaroslav Pynda
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Maurizio Dondi
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York; Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York
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2
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Case JA, Courter SA, McGhie AI, Patel KK, Sperry BW, Moloney E, Case KO, Burgett EV, Bateman TM. Accurate and efficient rapid acquisition early post-injection stress-first CZT SPECT myocardial perfusion imaging with tetrofosmin and attenuation correction. J Nucl Cardiol 2023; 30:2644-2654. [PMID: 37464251 DOI: 10.1007/s12350-023-03336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/01/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Myocardial perfusion imaging (MPI) protocols have not changed significantly despite advances in instrumentation and software. We compared an early post-injection, stress-first SPECT protocol to standard delayed imaging. METHODS 95 patients referred for SPECT MPI were imaged upright and supine on a Spectrum Dynamics D-SPECT CZT system with CT attenuation correction. Patients received injection of 99mTc tetrofosmin at peak of regadenoson stress and were imaged. Early post-stress (mean 17 ± 2 minutes) and Standard 1-h delay (mean 61 ± 13 min). Three blinded readers evaluated images for overall interpretation, perceived need for rest imaging, image quality, and reader confidence. Laboratory efficiency was also evaluated. RESULTS Blinded readers had the same response for the need for rest in 77.9% of studies. Studies also had the same interpretation in 89.5% of studies. Reader confidence was high (86.0% (Early) and 90.3% (Standard p = 0.52. Image quality was good or excellent in 87.4% Early vs 96.8% Standard (p = 0.09). Time between patient check-in and end of stress imaging was 104 ± (Standard) to 60 ± 18 minutes (Early) (p < 0.001). CONCLUSION Early post-injection stress-only imaging using CZT SPECT/CT appears promising with Tc-99m tetrofosmin with similar image quality, reader confidence, diagnosis, and need for a rest scan.
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Affiliation(s)
- James A Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA.
| | | | - AIain McGhie
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Krishna K Patel
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Icahn School of Medicine at Mount Sinai Medical Center, New York, New York, USA
| | - Brett W Sperry
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Erin Moloney
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Katrina O Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
- Boston University, Boston, MA, USA
| | - Eric V Burgett
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Timothy M Bateman
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Hage FG, Einstein AJ, Ananthasubramaniam K, Bourque JM, Case J, DePuey EG, Hendel RC, Henzlova MJ, Shah NR, Abbott BG, Al Jaroudi W, Better N, Doukky R, Duvall WL, Malhotra S, Pagnanelli R, Peix A, Reyes E, Saeed IM, Sanghani RM, Slomka PJ, Thompson RC, Veeranna V, Williams KA, Winchester DE. Quality metrics for single-photon emission computed tomography myocardial perfusion imaging: an ASNC information statement. J Nucl Cardiol 2023; 30:864-907. [PMID: 36607538 DOI: 10.1007/s12350-022-03162-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Fadi G Hage
- Section of Cardiology, Birmingham VA Medical Center, Birmingham, AL, USA.
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 446 GSB, 520 19Th Street South, Birmingham, AL, 35294, USA.
| | - Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine and Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Jamieson M Bourque
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - James Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
| | - E Gordon DePuey
- Mount Sinai Morningside Hospital, New York, NY, USA
- Bay Ridge Medical Imaging, Brooklyn, NY, USA
| | - Robert C Hendel
- Department of Medicine, Division of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Nishant R Shah
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Brian G Abbott
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Wael Al Jaroudi
- Division of Cardiovascular Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nathan Better
- Department of Nuclear Medicine and Cardiology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - W Lane Duvall
- Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | - Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
| | - Eliana Reyes
- Nuclear Medicine Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ibrahim M Saeed
- Virginia Heart, Falls Church, VA, USA
- INOVA Heart and Vascular Institute, Falls Church, VA, USA
- University of Missouri, Kansas City, MO, USA
| | - Rupa M Sanghani
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - Randall C Thompson
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Vikas Veeranna
- Division of Cardiology, Department of Medicine, New England Heart and Vascular Institute, Manchester, NH, USA
| | - Kim A Williams
- Department of Medicine, University of Louisville Department of Medicine, Louisville, KY, USA
| | - David E Winchester
- Malcom Randall VA Medical Center, Gainesville, FL, USA
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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Milà López M, Jiménez Heffernan A, Sánchez de Mora E, Fierro Alanis MP. [Nuclear Cardiology in the COVID-19 pandemic]. Rev Esp Med Nucl Imagen Mol 2023; 42:106-112. [PMID: 36683949 PMCID: PMC9841071 DOI: 10.1016/j.remn.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/18/2023]
Abstract
SARS-CoV-2 infection has a very important relationship with cardiovascular disease. Since the beginning of the pandemic, a close relationship has been observed between cardiovascular comorbidity and a worse prognosis in COVID-19 patients. The study of the pathophysiology of SARS-CoV-2 infection and cardiovascular disease suggests several concomitant hypotheses: direct myocardial damage by the virus, hypoxemia secondary to respiratory failure, inflammatory response to infection and/or thromboembolic phenomena. Cardiovascular damage can manifest in the acute phase of infection with acute myocardial infarction, myocarditis, arrhythmias..., during this phase Nuclear Cardiology procedures have not played a determining role in the diagnosis and management of these patients. On the other hand, in the subacute phase of the infection and in the post-acute COVID syndrome, Nuclear Cardiology seems to shed light on what happens in the cardiovascular system in this phase of the disease.The COVID-19 pandemic has represented a great challenge for health systems, with a significant reduction in non-urgent diagnostic procedures with the aim of reducing the risk of transmission to patients and health personnel. Nuclear Cardiology has not been an exception. In addition to the prioritization of urgent/non-deferrable procedures and general screening, hygiene and distance measures, the main organizations and scientific societies of Nuclear Medicine and Nuclear Cardiology released recommendations and guidelines for safe practice, introducing significant changes in myocardial perfusion SPECT protocols.
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Affiliation(s)
- M Milà López
- Servicio de Medicina Nuclear IDI, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - A Jiménez Heffernan
- Servicio de Medicina Nuclear, Hospital Universitario Juan Ramón Jiménez, Huelva, España
| | - E Sánchez de Mora
- Servicio de Medicina Nuclear, Hospital Universitario Juan Ramón Jiménez, Huelva, España
| | - M P Fierro Alanis
- Servicio de Medicina Nuclear IDI, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
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5
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Milà López M, Jiménez Heffernan A, Sánchez de Mora E, Fierro Alanis MP. Nuclear Cardiology in the COVID-19 pandemic. Rev Esp Med Nucl Imagen Mol 2023; 42:106-112. [PMID: 36681148 PMCID: PMC9847316 DOI: 10.1016/j.remnie.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/19/2023]
Abstract
SARS-CoV-2 infection has a very important relationship with cardiovascular disease. Since the beginning of the pandemic, a close relationship has been observed between cardiovascular comorbidity and a worse prognosis in COVID-19 patients. The study of the pathophysiology of SARS-CoV-2 infection and cardiovascular disease suggests several concomitant hypotheses: direct myocardial damage by the virus, hypoxemia secondary to respiratory failure, inflammatory response to infection and/or thromboembolic phenomena. Cardiovascular damage can manifest in the acute phase of infection with acute myocardial infarction, myocarditis, arrhythmias…, during this phase Nuclear Cardiology procedures have not played a determining role in the diagnosis and management of these patients. On the other hand, in the subacute phase of the infection and in the post-acute COVID syndrome, Nuclear Cardiology seems to shed light on what happens in the cardiovascular system in this phase of the disease. The COVID-19 pandemic has represented a great challenge for health systems, with a significant reduction in non-urgent diagnostic procedures with the aim of reducing the risk of transmission to patients and health personnel. Nuclear Cardiology has not been an exception. In addition to the prioritization of urgent/non-deferrable procedures and general screening, hygiene and distance measures, the main organizations and scientific societies of Nuclear Medicine and Nuclear Cardiology released recommendations and guidelines for safe practice, introducing significant changes in myocardial perfusion SPECT protocols.
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Affiliation(s)
- Marta Milà López
- Servicio de Medicina Nuclear IDI, Hospital Universitario de Tarragona Joan XXIII, Tarragona, Spain.
| | | | - Elena Sánchez de Mora
- Servicio de Medicina Nuclear, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
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6
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Myocardial perfusion imaging in the era of COVID-19: a systematic review. Clin Transl Imaging 2022; 11:165-197. [PMID: 36536657 PMCID: PMC9750842 DOI: 10.1007/s40336-022-00531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE As COVID-19 was uncovered, it became evident that specific individuals could experience multi-organ complications for quite a while after infection. Among them, there were several cardiovascular complications. Myocardial perfusion imaging single photon emission computed tomography (MPI SPECT) can be utilized to detect and evaluate cardiac problems regardless of whether COVID caused them. By examining all publications relevant to the impacts of the pandemic on SPECT MPI imaging, we aimed to understand how the COVID pandemic affected different aspects of the MPI, how intense these effects were, and what the consequences were. METHOD On the 6th of June, 2022, a four-domain search strategy was developed and implemented by searching the following databases: PubMed, SCOPUS, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials. The retrieved records have been put through two levels of screening. The search for forward and backward citations provided more results. RESULTS This study contained 32 papers, divided into the following three categories: 1. Case reports and series; 2. A comparison of the number of MPIs conducted before and after the pandemic; and 3. SPECT MPI findings. CONCLUSION We observed through the article review that CT scans performed in combination with MPI are crucial and should be interpreted within the context of COVID, especially during outbreaks. Moreover, we discovered that in the initial months of the pandemic, the number of SPECT MPIs performed globally decreased, with the fall being more significant in some countries, primarily in low- to middle-income regions. Lastly, we found that individuals with a history of COVID-19 may be more prone to having MPIs that demonstrate abnormalities, such as ischemia.
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7
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Thompson RC, Phillips LM, Dilsizian V, Gutierrez DP, Einstein AJ, Crews SF, Skali H, Jih FKY, Dondi M, Gimelli A, Bateman TM, Al-Mallah MH, Ghesani M, Dorbala S, Calnon DA. Update on guidance and best practices for nuclear cardiology laboratories during the coronavirus disease 2019 (COVID-19) pandemic: Emphasis on transition to chronic endemic state. An information statement from ASNC, IAEA, and SNMMI. J Nucl Cardiol 2022; 29:2013-2018. [PMID: 35499661 PMCID: PMC9059683 DOI: 10.1007/s12350-022-02984-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Randall C Thompson
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA.
| | - Lawrence M Phillips
- Division of Cardiology, NYU Langone Medical Center, New York, NY, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Society of Nuclear Medicine and Molecular Imaging (SNMMI), Reston, VA, USA
| | - Diana Paez Gutierrez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Suzanne F Crews
- Nuclear Cardiology, Northeast Georgia Health System, Gainesville, GA, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Hicham Skali
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Department of Medicine. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Felix Keng Yung Jih
- National Heart Centre, Singapore, Singapore
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Maurizio Dondi
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Timothy M Bateman
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
- Society of Nuclear Medicine and Molecular Imaging (SNMMI), Reston, VA, USA
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Munir Ghesani
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
- Society of Nuclear Medicine and Molecular Imaging (SNMMI), Reston, VA, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Department of Medicine. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Dennis A Calnon
- OhioHealth Heart and Vascular Physicians, Columbus, OH, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
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Al-Mallah M, Naqvi TZ. Unbiased COVID-19 Pandemic With Biased Global Recovery. J Am Coll Cardiol 2022; 79:2018-2020. [PMID: 35589163 DOI: 10.1016/j.jacc.2022.03.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Mouaz Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Fujiyoshi K, Ako J, Ishida K, Ishida M, Minami Y, Inomata T. Tako-tsubo-like left ventricular dysfunction in a patient with COVID-19 demonstrated by non-invasive multi-modality imaging. J Nucl Cardiol 2022; 29:863-865. [PMID: 33000408 PMCID: PMC7527244 DOI: 10.1007/s12350-020-02367-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Kazuhiro Fujiyoshi
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kohki Ishida
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan
| | - Miwa Ishida
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan.
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Al-Mallah MH. The Way Ahead: Life After COVID-19. Methodist Debakey Cardiovasc J 2022; 17:83-88. [PMID: 34992726 PMCID: PMC8680109 DOI: 10.14797/mdcvj.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Much has changed in the 2 years since the start of the coronavirus disease 19 (COVID-19) pandemic. The need for social distancing catalyzed the digitization of healthcare delivery and medical education—from telemedicine and virtual conferences to online residency/fellowship interviews. Vaccine development, particularly in the field of mRNA technology, led to widespread availability of safe and effective vaccines. With improved survival from acute infection, the healthcare system is dealing with the ever-growing cohort of patients with lingering symptoms. In addition, social media platforms have fueled a plethora of misinformation campaigns that have adversely affected prevention and control measures. In this review, we examine how COVID-19 has reshaped the healthcare system, and gauge its potential effects on life after the pandemic.
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Paez D, Mikhail-Lette M, Gnanasegaran G, Dondi M, Estrada-Lobato E, Bomanji J, Vinjamuri S, El-Haj N, Morozova O, Alonso O, Pellet O, Orellana P, Navarro MC, Delgado Bolton RC, Giammarile F. Nuclear Medicine Departments in the Era of COVID-19. Semin Nucl Med 2022; 52:41-47. [PMID: 34243905 PMCID: PMC8216881 DOI: 10.1053/j.semnuclmed.2021.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
From the outset of the COVID-19 pandemic we, the nuclear medicine (NM) community, expediently mobilized to enable continuity of essential services to the best of our abilities. For example, we effectuated adapted guidelines for NM standard operating procedures (SOPs) and enacted heightened infection protection measures for staff, patients, and the public, alike. Challenges in radionuclide supply chains were identified and often met. NM procedural volumes declined globally and underwent restoration of varying degrees, contingent upon local contexts. Serial surveys have gauged and chronicled such geographical variance of the impact of COVID-19 on NM service delivery and, though it may be too early to fully understand the long-term consequences of reduced NM services, overall, we can certainly expect that this era adversely affected the management of many patients afflicted with non-communicable diseases. Today we are unquestionably better prepared to face unforeseen outbreaks, but a degree of uncertainty lingers. Which lessons learned will endure in the form of permanent NM pandemic preparedness procedures and protocols? In this spirit, the present manuscript presents a revision of prior recommendations issued mid-pandemic to NM centers, some of which may become mainstays in NM service delivery and implementation. Discussed herein are (1) comparative worldwide survey results of the measurable impact of COVID-19 on the practice of nuclear medicine (2) the definitions of a pandemic and its phases (3) relevant, recently developed or updated guidelines specific to nuclear medicine (4) incidental findings of COVID-19 on hybrid nuclear medicine studies performed primarily for oncologic indications and (5) how pertinent pedagogical methods for medical education, research, and development have been re-invented in a suddenly more virtual world. NM professionals shall indefinitely adopt many of the measures implemented during this pandemic, to enable continuity of essential services while preventing the spread of the virus. Which ones? Practices must remain ready for possible new peaks or variants of the roiling COVID-19 contagion and for the emergence of potential new pathogens that may incite future outbreaks or pandemics. Communications technologies are here to stay and will continue to be used in a broad spectrum of applications, from telemedicine to education, but how best? NM departments must align synergistically with these trends, considering what adaptations to a more virtual professional environment should not only last but be further innovated. The paper aims to provide recent history, analysis, and a springboard for continued constructive dialogue. To best navigate the future, NM must continue to learn from this crisis and must continue to bring new questions, evidence, ideas, and warranted systematic updates to the figurative table.
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Affiliation(s)
- Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria,Address reprint requests to: Diana Paez, Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, PO Box 100, 1400 Vienna, Austria
| | - Miriam Mikhail-Lette
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - Maurizio Dondi
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Enrique Estrada-Lobato
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospital, London, United Kingdom
| | | | - Noura El-Haj
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Olga Morozova
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Omar Alonso
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Olivier Pellet
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Pilar Orellana
- Department of Nuclear Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria C. Navarro
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Roberto C. Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
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12
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Giammarile F, Vinjamuri S, Delgado Bolton RC, Pellet O. Gated equilibrium radionuclide ventriculography. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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13
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Giammarile F, Delgado Bolton RC, El-Haj N, Mikhail M, Morozova O, Orellana P, Pellet O, Estrada Lobato E, Pynda Y, Paez D. Impact of COVID-19 on Nuclear Medicine Departments in Africa and Latin America. Semin Nucl Med 2022; 52:31-40. [PMID: 34243907 PMCID: PMC8639221 DOI: 10.1053/j.semnuclmed.2021.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The International Atomic Energy Agency (IAEA) conducted a survey to determine the impact of the COVID-19 pandemic on nuclear medicine services worldwide at two specific time-points: June and October 2020. In this paper, we describe the impact of COVID-19 on nuclear medicine departments in Africa (19 countries, 41 centers) and Latin America (15 countries, 83 centers) obtained from the survey. Respectively in Africa and Latin America, the volume of nuclear medicine procedures decreased by 69% and 79% in June 2020 and 44% and 67% in October 2020. Among the nuclear medicine procedures, oncological PET studies showed less of a decline in utilization compared to conventional nuclear medicine studies. A gradual trend towards a return to the pre-COVID-19 status of the supply chains of radioisotopes, generators, and other essential materials was evident. Overall, in 2020, the pandemic-related challenges resulted in significant decrease in nuclear medicine diagnostic and therapeutic procedures in Africa and Latin America. The impact was more pronounced in Latin America than in Africa. The current COVID-19 pandemic poses many challenges for the practice of nuclear medicine. If adequately prepared, departments can continue to deliver their essential services, while mitigating the risk for patients and staff. This requires adapting the SOPs, as quickly as possible, to meet the new requirements.
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Key Words
- covid-19, coronavirus disease 2019
- cnm, conventional nuclear medicine
- hic, high-income countries
- iaea, international atomic energy agency
- ipc, infection prevention and control
- iris, international research integration system
- lic, low-income countries
- lmic, lower-middle-income countries
- pet, positron emission tomography
- ppe, personal protective equipment
- umic, upper-middle-income countries
- who, world health organisation
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Affiliation(s)
- Francesco Giammarile
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria,Address reprint requests to Francesco Giammarile,PhD, MD, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Roberto C. Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Noura El-Haj
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Miriam Mikhail
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Olga Morozova
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Pilar Orellana
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Olivier Pellet
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | | | - Yaroslav Pynda
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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14
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Giammarile F, Delgado Bolton RC, El-Haj N, Freudenberg LS, Herrmann K, Mikhail M, Morozova O, Orellana P, Pellet O, Estrada L E, Vinjamuri S, Gnanasegaran G, Pynda Y, Navarro-Marulanda MC, Choudhury PS, Paez D. Changes in the global impact of COVID-19 on nuclear medicine departments during 2020: an international follow-up survey. Eur J Nucl Med Mol Imaging 2021; 48:4318-4330. [PMID: 34148118 PMCID: PMC8214460 DOI: 10.1007/s00259-021-05444-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/31/2021] [Indexed: 12/14/2022]
Abstract
AIM As a follow-up to the international survey conducted by the International Atomic Energy Agency (IAEA) in April 2020, this survey aims to provide a situational snapshot of the COVID-19 impact on nuclear medicine services worldwide, 1 year later. The survey was designed to determine the impact of the pandemic at two specific time points: June and October 2020, and compare them to the previously collected data. MATERIALS AND METHODS A web-based questionnaire, in the same format as the April 2020 survey was disseminated to nuclear medicine facilities worldwide. Survey data was collected using a secure software platform hosted by the IAEA; it was made available for 6 weeks, from November 23 to December 31, 2020. RESULTS From 505 replies received from 96 countries, data was extracted from 355 questionnaires (of which 338 were fully completed). The responses came from centres across varying regions of the world and with heterogeneous income distributions. Regional differences and challenges across the world were identified and analysed. Globally, the volume of nuclear medicine procedures decreased by 73.3% in June 2020 and 56.9% in October 2020. Among the nuclear medicine procedures, oncological PET studies showed less of a decline in utilization compared to conventional nuclear medicine, particularly nuclear cardiology. The negative impact was also significantly less pronounced in high-income countries. A trend towards a gradual return to the pre-COVID-19 situation of the supply chains of radioisotopes, generators, and other essential materials was evident. CONCLUSION The year 2020 has a significant decrease in nuclear medicine diagnostic and therapeutic procedures as a result of the pandemic-related challenges. In June, the global decline recorded in the survey was greater than in October when the situation began to show improvement. However, the total number of procedures remained below those recorded in April 2020 and fell to less than half of the volumes normally carried out pre-pandemic.
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Affiliation(s)
- Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1400, Vienna, Austria.
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Noura El-Haj
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1400, Vienna, Austria
| | | | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Miriam Mikhail
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1400, Vienna, Austria
| | - Olga Morozova
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1400, Vienna, Austria
| | - Pilar Orellana
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1400, Vienna, Austria
| | - Olivier Pellet
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1400, Vienna, Austria
| | - Enrique Estrada L
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1400, Vienna, Austria
| | - Sobhan Vinjamuri
- Nuclear Medicine Department, Liverpool University Hospitals, Liverpool, UK
| | | | - Yaroslav Pynda
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1400, Vienna, Austria
| | - Maria C Navarro-Marulanda
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1400, Vienna, Austria
| | - Partha S Choudhury
- Nuclear Medicine Department, Rajiv Gandhi Cancer Institute, Delhi, India
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1400, Vienna, Austria
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15
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Hasnie UA, Hawi R, Andrikopoulou E, Iskandrian AE, Hage FG. Stress testing and myocardial perfusion imaging for patients after recovery from severe COVID-19 infection requiring hospitalization: A single-center experience. J Nucl Cardiol 2021; 28:2167-2173. [PMID: 33904148 PMCID: PMC8075365 DOI: 10.1007/s12350-021-02606-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/08/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND As the coronavirus pandemic progresses, patients that have recovered from COVID-19-related hospitalization require resumption of care for other medical issues. Thus far, the literature has not detailed the experience of stress testing in this patient population. METHODS We retrospectively reviewed patients that recovered from COVID-19-related hospitalizations and underwent SPECT MPI studies at the University of Alabama at Birmingham Medical Center. RESULTS 15 patients (median age 60 years, 67% male) were identified with COVID-19-related hospitalization and then underwent SPECT MPI imaging after recovery. During COVID-19-related hospitalization (median length of stay 8 days), patients received various COVID-19 therapies; 3 required mechanical ventilation. Stress tests (4 Exercise, 11 Pharmacologic) were performed 65 days (interquartile range 31-94 days) after the diagnosis of COVID-19. None of the patients experienced serious adverse events during or after stress testing. One patient required regadenoson reversal using aminophylline due to chest pain. CONCLUSION Over time, more patients that recover from COVID-19 infection will require MPI testing for myocardial ischemia evaluation. Our study provides some information regarding performing stress testing in patients who have recently recovered from COVID-19 infections requiring hospitalization. Further studies are recommended to establish formal protocols for testing in this cohort.
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Affiliation(s)
- Usman A. Hasnie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Riem Hawi
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, LHRB 326, 701 19th Street South, Birmingham, AL 35294 USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL USA
| | - Efstathia Andrikopoulou
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, LHRB 326, 701 19th Street South, Birmingham, AL 35294 USA
| | - Ami E. Iskandrian
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, LHRB 326, 701 19th Street South, Birmingham, AL 35294 USA
| | - Fadi G. Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, LHRB 326, 701 19th Street South, Birmingham, AL 35294 USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL USA
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16
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Araz M, Soydal Ç, Sütçü G, Demir B, Özkan E. Myocardial perfusion SPECT findings in postCOVID period. Eur J Nucl Med Mol Imaging 2021; 49:889-894. [PMID: 34490492 PMCID: PMC8421192 DOI: 10.1007/s00259-021-05552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate if (i) the risk of ischemia on myocardial perfusion scan (MPS), (ii) number of coronary angiographies (CAG) performed, and (iii) necessity for invasive (stent implantation or coronary artery bypass grafting (CABG)) or medical treatment increased in patients infected with COVID-19. METHODS Patients who were referred to MPS between August 2020 and April 2021 with a history of active symptomatic COVID-19 infection (confirmed by PCR positivity) in the last 6 months were involved in the study group. Age-and gender-matched control group was composed of randomly chosen patients who attended for MPS between January 2019 and September 2019, before pandemic. Frequency of ischemia, CAG, and invasive or medical treatments were compared between groups. RESULTS Ischemia was reported more frequently in the study group (p < 0.001). In clinical evaluation, regardless of the MPS results, the necessity for invasive evaluation with CAG and treatment (either medical therapy or invasive interventions) was higher in the study group (p = 0.006 and p = 0.015). It was also true for patients with abnormal MPS results (p = 0.008 and p = 0.024) but not for the patients with ischemia (p = 0.29 and p = 0.06). CONCLUSION There exists a significant increase in the frequency of ischemia on MPS, undergoing CAG, stent implantation or CABG, and initiation of medical therapy in patients with a history of COVID-19 infection in the last 6 months. MPS is a reliable method in patients who present with cardiovascular symptoms in the late COVID period.
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Affiliation(s)
- Mine Araz
- Department of Nuclear Medicine, Ankara University Medical School, Ankara, Turkey.
| | - Çiğdem Soydal
- Department of Nuclear Medicine, Ankara University Medical School, Ankara, Turkey
| | - Gizem Sütçü
- Department of Nuclear Medicine, Ankara University Medical School, Ankara, Turkey
| | - Burak Demir
- Department of Nuclear Medicine, Ankara University Medical School, Ankara, Turkey
| | - Elgin Özkan
- Department of Nuclear Medicine, Ankara University Medical School, Ankara, Turkey
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17
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Williams MC, Shaw L, Hirschfeld CB, Maurovich-Horvat P, Nørgaard BL, Pontone G, Jimenez-Heffernan A, Sinitsyn V, Sergienko V, Ansheles A, Bax JJ, Buechel R, Milan E, Slart RHJA, Nicol E, Bucciarelli-Ducci C, Pynda Y, Better N, Cerci R, Dorbala S, Raggi P, Villines TC, Vitola J, Malkovskiy E, Goebel B, Cohen Y, Randazzo M, Pascual TNB, Dondi M, Paez D, Einstein AJ. Impact of COVID-19 on the imaging diagnosis of cardiac disease in Europe. Open Heart 2021; 8:e001681. [PMID: 34353958 PMCID: PMC8349647 DOI: 10.1136/openhrt-2021-001681] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES We aimed to explore the impact of the COVID-19 pandemic on cardiac diagnostic testing and practice and to assess its impact in different regions in Europe. METHODS The online survey organised by the International Atomic Energy Agency Division of Human Health collected information on changes in cardiac imaging procedural volumes between March 2019 and March/April 2020. Data were collected from 909 centres in 108 countries. RESULTS Centres in Northern and Southern Europe were more likely to cancel all outpatient activities compared with Western and Eastern Europe. There was a greater reduction in total procedure volumes in Europe compared with the rest of the world in March 2020 (45% vs 41%, p=0.003), with a more marked reduction in Southern Europe (58%), but by April 2020 this was similar in Europe and the rest of the world (69% vs 63%, p=0.261). Regional variations were apparent between imaging modalities, but the largest reductions were in Southern Europe for nearly all modalities. In March 2020, location in Southern Europe was the only independent predictor of the reduction in procedure volume. However, in April 2020, lower gross domestic product and higher COVID-19 deaths were the only independent predictors. CONCLUSION The first wave of the COVID-19 pandemic had a significant impact on care of patients with cardiac disease, with substantial regional variations in Europe. This has potential long-term implications for patients and plans are required to enable the diagnosis of non-COVID-19 conditions during the ongoing pandemic.
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Affiliation(s)
| | - Leslee Shaw
- Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | | | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | | | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Vladimir Sergienko
- National Medical Research Center of Cardiology of Healthcare Ministry, Moscow, Russian Federation
| | - Alexey Ansheles
- National Medical Research Center of Cardiology of Healthcare Ministry, Moscow, Russian Federation
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronny Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Elisa Milan
- UOC Nuclear Medicine- Ospedale Cà Foncello, Treviso, Italy
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, Groningen, The Netherlands
| | - Edward Nicol
- Department of Imaging, Royal Brompton Hospital, London, UK
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, London, UK
- Guys and St Thomas NHS Trust and King's College London, London, UK
| | | | - Nathan Better
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Paolo Raggi
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Todd C Villines
- Medicine (Cardiology), Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - Eli Malkovskiy
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Yosef Cohen
- Technion Israel Institute of Technology, Haifa, Israel
| | - Michael Randazzo
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Diana Paez
- International Atomic Energy Agency, Vienna, Austria
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18
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Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) spread rapidly around the world in the early months of 2020 before the COVID-19 outbreak was officially declared a pandemic in March 2020. Worldwide volumes of non-emergent testing, such as cardiac PET and SPECT, decreased dramatically at the beginning of the lockdown as health systems attempted to limit the spread of the COVID-19 virus. Published reports of increasing cardiovascular mortality compared to months prior to the pandemic raised concerns that lack of access to appropriate cardiovascular testing was adversely affecting patient outcomes. Medical societies published guidance for the best practices of cardiovascular nuclear medicine laboratories to address this emerging cardiovascular epidemic. These nuclear cardiology expert consensus recommendations were remarkably consistent with those from other health organizations and heavily emphasized patient triage, screening of symptoms, strict PPE usage, and limiting patient dwell time in the nuclear medicine lab by favoring shorter testing protocols. Survey responses indicated that nuclear medicine labs took heed of these recommendations and adjusted practices to meet the cardiovascular needs of their population while minimizing transmission risk.
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Affiliation(s)
- Richard A Mills
- Saint Luke's Mid America Heart Institute and The University of Missouri, Kansas City, MO
| | - Randall C Thompson
- Saint Luke's Mid America Heart Institute and The University of Missouri, Kansas City, MO.
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19
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Jara BJ. Infection Prevention in the Era of COVID-19: 2021 Basic Procedure Review. J Nucl Med Technol 2021; 49:126-131. [PMID: 34083454 PMCID: PMC8712632 DOI: 10.2967/jnmt.121.262281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
Infection prevention and control practices represent a vital behavioral skill set, especially in the era of COVID-19. Standard precautions, correct use of personal protective equipment, proper hand hygiene, and appropriate cleaning and disinfecting are necessary to prevent health-care-acquired infections in care facilities.
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Affiliation(s)
- Barbara J Jara
- Nuclear Diagnostic Products, Pharmalogic, Lansdowne, Pennsylvania
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20
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O'Sullivan P, Younger J, Van Pelt N, O'Malley S, Lenturut-Katal D, Hirschfeld CB, Vitola JV, Cerci R, Williams MC, Shaw LJ, Raggi P, Villines TC, Dorbala S, Choi AD, Cohen Y, Goebel B, Malkovskiy E, Randazzo M, Pascual TNB, Pynda Y, Dondi M, Paez D, Einstein AJ, Better N. Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID). Heart Lung Circ 2021; 30:1477-1486. [PMID: 34053885 PMCID: PMC8126176 DOI: 10.1016/j.hlc.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/13/2021] [Accepted: 04/20/2021] [Indexed: 01/10/2023]
Abstract
Objectives The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p<0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p<0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology.
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Affiliation(s)
| | - John Younger
- Royal Brisbane Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | | | - Sue O'Malley
- Christchurch Hospital, Christchurch, New Zealand
| | | | - Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA
| | | | | | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Leslee J Shaw
- Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Paolo Raggi
- Department of Medicine and Division of Cardiology, University of Alberta, Edmonton, Canada
| | | | | | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Yosef Cohen
- Technion Israel Institute of Technology, Haifa, Israel
| | - Benjamin Goebel
- Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Eli Malkovskiy
- Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA; Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA
| | - Michael Randazzo
- Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA
| | | | | | | | - Diana Paez
- International Atomic Energy Agency, Vienna, Austria
| | - Andrew J Einstein
- Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA; Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA; Department of Radiology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, NY, USA
| | - Nathan Better
- Royal Melbourne Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
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21
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Scrima G, D'Amico M, Bertuccio G, Canavese G, De Sanctis P. Safety measures and clinical outcome of Nuclear Cardiology Department during Covid-19 lockdown pandemic: Northern Italy experience. J Nucl Cardiol 2021; 28:331-335. [PMID: 32737838 PMCID: PMC7394269 DOI: 10.1007/s12350-020-02286-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Covid-19 pandemic led to a complete renewal of clinical activities of Italian hospitals. During the lockdown, all hospitals in Italy had to suspend non-urgent clinical activities. The prolonged suspension of elective activities could have caused a series of problems. METHODS A new ad hoc protocol was designed. Single-day fast-imaging protocol with regadenoson-stress 99mTc-tetrofosmin imaging was preferred. Patients were contacted by phone 4 days before the test and answered to a questionnaire which will be repeated on the day of the exam. Body temperature <37.5 degrees C and no Covid-19 symptoms were necessary to enter the unit. Patients wore surgical mask and gloves. Social distancing was maintained throughout the examination. Healthcare professionals wore a personal protective equipment. RESULTS A total of 46 patients were studied from April 7 to May 15, 2020, before the publication of the recommendations from ASNC and SNMMI. None of the patients experienced complications. Follow-up of patients discharged was carried by phone. No Covid-19 infection symptoms were reported. On May 18, 2020 all the healthcare providers of nuclear cardiology department underwent serological testing IgG and IgM and none were positive. CONCLUSION Strict ad hoc hygiene protocol for Covid-19 pandemic avoids diagnostic-therapeutic delay and lengthening of waiting lists. Our experience confirms that pursuing WHO recommendations and recent indication of ASNC and SNMMI is safe for both health providers and patients. Moreover, the incidence of significant inducible ischemia rises when correct stratification of patients is performed.
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Affiliation(s)
- Giovanni Scrima
- Department of Cardiology, Santa Croce Hospital, Piazza Amedeo Ferdinando 3, 10024, Moncalieri, TO, Italy.
| | - Maurizio D'Amico
- Department of Cardiology, Santa Croce Hospital, Piazza Amedeo Ferdinando 3, 10024, Moncalieri, TO, Italy
| | - Giovanni Bertuccio
- Department of Nuclear Medicine, Santa Croce Hospital, Moncalieri, TO, Italy
| | - Giacomo Canavese
- Department of Nuclear Medicine, Santa Croce Hospital, Moncalieri, TO, Italy
| | - Paolo De Sanctis
- Humanitas University and Humanitas Research Hospital, Milan, MI, Italy
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22
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Skali H. The COVID-19 pandemic and nuclear cardiology: An opportunity to grow stronger? J Nucl Cardiol 2021; 28:336-337. [PMID: 33025475 PMCID: PMC7538366 DOI: 10.1007/s12350-020-02383-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Hicham Skali
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Einstein AJ, Shaw LJ, Hirschfeld C, Williams MC, Villines TC, Better N, Vitola JV, Cerci R, Dorbala S, Raggi P, Choi AD, Lu B, Sinitsyn V, Sergienko V, Kudo T, Nørgaard BL, Maurovich-Horvat P, Campisi R, Milan E, Louw L, Allam AH, Bhatia M, Malkovskiy E, Goebel B, Cohen Y, Randazzo M, Narula J, Pascual TNB, Pynda Y, Dondi M, Paez D. International Impact of COVID-19 on the Diagnosis of Heart Disease. J Am Coll Cardiol 2021; 77:173-185. [PMID: 33446311 PMCID: PMC7836433 DOI: 10.1016/j.jacc.2020.10.054] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. OBJECTIVES The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. RESULTS Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. CONCLUSIONS COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19-related changes in care delivery is warranted.
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Affiliation(s)
- Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA.
| | - Leslee J Shaw
- Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Cole Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Nathan Better
- Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | - Paolo Raggi
- University of Alberta, Edmonton, Alberta, Canada
| | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Bin Lu
- National Center for Cardiovascular Diseases, Beijing, China
| | - Valentin Sinitsyn
- University Hospital, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Vladimir Sergienko
- National Medical Research Center of Cardiology of Healthcare Ministry, Moscow, Russian Federation
| | | | | | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | | | | | - Lizette Louw
- Donald Gordon Medical Centre, Johannesburg, South Africa
| | | | - Mona Bhatia
- Fortis Escorts Heart Institute, New Delhi, India
| | - Eli Malkovskiy
- Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Columbia College, Columbia University in the City of New York, New York, New York, USA
| | - Benjamin Goebel
- Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Yosef Cohen
- Technion - Israel Institute of Technology, Haifa, Israel
| | - Michael Randazzo
- Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Jagat Narula
- Mount Sinai Medical Center, New York, New York, USA
| | | | | | | | - Diana Paez
- International Atomic Energy Agency, Vienna, Austria
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24
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Prevalence of abnormal SPECT myocardial perfusion imaging during the COVID-19 pandemic. Eur J Nucl Med Mol Imaging 2021; 48:2447-2454. [PMID: 33416952 PMCID: PMC7791164 DOI: 10.1007/s00259-020-05123-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023]
Abstract
Purpose The aim of this study is to evaluate the rate of abnormal myocardial perfusion imaging (MPI) studies at a single medical center during the COVID-19 pandemic compared to prior to the pandemic. Methods We retrospectively studied stress single-photon emission computed tomography (SPECT)-MPI studies performed during the peak of COVID-19 restrictions at the University of Alabama Medical Center in comparison to the same time period in 2019. Results SPECT-MPI volume was reduced from 553 per month in 2019 to 105 per month in 2020. The proportion of abnormal SPECT-MPI for the 2020 cohort (61 ± 13 years, 48% men, 41% black) was not different from the 2019 cohort (62 ± 12 years, 48% men, 42% black) (31% vs. 27%, p = 0.4). Similar proportion of patients in the 2 cohorts had abnormal myocardial perfusion, moderate-large perfusion defects, myocardial ischemia, myocardial scar, and abnormal left ventricular ejection fraction. The proportion of abnormal SPECT-MPIs was not different based on whether patients were evaluated face-to-face or by telemedicine (28% vs. 27%, p > 0.9) but was higher for cardiology providers (40% vs. 20%, p < 0.001). Conclusions There was a significant reduction in the number of SPECT-MPI studies performed during the peak restrictions from the pandemic. Despite this restriction, the rate of abnormal studies remained stable. Our study suggests that it remains difficult to predict which patients will have abnormal SPECT-MPI even when providers and stress laboratories are forced to prioritize the performance of studies to high-yield patients.
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Kaushik A, Patel S, Dubey K. COVID-19 and nuclear cardiology: Introducing the "forward" virtual visit. J Card Surg 2020; 36:783. [PMID: 33284490 DOI: 10.1111/jocs.15236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Atul Kaushik
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Surendra Patel
- Department of Trauma and Emergency Cardiothoracic Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Kalika Dubey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, India
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Zoghbi WA, DiCarli MF, Blankstein R, Choi AD, Dilsizian V, Flachskampf FA, Geske JB, Grayburn PA, Jaffer FA, Kwong RY, Leipsic JA, Marwick TH, Nagel E, Nieman K, Raman SV, Salerno M, Sengupta PP, Shaw LJ, Chandrashekhar YS. Multimodality Cardiovascular Imaging in the Midst of the COVID-19 Pandemic: Ramping Up Safely to a New Normal. JACC Cardiovasc Imaging 2020; 13:1615-1626. [PMID: 32646721 PMCID: PMC7290215 DOI: 10.1016/j.jcmg.2020.06.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- William A Zoghbi
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
| | - Marcelo F DiCarli
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew D Choi
- Department of Medicine, George Washington University, Washington, DC; Department of Radiology, George Washington University, Washington, DC
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Frank A Flachskampf
- Clinical Physiology and Cardiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jeffrey B Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Paul A Grayburn
- Department of Medicine, Baylor Scott and White Heart and Vascular Hospital, Dallas Texas
| | - Farouc A Jaffer
- Cardiovascular Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raymond Y Kwong
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan A Leipsic
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas H Marwick
- Department of Medicine, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt AM Main, Germany
| | - Koen Nieman
- Department of Medicine, Stanford University, Stanford, California; Department of Radiology, Stanford University, Stanford, California
| | - Subha V Raman
- Division of Cardiology, Indiana University School of Medicine, Bloomington, Indiana
| | - Michael Salerno
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Partho P Sengupta
- Department of Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Y S Chandrashekhar
- Department of Medicine, University of Minnesota and VA Medical Center, Minneapolis, Minnesota
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