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Sperry BW, Vamenta MS, Gunta SP, Thompson RC, Einstein AJ, Castillo M, Chaudhary PD, Bremner LI, Cohen YA, Bateman TM, McGhie AI. Influence of Body Mass Index on Radiation Exposure Across Imaging Modalities in the Evaluation of Chest Pain. J Am Heart Assoc 2024; 13:e033566. [PMID: 38591342 PMCID: PMC11262536 DOI: 10.1161/jaha.123.033566] [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: 11/15/2023] [Accepted: 03/07/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Essential to a patient-centered approach to imaging individuals with chest pain is knowledge of differences in radiation effective dose across imaging modalities. Body mass index (BMI) is an important and underappreciated predictor of effective dose. This study evaluated the impact of BMI on estimated radiation exposure across imaging modalities. METHODS AND RESULTS This was a retrospective analysis of patients with concern for cardiac ischemia undergoing positron emission tomography (PET)/computed tomography (CT), cadmium zinc telluride single-photon emission CT (SPECT) myocardial perfusion imaging, or coronary CT angiography (CCTA) using state-of-the-art imaging modalities and optimal radiation-sparing protocols. Radiation exposure was calculated across BMI categories based on established cardiac imaging-specific conversion factors. Among 9046 patients (mean±SD age, 64.3±13.1 years; 55% men; mean±SD BMI, 30.6±6.9 kg/m2), 4787 were imaged with PET/CT, 3092 were imaged with SPECT/CT, and 1167 were imaged with CCTA. Median (interquartile range) radiation effective doses were 4.4 (3.9-4.9) mSv for PET/CT, 4.9 (4.0-6.3) mSv for SPECT/CT, and 6.9 (4.0-11.2) mSv for CCTA. Patients at a BMI <20 kg/m2 had similar radiation effective dose with all 3 imaging modalities, whereas those with BMI ≥20 kg/m2 had the lowest effective dose with PET/CT. Radiation effective dose and variability increased dramatically with CCTA as BMI increased, and was 10 times higher in patients with BMI >45 kg/m2 compared with <20 kg/m2 (median, 26.9 versus 2.6 mSv). After multivariable adjustment, PET/CT offered the lowest effective dose, followed by SPECT/CT, and then CCTA (P<0.001). CONCLUSIONS Although median radiation exposure is modest across state-of-the-art PET/CT, SPECT/CT, and CCTA systems using optimal radiation-sparing protocols, there are significant variations across modalities based on BMI. These data are important for making patient-centered decisions for ischemic testing.
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Affiliation(s)
- Brett W. Sperry
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri–Kansas CityKansas CityMO
| | - Mary Stefanie Vamenta
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri–Kansas CityKansas CityMO
| | | | - Randall C. Thompson
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri–Kansas CityKansas CityMO
| | - Andrew J. Einstein
- Seymour, Paul and Gloria Milstein Division of CardiologyNew YorkNY
- Department of MedicineMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
- Department of RadiologyMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
| | - Michelle Castillo
- Seymour, Paul and Gloria Milstein Division of CardiologyNew YorkNY
- Department of MedicineMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
| | - Priyanka D. Chaudhary
- Department of RadiologyMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
| | - Luca I. Bremner
- Seymour, Paul and Gloria Milstein Division of CardiologyNew YorkNY
- Vagelos College of Physicians and SurgeonsMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
| | - Yosef A. Cohen
- Seymour, Paul and Gloria Milstein Division of CardiologyNew YorkNY
- Department of MedicineMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
- Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
| | - Timothy M. Bateman
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri–Kansas CityKansas CityMO
| | - A. Iain McGhie
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri–Kansas CityKansas CityMO
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2
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Oseran AS, Dong H, Wadhera RK. Cardiovascular hospitalizations for Medicare advantage beneficiaries in the United States, 2009 to 2019. Am Heart J 2023; 265:77-82. [PMID: 37451356 DOI: 10.1016/j.ahj.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Federal programs measuring hospital quality of care for acute cardiovascular conditions are based solely on Medicare fee-for-service (FFS) beneficiaries, and exclude Medicare Advantage (MA) beneficiaries. In this study we characterize the proportion of Medicare beneficiaries enrolled in MA at the time of acute myocardial infarction (AMI), heart failure (HF), and ischemic stroke hospitalization. METHODS Retrospective cross-sectional study of short-term acute care hospitals using Medicare claims in 2009 and 2019. RESULTS There were 2,653 hospitals in 2009 and 2,732 hospitals in 2019. Across hospitals, the proportion of Medicare beneficiaries hospitalized for AMI who were enrolled in MA increased between 2009 (hospital-level median 14.4% [IQR 5.1%-26.0%]) and 2019 (33.3% [IQR 20.6%-45.2%]), with substantial variation across hospitals. Similar patterns were observed for HF (13.0% [IQR 5.3%-24.3%] to 31.0% [IQR 20.2%-42.3%]) and ischemic stroke (14.6% [IQR 5.3%-26.7%] to 33.3% [IQR 20.9%-46.0%]). Within each hospital referral region, hospital size (large 36.3% vs small 24.5%; adjusted difference 6.7%, 95% CI, 4.5%-8.8%), teaching status (teaching 34.5% vs nonteaching 28.2%; 2.8%, 1.4%-4.1%), and ownership status (private nonprofit 32.3% vs public 24.5%; 5.2%, 3.5%-6.9%) were each associated with a higher hospital MA proportion. CONCLUSIONS The proportion of Medicare beneficiaries hospitalized for AMI, HF, and ischemic stroke enrolled in MA doubled between 2009 and 2019, with substantial variation across hospitals. These findings have implications for federal efforts to measure and improve quality, which currently focus only on FFS beneficiaries.
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Affiliation(s)
- Andrew S Oseran
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA; Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Huaying Dong
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA.
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Sorrell VL, Lindner JR, Pellikka PA, Kirkpatrick JN, Muraru D. Recognized and Unrecognized Value of Echocardiography in Guideline and Consensus Documents Regarding Patients With Chest Pain. J Am Soc Echocardiogr 2023; 36:146-153. [PMID: 36375734 DOI: 10.1016/j.echo.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
Guideline and consensus documents have recently been published on the important topic of the noninvasive evaluation of patients presenting with chest pain (CP) or patients with known acute or chronic coronary syndromes. Authors for these documents have included members representing multispecialty imaging societies, yet the process of generating consensus and the need to produce concise written documents have led to a situation where the particular advantages of echocardiography are overlooked. Broad guidelines such as these can be helpful when it comes to "when to do" noninvasive cardiac testing, but they do not pretend to offer nuances on "how to do" noninvasive cardiac testing. This report details the particular value of echocardiography and potential explanations for its understated role in recent guidelines. This report is categorized into the following sections: (1) impact of the level of evidence on guideline creation; (2) versatility of echocardiography in the assessment of CP and the inimitable role for echo Doppler echocardiography in the assessment of dyspnea; (3) value of point-of-care ultrasound in assessing CP and dyspnea; and (4) the future role of echocardiography in ischemic heart disease.
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Affiliation(s)
- Vincent L Sorrell
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky.
| | - Jonathan R Lindner
- Vice-chief for Research in the Cardiology Division, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | | | - James N Kirkpatrick
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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4
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Blankstein R, Shaw LJ, Gulati M, Atalay MK, Bax J, Calnon DA, Dyke CK, Ferencik M, Heitner JF, Henry TD, Hung J, Knuuti J, Lindner JR, Phillips LM, Raman SV, Rao SV, Rybicki FJ, Saraste A, Stainback RF, Thompson RC, Williamson E, Nieman K, Tremmel JA, Woodard PK, Di Carli MF, Chandrashekhar YS. Implications of the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Chest Pain Guideline for Cardiovascular Imaging: A Multisociety Viewpoint. JACC Cardiovasc Imaging 2022; 15:912-926. [PMID: 35512960 DOI: 10.1016/j.jcmg.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Leslee J Shaw
- Departments of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Martha Gulati
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Michael K Atalay
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Jeroen Bax
- Heart Center, Turku University Hospital, Turku, Finland; Leiden University Medical Centre, Leiden, the Netherlands
| | - Dennis A Calnon
- Ohio Health Heart & Vascular Physicians, Columbus, Ohio, USA
| | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juhani Knuuti
- Heart Center, Turku University Hospital, Turku, Finland
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Subha V Raman
- Indiana University CV Institute and Krannert CV Research Center, Indianapolis, Indiana, USA
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frank J Rybicki
- University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Antti Saraste
- Heart Center, Turku University Hospital, Turku, Finland; Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Raymond F Stainback
- Texas Heart Institute and Baylor College of Medicine, Division of Cardiology, Houston, Texas, USA
| | - Randall C Thompson
- St. Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | - Koen Nieman
- Stanford University, Palo Alto, California, USA
| | | | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Thompson RC, Al-Mallah MH, Beanlands RSB, Calnon DA, Dorbala S, Phillips LM, Polk DM, Soman P. ASNC's thoughts on the AHA/ACC chest pain guidelines. J Nucl Cardiol 2022; 29:19-23. [PMID: 34782993 DOI: 10.1007/s12350-021-02856-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Randall C Thompson
- St. Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA.
| | | | - Rob S B Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | | | | | | | | | - Prem Soman
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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