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Bremner L, Vitola J, Cerci R, Campisi R, Araujo Ríos R, Massardo T, Gutierrez-Villamil C, Solis F, Peix A, Speckter H, Sanchez Velez M, Flores AC, Madu E, Alexánderson-Rosas E, Ortellado J, Morales R, Mut F, Vera L, Hirschfeld CB, Shaw LJ, Williams MC, Villines TC, Better N, Dorbala S, Karthikeyan G, Malkovskiy E, Cohen YA, Randazzo M, Pascual TN, Pynda Y, Dondi M, Paez D, Einstein AJ. Cardiovascular testing recovery in Latin America one year into the COVID-19 pandemic: An analysis of data from an international longitudinal survey. Int J Cardiol Heart Vasc 2024; 52:101404. [PMID: 38590383 PMCID: PMC11000160 DOI: 10.1016/j.ijcha.2024.101404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/23/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
Background The COVID-19 pandemic disproportionately impacted Latin America (LATAM), significantly disrupting cardiovascular testing. This study evaluated cardiac procedure recovery in LATAM one year after the outbreak. Methods The International Atomic Energy Agency (IAEA) surveyed 669 centers in 107 countries worldwide, including 135 facilities in 19 LATAM countries, to assess cardiovascular procedure volumes in March 2019, April 2020, and April 2021, and changes in center practices and staffing conditions one year into the COVID-19 pandemic. Findings LATAM centers reported a 21 % decrease in procedure volumes in April 2021 from pre-pandemic-baseline, vs. a 0 % change in the rest of the world (RoW), and greater volume reductions for almost all procedure types. Centers in Central America and Mexico reported the largest procedure reductions (47 % reduction) compared to the Caribbean (15 %), and South America (14 %, p = 0.01), and this LATAM region was a significant predictor of lower procedure recovery in multivariable regression. More LATAM centers reported reduced salaries and increased layoffs of clinical staff compared to RoW, and LATAM respondents estimated that half of physician and non-physician staff experienced excess psychological stress related to the pandemic, compared to 25 % and 30 % in RoW (p < 0.001). Conclusions Cardiovascular testing recovery in LATAM trailed behind RoW for most procedure types, with centers in Central America and Mexico reporting the greatest volume reductions. This study found lasting impacts of COVID-19 on cardiovascular care in LATAM and the need for mental health support for LATAM healthcare workers in current and future pandemics.
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Affiliation(s)
- Luca Bremner
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | | | - Roxana Campisi
- Diagnóstico Maipú and Instituto Argentino de Diagnóstico Y Tratamiento S.A., Buenos Aires, Argentina
| | | | | | | | - Felix Solis
- Hospital Escalante Pradilla, Perez Zeledon, Costa Rica
| | - Amalia Peix
- Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
| | | | - Mayra Sanchez Velez
- Sociedad Ecuatoriana de Cardiología Y a La Sociedad Española de Imagen Cardíaca, Ecuador
| | | | - Ernest Madu
- Heart Institute of the Caribbean and HIC Heart Hospital, Kingston, Jamaica
| | | | | | - Rosanna Morales
- Departamento de Medicina Nuclear, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | | | - Cole B. Hirschfeld
- Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Leslee J. Shaw
- Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical Center, New York, NY, USA
| | | | - Todd C. Villines
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Nathan Better
- Cabrini Health, Royal Melbourne Hospital, Monash University and University of Melbourne, Melbourne, Australia, Melbourne, Australia
| | - Sharmila Dorbala
- Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Eli Malkovskiy
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Yosef A. Cohen
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Children's Hospital at Montefiore, New York, NY, USA
| | - Michael Randazzo
- Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA
| | | | - 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
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - INCAPS COVID
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Quanta Diagnostico, Curitiba, Brazil
- Diagnóstico Maipú and Instituto Argentino de Diagnóstico Y Tratamiento S.A., Buenos Aires, Argentina
- Instituto de Medicina Nuclear, Sucre, Bolivia
- Hospital Clinico Universidad de Chile, Santiago, Chile
- Fundacion Cardioinfantil, Instituto de Cardiologia, Bogota, Colombia
- Hospital Escalante Pradilla, Perez Zeledon, Costa Rica
- Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
- Cedimat, Santo Domingo, Dominican Republic
- Sociedad Ecuatoriana de Cardiología Y a La Sociedad Española de Imagen Cardíaca, Ecuador
- Clinica de Radiologia Brito Mejia Peña, San Salvador, El Salvador
- Heart Institute of the Caribbean and HIC Heart Hospital, Kingston, Jamaica
- Instituto Nacional de Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
- Central Hospital, Social Institute, Asunción, Paraguay
- Departamento de Medicina Nuclear, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
- Italian Hospital, Montevideo, Uruguay
- Urologico San Roman, Caracas, Venezuela
- Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical Center, New York, NY, USA
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA
- Cabrini Health, Royal Melbourne Hospital, Monash University and University of Melbourne, Melbourne, Australia, Melbourne, Australia
- Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Children's Hospital at Montefiore, New York, NY, USA
- Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA
- Philippine Nuclear Research Institute, Quezon City, Philippines
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
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- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Quanta Diagnostico, Curitiba, Brazil
- Diagnóstico Maipú and Instituto Argentino de Diagnóstico Y Tratamiento S.A., Buenos Aires, Argentina
- Instituto de Medicina Nuclear, Sucre, Bolivia
- Hospital Clinico Universidad de Chile, Santiago, Chile
- Fundacion Cardioinfantil, Instituto de Cardiologia, Bogota, Colombia
- Hospital Escalante Pradilla, Perez Zeledon, Costa Rica
- Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
- Cedimat, Santo Domingo, Dominican Republic
- Sociedad Ecuatoriana de Cardiología Y a La Sociedad Española de Imagen Cardíaca, Ecuador
- Clinica de Radiologia Brito Mejia Peña, San Salvador, El Salvador
- Heart Institute of the Caribbean and HIC Heart Hospital, Kingston, Jamaica
- Instituto Nacional de Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
- Central Hospital, Social Institute, Asunción, Paraguay
- Departamento de Medicina Nuclear, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
- Italian Hospital, Montevideo, Uruguay
- Urologico San Roman, Caracas, Venezuela
- Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical Center, New York, NY, USA
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA
- Cabrini Health, Royal Melbourne Hospital, Monash University and University of Melbourne, Melbourne, Australia, Melbourne, Australia
- Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Children's Hospital at Montefiore, New York, NY, USA
- Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA
- Philippine Nuclear Research Institute, Quezon City, Philippines
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Investigators Group
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Quanta Diagnostico, Curitiba, Brazil
- Diagnóstico Maipú and Instituto Argentino de Diagnóstico Y Tratamiento S.A., Buenos Aires, Argentina
- Instituto de Medicina Nuclear, Sucre, Bolivia
- Hospital Clinico Universidad de Chile, Santiago, Chile
- Fundacion Cardioinfantil, Instituto de Cardiologia, Bogota, Colombia
- Hospital Escalante Pradilla, Perez Zeledon, Costa Rica
- Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
- Cedimat, Santo Domingo, Dominican Republic
- Sociedad Ecuatoriana de Cardiología Y a La Sociedad Española de Imagen Cardíaca, Ecuador
- Clinica de Radiologia Brito Mejia Peña, San Salvador, El Salvador
- Heart Institute of the Caribbean and HIC Heart Hospital, Kingston, Jamaica
- Instituto Nacional de Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
- Central Hospital, Social Institute, Asunción, Paraguay
- Departamento de Medicina Nuclear, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
- Italian Hospital, Montevideo, Uruguay
- Urologico San Roman, Caracas, Venezuela
- Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical Center, New York, NY, USA
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA
- Cabrini Health, Royal Melbourne Hospital, Monash University and University of Melbourne, Melbourne, Australia, Melbourne, Australia
- Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Children's Hospital at Montefiore, New York, NY, USA
- Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA
- Philippine Nuclear Research Institute, Quezon City, Philippines
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
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Sethwala A, Hirschfeld CB, O'Sullivan P, Akbarally M, Younger J, Van Pelt N, Randazzo M, Lenturut-Katal D, Vitola JV, Cerci R, Williams MC, Shaw LJ, Karthikeyan G, Villines TC, Dorbala S, Choi AD, Cohen YA, Malkovskiy E, Pascual TNB, Pynda Y, Dondi M, Paez D, Einstein AJ, Better N. Recovery Rates of Diagnostic Cardiac Procedural Volume in Oceania 1 Year Into COVID-19: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID 2). Heart Lung Circ 2024; 33:384-391. [PMID: 38365497 DOI: 10.1016/j.hlc.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/10/2023] [Accepted: 12/10/2023] [Indexed: 02/18/2024]
Abstract
AIM The aim of this study was to assess the recovery rates of diagnostic cardiac procedure volumes in the Oceania Region, midway through the coronavirus disease 2019 (COVID-19) pandemic. METHODS A survey was performed comparing procedure volumes between March 2019 (pre-pandemic), April 2020 (during first wave of COVID-19 pandemic), and April 2021 (1 year into the COVID-19 pandemic). A total of 31 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, as well as teaching and non-teaching hospitals. A comparison was made with 549 centres in 96 countries in the rest of the world (RoW) outside of Oceania. The total number and median percentage change in procedure volume were measured between the three timepoints, compared by test type and by facility. RESULTS A total of 11,902 cardiac diagnostic procedures were performed in Oceania in April 2021 as compared with 11,835 pre-pandemic in March 2019 and 5,986 in April 2020; whereas, in the RoW, 499,079 procedures were performed in April 2021 compared with 497,615 pre-pandemic in March 2019 and 179,014 in April 2020. There was no significant difference in the median recovery rates for total procedure volumes between Oceania (-6%) and the RoW (-3%) (p=0.81). While there was no statistically significant difference in percentage recovery been functional ischaemia testing and anatomical coronary testing in Oceania as compared with the RoW, there was, however, a suggestion of poorer recovery in anatomical coronary testing in Oceania as compared with the RoW (CT coronary angiography -16% in Oceania vs -1% in RoW, and invasive coronary angiography -20% in Oceania vs -9% in RoW). There was no statistically significant difference in recovery rates in procedure volume between metropolitan vs regional (p=0.44), public vs private (p=0.92), hospital vs outpatient (p=0.79), or teaching vs non-teaching centres (p=0.73). CONCLUSIONS Total cardiology procedure volumes in Oceania normalised 1 year post-pandemic compared to pre-pandemic levels, with no significant difference compared with the RoW and between the different types of health care facilities.
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Affiliation(s)
| | - Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center, Weill Cornell Medicine, and NewYork-Presbyterian Hospital, New York, NY, USA
| | | | | | - John Younger
- Royal Brisbane Hospital, Brisbane, Qld, Australia University of Queensland, Brisbane, Qld, Australia
| | | | - Michael Randazzo
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | | | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Leslee J Shaw
- Blavatnik Family Women's Health Research Institute, Mount Sinai Medical Center, New York, NY, USA
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sharmila Dorbala
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Yosef A Cohen
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA; Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Eli Malkovskiy
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Thomas N B Pascual
- Department of Science and Technology-Philippines, Philippine Nuclear Research Institute, Manila, Philippines
| | - Yaroslav Pynda
- Department of Science and Technology-Philippines, Philippine Nuclear Research Institute, Manila, Philippines
| | - Maurizio Dondi
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, 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, NY, USA; Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Nathan Better
- Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Health, Malvern, Vic, Australia; Monash University and University of Melbourne, Melbourne, Vic, Australia.
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3
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Jayadeva PS, Stowers S, Tang EW, Vitola J, Cerci R, Yao J, Westcott J, Elison B, Better N. The impact of coronary calcium score as an addition to myocardial perfusion imaging in altering clinical management (ICCAMPA trial). J Nucl Cardiol 2023; 30:1004-1018. [PMID: 36097241 DOI: 10.1007/s12350-022-03086-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/20/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AIM: Myocardial perfusion imaging (MPI) is a key tool for the identification and risk stratification of patients with coronary artery disease. The use of a coronary calcium score further adds to prognostic data above MPI alone. In this study, our aim was to evaluate the extent to which the use of a coronary artery calcium (CAC) score, when co-reported with MPI, impacts changes in clinical management in patients without a history of coronary artery disease (CAD) undergoing functional imaging. METHODS This is a multicenter international study which incorporated a standardized questionnaire to evaluate changes in clinician management after MPI results were given with and without the additional information of a CAC score. Calcium scoring on a SPECT-CT system was performed via a semiquantitative Shemesh score (0-12) with a 0-3 score from the left main, left anterior descending, left circumflex, and right coronary arteries. CT of the chest was read independently, and non-coronary findings were reported alongside the CAC score. RESULTS A total of 281 patients were enrolled across 3 international centers (Brazil, Australia, New Zealand). Of the 281 patients, 133 (47%) had management altered after the clinician was made aware of the CAC score. The impact of the CAC in changing clinical management was significant, particularly in patients with a negative MPI (P < 0.0001), but also in MPI-positive patients (P = 0.0021). The most common management change was the addition or intensification of statin therapy. CONCLUSION The addition of the CAC component to MPI yielded significant management changes in nearly half of all patients undergoing MPI for suspected CAD. This trend was observed across all centers in the three countries involved and was particularly evident in patient with a negative MPI.
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Affiliation(s)
- Pavithra S Jayadeva
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - Stephen Stowers
- Department of Cardiology, Palmerston North Hospital, Palmerston North, New Zealand
| | - E W Tang
- Department of Cardiology, Palmerston North Hospital, Palmerston North, New Zealand
| | - Joao Vitola
- Department of Nuclear Medicine, Quanta Diagnostico por Imagem, Curitiba, Brazil
| | - Rodrigo Cerci
- Department of Nuclear Medicine, Quanta Diagnostico por Imagem, Curitiba, Brazil
| | - Jessica Yao
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - James Westcott
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Barry Elison
- Department of Nuclear Medicine, Wollongong Hospital, Wollongong, NSW, Australia
| | - Nathan Better
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Departments of Nuclear Medicine and Cardiology, Royal Melbourne Hospital, Parkville, Australia
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Armstrong AC, Cerci R, Matheson MB, Magalhães T, Kishi S, Brinker J, Clouse ME, Rochitte CE, Cox C, Lima JAC, Arbab-Zadeh A. Predicting Significant Coronary Obstruction in a Population with Suspected Coronary Disease and Absence of Coronary Calcium: CORE-64 / CORE320 Studies. Arq Bras Cardiol 2023; 120:e20220183. [PMID: 36946854 DOI: 10.36660/abc.20220183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/16/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Coronary artery calcium (CAC) scanning can be performed using non-contrast computed tomography to predict cardiovascular events, but has less value for risk stratification in symptomatic patients. OBJECTIVE To identify and validate predictors of significant coronary obstruction (SCO) in symptomatic patients without coronary artery calcification. METHODS A total of 4,258 participants were screened from the CORE64 and CORE320 studies that enrolled patients referred for invasive angiography, and from the Quanta Registry that included patients referred for coronary computed tomography angiography (CTA). Logistic regression models evaluated associations between cardiovascular risk factors, CAC, and SCO. An algorithm to assess the risk of SCO was proposed for patients without CAC. Significance level of 5% was used in the analyses. RESULTS Of the 509 participants of the CORE study, 117 (23%) had zero coronary calcium score; 13 (11%) patients without CAC had SCO. Zero calcium score was related to younger age, female gender, lower body mass index, no diabetes, and no dyslipidemia. Being a current smoker increased ~3.5 fold the probability of SCO and other CV risk factors were not significantly associated. Considering the clinical findings, an algorithm to further stratify zero calcium score patients was proposed and had a limited performance in the validation cohort (AUC 58; 95%CI 43, 72). CONCLUSION A lower cardiovascular risk profile is associated with zero calcium score in a setting of high-risk patients. Smoking is the strongest predictor of SCO in patients without CAC.
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Affiliation(s)
- Anderson C Armstrong
- Universidade Federal do Vale do São Francisco , Petrolina , PE - Brasil
- Johns Hopkins Hospital , Baltimore - EUA
| | | | | | | | | | | | | | - Carlos E Rochitte
- Instituto do Coração do Hospital das Clínicas da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christopher Cox
- Johns Hopkins Bloomberg School of Public Health , Baltimore - EUA
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5
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Kim Y, Choi AD, Telluri A, Lipkin I, Bradley AJ, Sidahmed A, Jonas R, Andreini D, Bathina R, Baggiano A, Cerci R, Choi EY, Choi JH, Choi SY, Chung N, Cole J, Doh JH, Ha SJ, Her AY, Kepka C, Kim JY, Kim JW, Kim SW, Kim W, Pontone G, Villines TC, Cho I, Danad I, Heo R, Lee SE, Lee JH, Park HB, Sung JM, Crabtree T, Earls JP, Min JK, Chang HJ. Atherosclerosis Imaging Quantitative Computed Tomography (AI-QCT) to guide referral to invasive coronary angiography in the randomized controlled CONSERVE trial. Clin Cardiol 2023; 46:477-483. [PMID: 36847047 PMCID: PMC10189079 DOI: 10.1002/clc.23995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
AIMS We compared diagnostic performance, costs, and association with major adverse cardiovascular events (MACE) of clinical coronary computed tomography angiography (CCTA) interpretation versus semiautomated approach that use artificial intelligence and machine learning for atherosclerosis imaging-quantitative computed tomography (AI-QCT) for patients being referred for nonemergent invasive coronary angiography (ICA). METHODS CCTA data from individuals enrolled into the randomized controlled Computed Tomographic Angiography for Selective Cardiac Catheterization trial for an American College of Cardiology (ACC)/American Heart Association (AHA) guideline indication for ICA were analyzed. Site interpretation of CCTAs were compared to those analyzed by a cloud-based software (Cleerly, Inc.) that performs AI-QCT for stenosis determination, coronary vascular measurements and quantification and characterization of atherosclerotic plaque. CCTA interpretation and AI-QCT guided findings were related to MACE at 1-year follow-up. RESULTS Seven hundred forty-seven stable patients (60 ± 12.2 years, 49% women) were included. Using AI-QCT, 9% of patients had no CAD compared with 34% for clinical CCTA interpretation. Application of AI-QCT to identify obstructive coronary stenosis at the ≥50% and ≥70% threshold would have reduced ICA by 87% and 95%, respectively. Clinical outcomes for patients without AI-QCT-identified obstructive stenosis was excellent; for 78% of patients with maximum stenosis < 50%, no cardiovascular death or acute myocardial infarction occurred. When applying an AI-QCT referral management approach to avoid ICA in patients with <50% or <70% stenosis, overall costs were reduced by 26% and 34%, respectively. CONCLUSIONS In stable patients referred for ACC/AHA guideline-indicated nonemergent ICA, application of artificial intelligence and machine learning for AI-QCT can significantly reduce ICA rates and costs with no change in 1-year MACE.
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Affiliation(s)
- Yumin Kim
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Andrew D Choi
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Anha Telluri
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Isabella Lipkin
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Andrew J Bradley
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Alfateh Sidahmed
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Rebecca Jonas
- Jefferson Medical Institute, Philadelphia, Pennsylvania, USA
| | | | - Ravi Bathina
- CARE Hospital and FACTS Foundation, Hyderabad, India
| | | | | | | | | | - So-Yeon Choi
- Ajou University Hospital, Gyeonggi-do, South Korea
| | - Namsik Chung
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Jason Cole
- Cardiology Associates of Mobile, Mobile, Alabama, USA
| | - Joon-Hyung Doh
- Inje University, Ilsan Paik Hospital, Gyeonggi-do, South Korea
| | - Sang-Jin Ha
- Gangneung Asan Hospital, Gangwon-do, South Korea
| | - Ae-Young Her
- Kangwon National University Hospital, Gangwon-do, South Korea
| | - Cezary Kepka
- National Institute of Cardiology, Warsaw, Poland
| | | | - Jin Won Kim
- Korea University Guro Hospital, Seoul, South Korea
| | | | - Woong Kim
- Yeungnam University Hospital, Daegu, South Korea
| | | | - Todd C Villines
- University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Iksung Cho
- Chung-Ang University Hospital, Seoul, South Korea
| | | | - Ran Heo
- Hanyang University, Hanyang University Medical Center, Seoul, South Korea
| | - Sang-Eun Lee
- Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, South Korea
| | - Ji Hyun Lee
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Hyung-Bok Park
- Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, South Korea.,International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Ji-Min Sung
- Jefferson Medical Institute, Philadelphia, Pennsylvania, USA
| | | | - James P Earls
- The George Washington University School of Medicine, Washington, District of Columbia, USA.,Cleerly Inc, New York, New York, USA
| | | | - Hyuk-Jae Chang
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
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Einstein AJ, Hirschfeld C, Williams MC, Vitola JV, Better N, Villines TC, Cerci R, Shaw LJ, Choi AD, Dorbala S, Karthikeyan G, Lu B, Sinitsyn V, Ansheles AA, Kudo T, Bucciarelli-Ducci C, Nørgaard BL, Maurovich-Horvat P, Campisi R, Milan E, Louw L, Allam AH, Bhatia M, Sewanan L, Malkovskiy E, Cohen Y, Randazzo M, Narula J, Morozova O, Pascual TN, Pynda Y, Dondi M, Paez D. Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19. J Am Coll Cardiol 2022; 79:2001-2017. [PMID: 35589162 PMCID: PMC9109706 DOI: 10.1016/j.jacc.2022.03.348] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown. OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide. METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery. RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing. CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing.
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Affiliation(s)
- 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, USA,Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA,Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA,Address for correspondence: Dr Andrew J. Einstein, Columbia University Irving Medical Center, Seymour, Paul and Gloria Milstein Division of Cardiology, 622 West 168th Street, PH 10-203, New York, New York 10032, USA
| | - Cole Hirschfeld
- Division of Cardiology, Weill Cornell Medicine and NewYork-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 and University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Leslee J. Shaw
- Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical Center, New York, New York, USA
| | - Andrew D. Choi
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | | | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bin Lu
- National Center for Cardiovascular Diseases, Beijing, China
| | - Valentin Sinitsyn
- University Hospital, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Alexey A. Ansheles
- National Medical Research Center of Cardiology of Healthcare Ministry, Moscow, Russian Federation
| | | | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys’ and St Thomas NHS Trust and King’s College London, London, United Kingdom
| | | | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | | | | | - Lizette Louw
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Mona Bhatia
- Fortis Escorts Heart Institute, New Delhi, India
| | - Lorenzo Sewanan
- Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - 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, USA,Department of Medicine, Columbia University Irving Medical Center and 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 and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jagat Narula
- Mount Sinai Medical Center, New York, New York, USA
| | - Olga Morozova
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - 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
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Dondi M, Milan E, Pontone G, Hirschfeld CB, Williams M, Shaw LJ, Pynda Y, Raggi P, Cerci R, Vitola J, Better N, Villines TC, Dorbala S, Pascual TNB, Giubbini R, Einstein AJ, Paez D. Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID). Int J Cardiol 2021; 341:100-106. [PMID: 34478789 PMCID: PMC8406540 DOI: 10.1016/j.ijcard.2021.08.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/04/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022]
Abstract
Background In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p < 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures.
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Affiliation(s)
- Maurizio Dondi
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
| | | | | | - Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, USA
| | | | - Leslee J Shaw
- Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, USA
| | - Yaroslav Pynda
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Paolo Raggi
- Division of Cardiology, University of Alberta, Canada
| | | | | | - Nathan Better
- Royal Melbourne Hospital and University of Melbourne, Australia
| | - Todd C Villines
- Division of Cardiology, University of Virginia, Charlottesville, VA, USA
| | | | | | - Raffaele Giubbini
- Department of Imaging, Spedali Civili and University of Brescia, Italy
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, USA; Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, USA
| | - Diana Paez
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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Kudo T, Lahey R, Hirschfeld CB, Williams MC, Lu B, Alasnag M, Bhatia M, Henry Bom HS, Dautov T, Fazel R, Karthikeyan G, Keng FY, Rubinshtein R, Better N, Cerci RJ, Dorbala S, Raggi P, Shaw LJ, Villines TC, Vitola JV, Choi AD, Malkovskiy E, Goebel B, Cohen YA, Randazzo M, Pascual TN, Pynda Y, Dondi M, Paez D, Einstein AJ, Einstein AJ, Paez D, Dondi M, Better N, Cerci R, Dorbala S, Pascual TN, Raggi P, Shaw LJ, Villines TC, Vitola JV, Williams MC, Pynda Y, Hinterleitner G, Lu Y, Morozova O, Xu Z, Hirschfeld CB, Cohen Y, Goebel B, Malkovskiy E, Randazzo M, Choi A, Lopez-Mattei J, Parwani P, Nasery MN, Goda A, Shirka E, Benlabgaa R, Bouyoucef S, Medjahedi A, Nailli Q, Agolti M, Aguero RN, Alak MDC, Alberguina LG, Arroñada G, Astesiano A, Astesiano A, Norton CB, Benteo P, Blanco J, Bonelli JM, Bustos JJ, Cabrejas R, Cachero J, Campisi R, Canderoli A, Carames S, Carrascosa P, Castro R, Cendoya O, Cognigni LM, Collaud C, Collaud C, Cortes C, Courtis J, Cragnolino D, Daicz M, De La Vega A, De Maria ST, Del Riego H, Dettori F, Deviggiano A, Dragonetti L, Embon M, Enriquez RE, Ensinas J, Faccio F, Facello A, Topping W, Tweed K, Weir-Mccall J, Abbara S, Abbasi T, Abbott B, Abohashem S, Abramson S, Al-Abboud T, Al-Mallah M, Garofalo D, Almousalli O, Ananthasubramaniam K, Kumar MA, Askew J, Attanasio L, Balmer-Swain M, Bayer RR, Bernheim A, Bhatti S, Bieging E, Geronazzo R, Blankstein R, Bloom S, Blue S, Bluemke D, Borges A, Branch K, Bravo P, Brothers J, Budoff M, Bullock-Palmer R, Gonza N, Burandt A, Burke FW, Bush K, Candela C, Capasso E, Cavalcante J, Chang D, Chatterjee S, Chatzizisis Y, Cheezum M, Gutierrez L, Chen T, Chen J, Chen M, Choi A, Clarcq J, Cordero A, Crim M, Danciu S, Decter B, Dhruva N, Guzzo MA, Doherty N, Doukky R, Dunbar A, Duvall W, Edwards R, Esquitin K, Farah H, Fentanes E, Ferencik M, Fisher D, Guzzo MA, Fitzpatrick D, Foster C, Fuisz T, Gannon M, Gastner L, Gerson M, Ghoshhajra B, Goldberg A, Goldner B, Gonzalez J, Hasbani V, Gore R, Gracia-López S, Hage F, Haider A, Haider S, Hamirani Y, Hassen K, Hatfield M, Hawkins C, Hawthorne K, Huerin M, Heath N, Hendel R, Hernandez P, Hill G, Horgan S, Huffman J, Hurwitz L, Iskandrian A, Janardhanan R, Jellis C, Jäger V, Jerome S, Kalra D, Kaviratne S, Kay F, Kelly F, Khalique O, Kinkhabwala M, Iii GK, Kircher J, Kirkbride R, Lewkowicz JM, Kontos M, Kottam A, Krepp J, Layer J, Lee SH, Leppo J, Lesser J, Leung S, Lewin H, Litmanovich D, López De Munaín MNA, Liu Y, Lopez-Mattei J, Magurany K, Markowitz J, Marn A, Matis SE, Mckenna M, Mcrae T, Mendoza F, Merhige M, Lotti JM, Min D, Moffitt C, Moncher K, Moore W, Morayati S, Morris M, Mossa-Basha M, Mrsic Z, Murthy V, Nagpal P, Marquez A, Napier K, Nelson K, Nijjar P, Osman M, Parwani P, Passen E, Patel A, Patil P, Paul R, Phillips L, Masoli O, Polsani V, Poludasu R, Pomerantz B, Porter T, Prentice R, Pursnani A, Rabbat M, Ramamurti S, Rich F, Luna HR, Masoli OH, Robinson A, Robles K, Rodríguez C, Rorie M, Rumberger J, Russell R, Sabra P, Sadler D, Schemmer M, Schoepf UJ, Mastrovito E, Shah S, Shah N, Shanbhag S, Sharma G, Shayani S, Shirani J, Shivaram P, Sigman S, Simon M, Slim A, Mayoraz M, Smith D, Smith A, Soman P, Sood A, Srichai-Parsia MB, Streeter J, T A, Tawakol A, Thomas D, Thompson R, Melado GE, Torbet T, Trinidad D, Ullery S, Unzek S, Uretsky S, Vallurupalli S, Verma V, Waller A, Wang E, Ward P, Mele A, Weissman G, Wesbey G, White K, Winchester D, Wolinsky D, Yost S, Zgaljardic M, Alonso O, Beretta M, Ferrando R, Merani MF, Kapitan M, Mut F, Djuraev O, Rozikhodjaeva G, Le Ngoc H, Mai SH, Nguyen XC, Meretta AH, Molteni S, Montecinos M, Noguera E, Novoa C, Sueldo CP, Ascani SP, Pollono P, Pujol MP, Radzinschi A, Raimondi G, Redruello M, Rodríguez M, Rodríguez M, Romero RL, Acuña AR, Rovaletti F, San Miguel L, Solari L, Strada B, Traverso S, Traverzo SS, Espeche MDHV, Weihmuller JS, Wolcan J, Zeffiro S, Sakanyan M, Beuzeville S, Boktor R, Butler P, Calcott J, Carr L, Chan V, Chao C, Chong W, Dobson M, Downie D, Dwivedi G, Elison B, Engela J, Francis R, Gaikwad A, Basavaraj AG, Goodwin B, Greenough R, Hamilton-Craig C, Hsieh V, Joshi S, Lederer K, Lee K, Lee J, Magnussen J, Mai N, Mander G, Murton F, Nandurkar D, Neill J, O'Rourke E, O'Sullivan P, Pandos G, Pathmaraj K, Pitman A, Poulter R, Premaratne M, Prior D, Ridley L, Rutherford N, Salehi H, Saunders C, Scarlett L, Seneviratne S, Shetty D, Shrestha G, Shulman J, Solanki V, Stanton T, Stuart M, Stubbs M, Swainson I, Taubman K, Taylor A, Thomas P, Unger S, Upton A, Vamadevan S, Van Gaal W, Verjans J, Voutnis D, Wayne V, Wilson P, Wong D, Wong K, Younger J, Feuchtner G, Mirzaei S, Weiss K, Maroz-Vadalazhskaya N, Gheysens O, Homans F, Moreno-Reyes R, Pasquet A, Roelants V, Van De Heyning CM, Ríos RA, Soldat-Stankovic V, Stankovic S, Albernaz Siqueira MH, Almeida A, Alves Togni PH, Andrade JH, Andrade L, Anselmi C, Araújo R, Azevedo G, Bezerra S, Biancardi R, Grossman GB, Brandão S, Pianta DB, Carreira L, Castro B, Chang T, Cunali F, Cury R, Dantas R, de Amorim Fernandes F, De Lorenzo A, De Macedo Filho R, Erthal F, Fernandes F, Fernandes J, Fernandes F, De Souza TF, Alves WF, Ghini B, Goncalves L, Gottlieb I, Hadlich M, Kameoka V, Lima R, Lima A, Lopes RW, Machado e Silva R, Magalhães T, Silva FM, Mastrocola LE, Medeiros F, Meneghetti JC, Naue V, Naves D, Nolasco R, Nomura C, Oliveira JB, Paixao E, De Carvalho FP, Pinto I, Possetti P, Quinta M, Nogueira Ramos RR, Rocha R, Rodrigues A, Rodrigues C, Romantini L, Sanches A, Santana S, Sara da Silva L, Schvartzman P, Matushita CS, Senra T, Shiozaki A, Menezes de Siqueira ME, Siqueira C, Smanio P, Soares CE, Junior JS, Bittencourt MS, Spiro B, Mesquita CT, Torreao J, Torres R, Uellendahl M, Monte GU, Veríssimo O, Cabeda EV, Pedras FV, Waltrick R, Zapparoli M, Naseer H, Garcheva-Tsacheva M, Kostadinova I, Theng Y, Abikhzer G, Barette R, Chow B, Dabreo D, Friedrich M, Garg R, Hafez MN, Johnson C, Kiess M, Leipsic J, Leung E, Miller R, Oikonomou A, Probst S, Roifman I, Small G, Tandon V, Trivedi A, White J, Zukotynski K, Canessa J, Muñoz GC, Concha C, Hidalgo P, Lovera C, Massardo T, Vargas LS, Abad P, Arturo H, Ayala S, Benitez L, Cadena A, Caicedo C, Moncayo AC, Moncayo AC, Gomez S, Gutierrez Villamil CT, Jaimes C, Londoño J, Londoño Blair JL, Pabon L, Pineda M, Rojas JC, Ruiz D, Escobar MV, Vasquez A, Vergel D, Zuluaga A, Gamboa IB, Castro G, González U, Baric A, Batinic T, Franceschi M, Paar MH, Jukic M, Medakovic P, Persic V, Prpic M, Punda A, Batista JF, Gómez Lauchy JM, Gutierrez YM, Gutierrez YM, Menéndez R, Peix A, Rochela L, Panagidis C, Petrou I, Engelmann V, Kaminek M, Kincl V, Lang O, Simanek M, Abdulla J, Bøttcher M, Christensen M, Gormsen LC, Hasbak P, Hess S, Holdgaard P, Johansen A, Kyhl K, Norgaard BL, Øvrehus KA, Rønnow Sand NP, Steffensen R, Thomassen A, Zerahn B, Perez A, Escorza Velez GA, Velez MS, Abdel Aziz IS, Abougabal M, Ahmed T, Allam A, Asfour A, Hassan M, Hassan A, Ibrahim A, Kaffas S, Kandeel A, Ali MM, Mansy A, Maurice H, Nabil S, Shaaban M, Flores AC, Poksi A, Knuuti J, Kokkonen V, Larikka M, Uusitalo V, Bailly M, Burg S, Deux JF, Habouzit V, Hyafil F, Lairez O, Proffit F, Regaieg H, Sarda-Mantel L, Tacher V, Schneider RP, Ayetey H, Angelidis G, Archontaki A, Chatziioannou S, Datseris I, Fragkaki C, Georgoulias P, Koukouraki S, Koutelou M, Kyrozi E, Repasos E, Stavrou P, Valsamaki P, Gonzalez C, Gutierrez G, Maldonado A, Buga K, Garai I, Maurovich-Horvat P, Schmidt E, Szilveszter B, Várady E, Banthia N, Bhagat JK, Bhargava R, Bhat V, Bhatia M, Choudhury P, Chowdekar VS, Irodi A, Jain S, Joseph E, Kumar S, Girijanandan Mahapatra PD, Mitra D, Mittal BR, Ozair A, Patel C, Patel T, Patel R, Patel S, Saxena S, Sengupta S, Singh S, Singh B, Sood A, Verma A, Affandi E, Alam PS, Edison E, Gunawan G, Hapkido H, Hidayat B, Huda A, Mukti AP, Prawiro D, Soeriadi EA, Syawaluddin H, Albadr A, Assadi M, Emami F, Houshmand G, Maleki M, Rostami MT, Zakavi SR, Zaid EA, Agranovich S, Arnson Y, Bar-Shalom R, Frenkel A, Knafo G, Lugassi R, Maor Moalem IS, Mor M, Muskal N, Ranser S, Shalev A, Albano D, Alongi P, Arnone G, Bagatin E, Baldari S, Bauckneht M, Bertelli P, Bianco F, Bonfiglioli R, Boni R, Bruno A, Bruno I, Busnardo E, Califaretti E, Camoni L, Carnevale A, Casoni R, Cavallo AU, Cavenaghi G, Chierichetti F, Chiocchi M, Cittanti C, Colletta M, Conti U, Cossu A, Cuocolo A, Cuzzocrea M, De Rimini ML, De Vincentis G, Del Giudice E, Del Torto A, Della Tommasina V, Durmo R, Erba PA, Evangelista L, Faletti R, Faragasso E, Farsad M, Ferro P, Florimonte L, Frantellizzi V, Fringuelli FM, Gatti M, Gaudiano A, Gimelli A, Giubbini R, Giuffrida F, Ialuna S, Laudicella R, Leccisotti L, Leva L, Liga R, Liguori C, Longo G, Maffione M, Mancini ME, Marcassa C, Milan E, Nardi B, Pacella S, Pepe G, Pontone G, Pulizzi S, Quartuccio N, Rampin L, Ricci F, Rossini P, Rubini G, Russo V, Sacchetti GM, Sambuceti G, Scarano M, Sciagrà R, Sperandio M, Stefanelli A, Ventroni G, Zoboli S, Baugh D, Chambers D, Madu E, Nunura F, Asano H, Chimura CM, Fujimoto S, Fujisue K, Fukunaga T, Fukushima Y, Fukuyama K, Hashimoto J, Ichikawa Y, Iguchi N, Imai M, Inaki A, Ishimura H, Isobe S, Kadokami T, Kato T, Kudo T, Kumita S, Maruno H, Mataki H, Miyagawa M, Morimoto R, Moroi M, Nagamachi S, Nakajima K, Nakata T, Nakazato R, Nanasato M, Naya M, Norikane T, Ohta Y, Okayama S, Okizaki A, Otomi Y, Otsuka H, Saito M, Sakata SY, Sarai M, Sato D, Shiraishi S, Suwa Y, Takanami K, Takehana K, Taki J, Tamaki N, Taniguchi Y, Teragawa H, Tomizawa N, Tsujita K, Umeji K, Wakabayashi Y, Yamada S, Yamazaki S, Yoneyama T, Rawashdeh M, Batyrkhanov D, Dautov T, Makhdomi K, Ombati K, Alkandari F, Garashi M, Coie TL, Rajvong S, Kalinin A, Kalnina M, Haidar M, Komiagiene R, Kviecinskiene G, Mataciunas M, Vajauskas D, Picard C, Karim NKA, Reichmuth L, Samuel A, Allarakha MA, Naojee AS, Alexanderson-Rosas E, Barragan E, González-Montecinos AB, Cabada M, Rodriguez DC, Carvajal-Juarez I, Cortés V, Cortés F, De La Peña E, Gama-Moreno M, González L, Ramírez NG, Jiménez-Santos M, Matos L, Monroy E, Morelos M, Ornelas M, Ortga Ramirez JA, Preciado-Anaya A, Preciado-Gutiérrez ÓU, Barragan AP, Rosales Uvera SG, Sandoval S, Tomas MS, Sierra-Galan LM, Sierra-Galan LM, Siu S, Vallejo E, Valles M, Faraggi M, Sereegotov E, Ilic S, Ben-Rais N, Alaoui NI, Taleb S, Pa Myo KP, Thu PS, Ghimire RK, Rajbanshi B, Barneveld P, Glaudemans A, Habets J, Koopmans KP, Manders J, Pool S, Scholte A, Scholtens A, Slart R, Thimister P, Van Asperen EJ, Veltman N, Verschure D, Wagenaar N, Edmond J, Ellis C, Johnson K, Keenan R, Kueh SH(A, Occleshaw C, Sasse A, To A, Van Pelt N, Young C, Cuadra T, Roque Vanegas HB, Soli IA, Issoufou DM, Ayodele T, Madu C, Onimode Y, Efros-Monsen E, Forsdahl SH, Hildre Dimmen JM, Jørgensen A, Krohn I, Løvhaugen P, Bråten AT, Al Dhuhli H, Al Kindi F, Al-Bulushi N, Jawa Z, Tag N, Afzal MS, Fatima S, Younis MN, Riaz M, Saadullah M, Herrera Y, Lenturut-Katal D, Vázquez MC, Ortellado J, Akhter A, Cao D, Cheung S, Dai X, Gong L, Han D, Hou Y, Li C, Li T, Li D, Li S, Liu J, Liu H, Lu B, Ng MY, Sun K, Tang G, Wang J, Wang X, Wang ZQ, Wang Y, Wang Y, Wu J, Wu Z, Xia L, Xiao J, Xu L, Yang Y, Yin W, Yu J, Yuan L, Zhang T, Zhang L, Zhang YG, Zhang X, Zhu L, Alfaro A, Abrihan P, Barroso A, Cruz E, Gomez MR, Magboo VP, Medina JM, Obaldo J, Pastrana D, Pawhay CM, Quinon A, Tang JM, Tecson B, Uson KJ, Uy M, Kostkiewicz M, Kunikowska J, Bettencourt N, Cantinho G, Ferreira A, Syed G, Arnous S, Atyani S, Byrne A, Gleeson T, Kerins D, Meehan C, Murphy D, Murphy M, Murray J, O'Brien J, Bang JI, Bom H, Cho SG, Hong CM, Jang SJ, Jeong YH, Kang WJ, Kim JY, Lee J, Namgung CK, So Y, Won KS, Majstorov V, Vavlukis M, Salobir BG, Štalc M, Benedek T, Benedek I, Mititelu R, Stan CA, Ansheles A, Dariy O, Drozdova O, Gagarina N, Gulyaev VM, Itskovich I, Karalkin A, Kokov A, Migunova E, Pospelov V, Ryzhkova D, Saifullina G, Sazonova S, Sergienko V, Shurupova I, Trifonova T, Ussov WY, Vakhromeeva M, Valiullina N, Zavadovsky K, Zhuravlev K, Alasnag M, Okarvi S, Saranovic DS, Keng F, Jason See JH, Sekar R, Yew MS, Vondrak A, Bejai S, Bennie G, Bester R, Engelbrecht G, Evbuomwan O, Gongxeka H, Vuuren MJ, Kaplan M, Khushica P, Lakhi H, Louw L, Malan N, Milos K, Modiselle M, More S, Naidoo M, Scholtz L, Vangu M, Aguadé-Bruix S, Blanco I, Cabrera A, Camarero A, Casáns-Tormo I, Cuellar-Calabria H, Flotats A, Fuentes Cañamero ME, García ME, Jimenez-Heffernan A, Leta R, Diaz JL, Lumbreras L, Marquez-Cabeza JJ, Martin F, Martinez de Alegria A, Medina F, Canal MP, Peiro V, Pubul-Nuñez V, Rayo Madrid JI, Rey CR, Perez RR, Ruiz J, Hernández GS, Sevilla A, Zeidán N, Nanayakkara D, Udugama C, Simonsson M, Alkadhi H, Buechel RR, Burger P, Ceriani L, De Boeck B, Gräni C, Juillet de Saint Lager Lucas A, Kamani CH, Kawel-Boehm N, Manka R, Prior JO, Rominger A, Vallée JP, Khiewvan B, Premprabha T, Thientunyakit T, Sellem A, Kir KM, Sayman H, Sebikali MJ, Muyinda Z, Kmetyuk Y, Korol P, Mykhalchenko O, Pliatsek V, Satyr M, Albalooshi B, Ahmed Hassan MI, Anderson J, Bedi P, Biggans T, Bularga A, Bull R, Burgul R, Carpenter JP, Coles D, Cusack D, Deshpande A, Dougan J, Fairbairn T, Farrugia A, Gopalan D, Gummow A, Ramkumar PG, Hamilton M, Harbinson M, Hartley T, Hudson B, Joshi N, Kay M, Kelion A, Khokhar A, Kitt J, Lee K, Low C, Mak SM, Marousa N, Martin J, Mcalindon E, Menezes L, Morgan-Hughes G, Moss A, Murray A, Nicol E, Patel D, Peebles C, Pugliese F, Luis Rodrigues JC, Rofe C, Sabharwal N, Schofield R, Semple T, Sharma N, Strouhal P, Subedi D. Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia. JACC: Asia 2021; 1:187-199. [PMID: 36338167 PMCID: PMC9627847 DOI: 10.1016/j.jacasi.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/12/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Abstract
Background The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Dewey M, Rochitte CE, Ostovaneh MR, Chen MY, George RT, Niinuma H, Kitagawa K, Laham R, Kofoed K, Nomura C, Sakuma H, Yoshioka K, Mehra VC, Jinzaki M, Kuribayashi S, Laule M, Paul N, Scholte AJ, Cerci R, Hoe J, Tan SY, Rybicki FJ, Matheson MB, Vavere AL, Arai AE, Miller JM, Cox C, Brinker J, Clouse ME, Di Carli M, Lima JAC, Arbab-Zadeh A. Prognostic value of noninvasive combined anatomic/functional assessment by cardiac CT in patients with suspected coronary artery disease - Comparison with invasive coronary angiography and nuclear myocardial perfusion imaging for the five-year-follow up of the CORE320 multicenter study. J Cardiovasc Comput Tomogr 2021; 15:485-491. [PMID: 34024757 DOI: 10.1016/j.jcct.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few data exist on long-term outcome in patients undergoing combined coronary CT angiography (CTA) and myocardial CT perfusion imaging (CTP) as well as invasive coronary angiography (ICA) and single photon emission tomography (SPECT). METHODS At 16 centers, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA within 60 days. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC). RESULTS Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA-CTP findings compared to ICA-SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: -0.03, 0.36). Abnormal results by combined CTA-CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA-SPECT (95% CI for difference: -0.05, 0.39). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI -4.6, 4.9). When MACE was restricted to cardiovascular death, myocardial infarction, or stroke, AUC for CTA-CTP was 71 vs. 60 by ICA-SPECT (difference 11.2; 95% CI -1.0, 19.7). CONCLUSIONS Combined CTA-CTP evaluation yields at least equal 5-year prognostic information as combined ICA-SPECT assessment in patients presenting with suspected coronary artery disease. Noninvasive cardiac CT assessment may eliminate the need for diagnostic cardiac catheterization in many patients. CLINICAL TRIAL REGISTRATION NCT00934037.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany
| | - Carlos E Rochitte
- InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil
| | - Mohammad R Ostovaneh
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Marcus Y Chen
- Cardiology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Richard T George
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Hiroyuki Niinuma
- Memorial Heart Center, Iwate Medical University, Morioka, Japan; Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Roger Laham
- Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass, USA
| | - Klaus Kofoed
- Department of Cardiology, Rigs Hospitalet, University of Copenhagen, Denmark
| | - Cesar Nomura
- Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | | | - Vishal C Mehra
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | | | | | - Michael Laule
- Department of Medicine/Cardiology, Charité Medical School-Humboldt, Berlin, Germany
| | - Narinder Paul
- Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rodrigo Cerci
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - John Hoe
- Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore
| | - Swee Yaw Tan
- Department of Cardiology, National Heart Centre, Singapore
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, OH, USA
| | - Matthew B Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Vavere
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Andrew E Arai
- Cardiology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Julie M Miller
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeffrey Brinker
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Melvin E Clouse
- Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass, USA
| | - Marcelo Di Carli
- Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - João A C Lima
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Armin Arbab-Zadeh
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA.
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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O'Sullivan P, Younger J, Van Pelt N, O'Malley S, Lenturut-Katal D, Hirschfeld C, Vitola J, Cerci R, Williams M, Shaw L, Raggi P, Villines T, Dorbala S, Choi A, Cohen Y, Goebel B, Malkovskiy E, Randazzo M, Pascual T, Pynda Y, Dondi M, Paez D, Einstein A, Better N. Impact of COVID-19 Pandemic on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-invasive Cardiology Protocol Survey on COVID-19. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Baskaran L, Ying X, Xu Z, Al’Aref SJ, Lee BC, Lee SE, Danad I, Park HB, Bathina R, Baggiano A, Beltrama V, Cerci R, Choi EY, Choi JH, Choi SY, Cole J, Doh JH, Ha SJ, Her AY, Kepka C, Kim JY, Kim JW, Kim SW, Kim W, Lu Y, Kumar A, Heo R, Lee JH, Sung JM, Valeti U, Andreini D, Pontone G, Han D, Villines TC, Lin F, Chang HJ, Min JK, Shaw LJ. Machine learning insight into the role of imaging and clinical variables for the prediction of obstructive coronary artery disease and revascularization: An exploratory analysis of the CONSERVE study. PLoS One 2020; 15:e0233791. [PMID: 32584909 PMCID: PMC7316297 DOI: 10.1371/journal.pone.0233791] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/12/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Machine learning (ML) is able to extract patterns and develop algorithms to construct data-driven models. We use ML models to gain insight into the relative importance of variables to predict obstructive coronary artery disease (CAD) using the Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization (CONSERVE) study, as well as to compare prediction of obstructive CAD to the CAD consortium clinical score (CAD2). We further perform ML analysis to gain insight into the role of imaging and clinical variables for revascularization. METHODS For prediction of obstructive CAD, the entire ICA arm of the study, comprising 719 patients was used. For revascularization, 1,028 patients were randomized to invasive coronary angiography (ICA) or coronary computed tomographic angiography (CCTA). Data was randomly split into 80% training 20% test sets for building and validation. Models used extreme gradient boosting (XGBoost). RESULTS Mean age was 60.6 ± 11.5 years and 64.3% were female. For the prediction of obstructive CAD, the AUC was significantly higher for ML at 0.779 (95% CI: 0.672-0.886) than for CAD2 (0.696 [95% CI: 0.594-0.798]) (P = 0.01). BMI, age, and angina severity were the most important variables. For revascularization, the model obtained an overall area under the receiver-operation curve (AUC) of 0.958 (95% CI = 0.933-0.983). Performance did not differ whether the imaging parameters used were from ICA (AUC 0.947, 95% CI = 0.903-0.990) or CCTA (AUC 0.941, 95% CI = 0.895-0.988) (P = 0.90). The ML model obtained sensitivity and specificity of 89.2% and 92.9%, respectively. Number of vessels with ≥70% stenosis, maximum segment stenosis severity (SSS) and body mass index (BMI) were the most important variables. Exclusion of imaging variables resulted in performance deterioration, with an AUC of 0.705 (95% CI 0.614-0.795) (P <0.0001). CONCLUSIONS For obstructive CAD, the ML model outperformed CAD2. BMI is an important variable, although currently not included in most scores. In this ML model, imaging variables were most associated with revascularization. Imaging modality did not influence model performance. Removal of imaging variables reduced model performance.
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Affiliation(s)
- Lohendran Baskaran
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, United States of America
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America
- Department of Cardiovascular Medicine, National Heart Centre, Singapore, Singapore
| | - Xiaohan Ying
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America
| | - Zhuoran Xu
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, United States of America
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America
| | - Subhi J. Al’Aref
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, United States of America
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America
| | - Benjamin C. Lee
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, United States of America
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Hyung-Bok Park
- Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, South Korea
| | - Ravi Bathina
- CARE Hospital and FACTS Foundation, Hyderabad, India
| | | | | | | | | | | | - So-Yeon Choi
- Ajou University Hospital, Gyeonggi-do, South Korea
| | - Jason Cole
- Cardiology Associates of Mobile, Mobile, Alabama, United States of America
| | - Joon-Hyung Doh
- Inje University, Ilsan Paik Hospital, Gyeonggi-do, South Korea
| | - Sang-Jin Ha
- Gangneung Asan Hospital, Gangwon-do, South Korea
| | - Ae-Young Her
- Kangwon National University Hospital, Gangwon-do, South Korea
| | | | | | - Jin-Won Kim
- Korea University Guro Hospital, Seoul, South Korea
| | | | - Woong Kim
- Yeungnam University Hospital, Daegu, South Korea
| | - Yao Lu
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America
| | - Amit Kumar
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America
| | - Ran Heo
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Hyun Lee
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Ji-min Sung
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Uma Valeti
- Department of Medicine, Stanford Medicine, Stanford, California, United States of America
| | | | | | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States of America
| | - Todd C. Villines
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Fay Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, United States of America
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Seoul, South Korea
| | - James K. Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, United States of America
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America
- Cleerly, Inc, New York, New York, United States of America
| | - Leslee J. Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, United States of America
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America
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15
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Jayadeva P, Vitola J, Cerci R, Yao J, Stowers S, Morita M, Westcott J, Zier S, Elison B, Better N. 416 The Impact of Coronary Calcium Score as an Addition to Myocardial Perfusion Imaging in Altering Clinical Management (ICCAMPA Trial). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Vitola JV, Cerci R. Mexico-city does not look like Beverly-Hills: A multimodality and cardiac imager perspective! J Nucl Cardiol 2019; 26:1625-1629. [PMID: 31270745 DOI: 10.1007/s12350-019-01806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
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17
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Traub Kormann D, Cerci R, Zapparoli M, Antonio Fruet Bettini L, Henrique Ramos Prado P, Vitola J, Morita Fernandes Da Silva M. P6430Does positive family history for premature coronary artery disease increase the cardiovascular risk among elderly? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Family history (FH) for premature coronary artery disease (CAD) increases the risk of coronary artery disease and appears to be independently associated with high coronary artery calcium scores (CAC). However, it is uncertain if the positive FH predict high CAC among elderly individuals, as it does among younger individuals.
Objective
We investigated whether the association between family history (FH) for premature coronary artery disease and coronary calcium scores differs according to age.
Methods
We evaluated individuals referred to 128-slice multi-detector computed tomography to measure CAC scores at a single center from 2011 to 2017. Individuals with known CAD or typical angina were excluded. Positive FH was defined as first-degree relatives with early onset CAD (men ≤55 years, women ≤65 years). High CAC scores were defined as above 100 Agatston or higher than the 75th percentile for age and sex. The participants were divided in two age categories: “Younger age” for men ≤55 years old or women ≤65 years old, and “Older age” otherwise.
Results
We evaluated 3187 individuals ageing from 18 to 92 years, 54% (n=1721) being categorized as “Younger age”. Overall, participants with positive FH (n=759) were younger (56±12 vs 60±13) and more frequently women (54% vs 48%) than those with negative FH. Positive FH was independently associated with high CAC, after adjustment for age, sex, body mass index, smoking status, hypertension, diabetes mellitus, dyslipidemia and sedentary lifestyle. This association was similar between individuals at “Younger age” [Odds Ratio 1.46 (95% Confidence Interval 1.15 - 1.86)] and individuals at “Older Age” [OR 1.65 (95% IC 1.23 - 2.20), p for interaction = 0.79, Figure]
Conclusion
Positive FH for premature CAD was associated with higher CAC scores, independently of other cardiovascular risk factors, and this association was similar between younger and older individuals.
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Affiliation(s)
| | - R Cerci
- Quanta diagnostic center, Curitiba, Brazil
| | | | | | | | - J Vitola
- Quanta diagnostic center, Curitiba, Brazil
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18
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Karthikeyan G, Guzic Salobir B, Jug B, Devasenapathy N, Alexanderson E, Vitola J, Kraft O, Ozkan E, Sharma S, Purohit G, Dolenc Novak M, Meave A, Trevethan S, Cerci R, Zier S, Gotthardtová L, Jonszta T, Altin T, Soydal C, Patel C, Gulati G, Paez D, Dondi M, Kashyap R. Functional compared to anatomical imaging in the initial evaluation of patients with suspected coronary artery disease: An international, multi-center, randomized controlled trial (IAEA-SPECT/CTA study). J Nucl Cardiol 2017; 24:507-517. [PMID: 27796852 PMCID: PMC5413523 DOI: 10.1007/s12350-016-0664-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/14/2016] [Accepted: 08/14/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To test the hypothesis that, in the initial evaluation of patients with suspected coronary artery disease (CAD), stress myocardial perfusion imaging (MPI) would result in less downstream testing than coronary computed tomographic angiography (CCTA). METHODS In this international, randomized trial, mildly symptomatic patients with an intermediate likelihood of having CAD, and asymptomatic patients at intermediate risk of cardiac events, underwent either initial stress-rest MPI or CCTA. The primary outcome was downstream noninvasive or invasive testing at 6 months. Secondary outcomes included cumulative effective radiation dose (ERD) and costs at 12 months. RESULTS We recruited 303 patients (151 MPI and 152 CTA) from 6 centers in 6 countries. The initial MPI was abnormal in 29% (41/143) and CCTA in 56% (79/141) of patients. Fewer patients undergoing initial stress-rest MPI had further downstream testing at 6 months (adjusted OR 0.51, 95% CI 0.28-0.91, P = 0.023). There was a small increase in the median cumulative ERD with MPI (9.6 vs. 8.8 mSv, P = 0.04), but no difference in costs between the two strategies at 12 months. CONCLUSION In the management of patients with suspected CAD, a strategy of initial stress MPI is substantially less likely to require further downstream testing than initial testing with CCTA. TRIAL REGISTRATION clinicaltrials.gov identification number NCT01368770.
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Affiliation(s)
- Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Barbara Guzic Salobir
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- Department of Vascular Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Erick Alexanderson
- Department of Nuclear Medicine, Ignacio Chávez National Institute of Cardiology, Mexico City, Mexico
| | - Joao Vitola
- Quanta Diagnóstico & Terapia, Curitiba, Brazil
| | - Otakar Kraft
- Department of Nuclear Medicine, Faculty Hospital Ostrava, Ostrava, Czech Republic
| | - Elgin Ozkan
- Department of Nuclear Medicine, Ankara University Medical Faculty, Ankara, Turkey
| | - Saket Sharma
- Indian Institute of Public Health-Delhi, Gurgaon, India
| | - Gaurav Purohit
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Maja Dolenc Novak
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Aloha Meave
- Department of Radiology, Ignacio Chávez National Institute of Cardiology, Mexico City, Mexico
| | - Sergio Trevethan
- Department of Nuclear Medicine, Ignacio Chávez National Institute of Cardiology, Mexico City, Mexico
| | | | - Sandra Zier
- Quanta Diagnóstico & Terapia, Curitiba, Brazil
| | - Lucia Gotthardtová
- Department of Cardiology, Faculty Hospital Ostrava, Ostrava, Czech Republic
| | - Tomáš Jonszta
- Department of Radiology, Faculty Hospital Ostrava, Ostrava, Czech Republic
| | - Timucin Altin
- Department of Cardiology, Ankara University Medical Faculty, Ankara, Turkey
| | - Cigdem Soydal
- Department of Nuclear Medicine, Ankara University Medical Faculty, Ankara, Turkey
| | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gurpreet Gulati
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Diana Paez
- 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
| | - Ravi Kashyap
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
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19
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Arbab-Zadeh A, Di Carli MF, Cerci R, George RT, Chen MY, Dewey M, Niinuma H, Vavere AL, Betoko A, Plotkin M, Cox C, Clouse ME, Arai AE, Rochitte CE, Lima JAC, Brinker J, Miller JM. Accuracy of Computed Tomographic Angiography and Single-Photon Emission Computed Tomography-Acquired Myocardial Perfusion Imaging for the Diagnosis of Coronary Artery Disease. Circ Cardiovasc Imaging 2016; 8:e003533. [PMID: 26467105 DOI: 10.1161/circimaging.115.003533] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Establishing the diagnosis of coronary artery disease (CAD) in symptomatic patients allows appropriately allocating preventative measures. Single-photon emission computed tomography (CT)-acquired myocardial perfusion imaging (SPECT-MPI) is frequently used for the evaluation of CAD, but coronary CT angiography (CTA) has emerged as a valid alternative. METHODS AND RESULTS We compared the accuracy of SPECT-MPI and CTA for the diagnosis of CAD in 391 symptomatic patients who were prospectively enrolled in a multicenter study after clinical referral for cardiac catheterization. The area under the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of CTA and SPECT-MPI for identifying patients with CAD defined as the presence of ≥1 coronary artery with ≥50% lumen stenosis by quantitative coronary angiography. Sensitivity to identify patients with CAD was greater for CTA than SPECT-MPI (0.92 versus 0.62, respectively; P<0.001), resulting in greater overall accuracy (area under the receiver operating characteristic curve, 0.91 [95% confidence interval, 0.88-0.94] versus 0.69 [0.64-0.74]; P<0.001). Results were similar in patients without previous history of CAD (area under the receiver operating characteristic curve, 0.92 [0.89-0.96] versus 0.67 [0.61-0.73]; P<0.001) and also for the secondary end points of ≥70% stenosis and multivessel disease, as well as subgroups, except for patients with a calcium score of ≥400 and those with high-risk anatomy in whom the overall accuracy was similar because CTA's superior sensitivity was offset by lower specificity in these settings. Radiation doses were 3.9 mSv for CTA and 9.8 for SPECT-MPI (P<0.001). CONCLUSIONS CTA is more accurate than SPECT-MPI for the diagnosis of CAD as defined by conventional angiography and may be underused for this purpose in symptomatic patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00934037.
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Affiliation(s)
- Armin Arbab-Zadeh
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Marcelo F Di Carli
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
| | - Rodrigo Cerci
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Richard T George
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Marcus Y Chen
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Marc Dewey
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Hiroyuki Niinuma
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Andrea L Vavere
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Aisha Betoko
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Michail Plotkin
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Christopher Cox
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Melvin E Clouse
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Andrew E Arai
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Carlos E Rochitte
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Joao A C Lima
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Jeffrey Brinker
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
| | - Julie M Miller
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.)
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Wanderley MR, Pereira Da Cunha CL, Cunha C, Da Silva JA, Stier A, Franca Neto O, Kormann OJ, Shin Ike I, Cerci R, Vitola J. Long term outcome of patients with high -risk exercise testing and normal myocardial perfusion imaging. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yoneyama K, Vavere AL, Cerci R, Ahmed R, Arai AE, Niinuma H, Rybicki FJ, Rochitte CE, Clouse ME, George RT, Lima JAC, Arbab-Zadeh A. Influence of image acquisition settings on radiation dose and image quality in coronary angiography by 320-detector volume computed tomography: the CORE320 pilot experience. Heart Int 2012. [PMID: 23185678 PMCID: PMC3504303 DOI: 10.4081/hi.2012.e11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The objective of this study was to investigate the impact of image acquisition settings and patients' characteristics on image quality and radiation dose for coronary angiography by 320-row computed tomography (CT). CORE320 is a prospective study to investigate the diagnostic performance of 320-detector CT for detecting coronary artery disease and associated myocardial ischemia. A run-in phase in 65 subjects was conducted to test the adequacy of the computed tomography angiography (CTA) acquisition protocol. Tube current, exposure window, and number of cardiac beats per acquisition were adjusted according to subjects' gender, heart rate, and body mass index (BMI). Main outcome measures were image quality, assessed by contrast/noise measurements and qualitatively on a 4-point scale, and radiation dose, estimated by the dose-length-product. Average heart rate at image acquisition was 55.0±7.3 bpm. Median Agatston calcium score was 27.0 (interquartile range 1-330). All scans were prospectively triggered. Single heart beat image acquisition was obtained in 61 of 65 studies (94%). Sixty-one studies (94%) and 437 of 455 arterial segments (96%) were of diagnostic image quality. Estimated radiation dose was significantly greater in obese (5.3±0.4 mSv) than normal weight (4.6±0.3 mSv) or overweight (4.7±0.3 mSv) subjects (P<0.001). BMI was the strongest factor influencing image quality (odds ratio=1.457, P=0.005). The CORE320 CTA image acquisition protocol achieved a good balance between image quality and radiation dose for a 320-detector CT system. However, image quality in obese subjects was reduced compared to normal weight subjects, possibly due to tube voltage/current restrictions mandated by the study protocol.
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Affiliation(s)
- Kihei Yoneyama
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mehra VC, Valdiviezo C, Arbab-Zadeh A, Ko BS, Seneviratne SK, Cerci R, Lima JAC, George RT. A stepwise approach to the visual interpretation of CT-based myocardial perfusion. J Cardiovasc Comput Tomogr 2011; 5:357-69. [PMID: 22146495 DOI: 10.1016/j.jcct.2011.10.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 11/15/2022]
Abstract
Cardiovascular anatomic and functional testing have been longstanding and key components of cardiac risk assessment. As part of that strategy, CT-based imaging has made steady progress, with coronary computed tomography angiography (CTA) now established as the most sensitive noninvasive strategy for assessment of significant coronary artery disease. Myocardial CT perfusion imaging (CTP), as the functional equivalent of coronary CTA, is being tested in currently ongoing multicenter trials and is proposed to enhance the accuracy of coronary CTA alone. However, unlike coronary CTA that has published guidelines for interpretation and is rapidly gaining applicability in the noninvasive risk assessment paradigms, myocardial CTP is rapidly evolving, and guidance on a standard approach to its interpretation is lacking. In this article we describe a practical stepwise approach for interpretation of myocardial CTP that should add to the clinical applicability of this modality. These steps include (1) coronary CTA interpretation for potentially obstructive atherosclerosis, (2) reconstruction and preprocessing of myocardial CTP images, (3) image quality assessment and the identification of potentially confounding artifacts, (4) rest and stress image interpretation for enhancement patterns and areas of hypoattenuation, and (5) correlation of coronary anatomy and myocardial perfusion deficits. This systematic review uses already published methods from multiple clinical studies and is intended for general usage, independent of the platform used for image acquisition.
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