Combining Coronary Artery Calcium Scanning with SPECT/PET Myocardial Perfusion Imaging
|
|
|
- Felicia Hart
- 5 years ago
- Views:
Transcription
1 Combining Coronary Artery Calcium Scanning with SPECT/PET Myocardial Perfusion Imaging Daniel S. Berman, MD Director, Cardiac Imaging Cedars-Sinai Heart Institute Professor of Medicine and Imaging Cedars-Sinai Controversies 2018 Beverly Hills
2 DISCLOSURES Daniel S. Berman, M.D. declares the following relationships: Software royalties from CSMC
3 MG 72 M 09/98 70 y/o male physician tennis player Asymptomatic Total cholesterol: 220 mg/dl; LDL 152 Recent exercise thallium scan was normal
4 MG 72 M 09/98 After normal thallium: No changes
5 MG 72 M 09/98 After normal thallium: No changes Offered a coronary calcium scan
6 MG 72 M 09/98 CAC Results Location # Calcified Calcified Plaque Calcium Score Lesions Volume (mm 3 ) LAD LCX RCA Total * * 97th percentile
7 MG 72 M 09/98 After CAC scan: Started statin and aspirin Changed eating habits Lost lbs within one month Increased exercise Alive and well 17 years later
8 Value of an Imaging Test Does the test result in improved outcomes or reduce costs? Does the test PREDICT risk?
9 Value of an Imaging Test Does the test result in improved outcomes or reduce costs? Must affect patient management Does the test PREDICT risk?
10 Coronary Artery Calcium (CAC) CAC: a marker of CAD Burden of coronary atherosclerosis Integrated lifetime effect of all risk factors Overcomes the limitations of global risk scores Improves risk stratification <1 msv (~ mammogram) Single breath No contrast
11 All Cause Mortality and CAC Scores: Long Term Prognosis in 25,253 patients 0 (n=11,044) (n=3,567) (n=5,032) Cumulative Survival (n=2,616) : 10.4 x increased risk (n=561) (n=955) (n=514) =1363, p< for variable overall and for each category subset Time to FollowFollow-up (Years) ,000+ (n=964) 12.0 Budoff, et al. JACC 2007; 49:
12 All Cause Mortality and CAC Scores: Long Term Prognosis in 25,253 patients 0 (n=11,044) (n=3,567) (n=5,032) Cumulative Survival (n=2,616) : 10.4 x increased risk (n=561) (n=955) (n=514) Consistent findings in multiple large registries and population-based studies1,000+ (n=964) =1363, p< for variable overall and for each category subset Time to FollowFollow-up (Years) Budoff, et al. JACC 2007; 49:
13 CAC leads to better treatment / lifestyle More targeted preventive treatment Upscale or downscale Improvement in risk factor profile1 Intensification of Rx2 Better adherence to Rx3,5 Dietary modifications4 Increased exercise4 1 Rozanski et al, JACC 2011 (EISNER Study) 2 Nasir K et al, Circ Cardiovasc Qual Outcomes 2010 (MESA) 3 Kalia NK et al, Atherosclerosis Orakzai RH et al, Am J Cardiol Taylor A t al, JACC 2008
14 CAC in Guiding Treatment in Patients with 5-20% ASCVD Risk Modified from Hecht, et al JCCT 2017
15 2018 Cholesterol Clinical Practice Guidelines Primary Prevention: 2 Emphasize Adherence to Healthy Lifestyle Age 40-75y and LDL-C 70 - <190 mg/dl without diabetes mellitus 10-year ASCVD risk percent begins risk discussion 7.5% - <20% Intermediate risk Risk discussion: If risk estimate + risk enhancers favor statin, initiate moderateintensity statin to reduce LDL-C by 30% 49% (Class I) If risk decision is uncertain: Consider measuring CAC in selected adults: CAC Consideration 0 Consider no statin 1-99 Favors statin (especially >age 55) 100+ or 75th percentile Initiate statin therapy Grundy SM, et al. Circulalation 2018
16 Noninvasive Imaging for CAD Suspected CAD Pre-test likelihood of CAD Intermediate to High (50-100%) Ischemia Testing
17 Post-SPECT Cardiac Mortality and Rx Given 5 N=10,627 F/U: 1.9 ± 0.6 yrs * Medical Rx 2 * Revasc Risk adjusted *p< log Hazard Ratio 6 Early Revascularization vs Medical Therapy % 25% 32.5% 50% % Myocardium Ischemic Hachamovitch, et al. (Cedars-Sinai) Circulation 2003
18 Post-SPECT Cardiac Mortality and Rx Given 5 N=10,627 F/U: 1.9 ± 0.6 yrs * Medical Rx 2 * Revasc Risk adjusted *p< log Hazard Ratio 6 Early Revascularization vs Medical Therapy 0 Fundamental limitation of SPECT/PET MPI Does not detect subclinical atherosclerosis 12.5% 25% 32.5% 50% % Myocardium Ischemic Hachamovitch, et al. (Cedars-Sinai) Circulation 2003
19 Noninvasive Imaging for CAD Suspected CAD Pre-test likelihood of CAD Intermediate to High (50-100%) Ischemia Testing + CAC
20 Noninvasive Imaging for CAD Suspected CAD Pre-test likelihood of CAD Intermediate to High (50-100%) Ischemia Testing + CAC of SPECT/PET+CAC vs CCTA Could Potential be performed with hybrid imaging or add on CAC has not been tested in RCT
21 Hybrid SPECT/CT and PET/CT GE SPECT/CT Siemens PET/CT Attenuation correction Coronary artery calcium scoring
22 Hybrid SPECT/CT and PET/CT GE SPECT/CT Siemens PET/CT CAC: Routine with hybrid or low-cost separate add-on procedure Attenuation correction Coronary artery calcium scoring
23 CAC in Patients Undergoing SPECT/PET-MPI Detects subclinical atherosclerosis Improves risk assessment Increases diagnostic certainty Improves identification of patients at highest risk Leads to greater change in patient management
24 CAC Distribution in Normal SPECT-MPI Patients CAC score Berman et al 16% 0 3% 1-9 He et al 11% 6% % 26% 23% % % JACC % Circulation 2000
25 CAC Distribution in Normal SPECT-MPI Patients CAC score Berman et al 16% 0 3% 1-9 He et al 11% 6% % 26% 23% % % JACC % Circulation 2000
26 CAC in Patients Undergoing SPECT/PET-MPI Detects subclinical atherosclerosis Improves risk assessment Increases diagnostic certainty Improves identification of patients at highest risk Leads to greater change in patient management
27 Added Prognostic Value of CAC in Rb-PET MPI PET/CT: N=695 FU 6-28 months Adjusted: age, sex, symptoms and RF Schenker et al. Circulation 2008;117:
28 Added Prognostic Value of CAC in SPECT MPI Event Rates by CAC in Normal and Abnormal Scan Years to event Years to event N=4897 symptomatic patients Highest category: >1000 F/u: median 940 days MACE (278): MI, ACD, late revascularization (>90 days) MACE rate: 2.3%/year Engbers, et al: Circ Imaging 2016
29 CAC+MPS: Multivariable Predictors of MACE Age +10 y Male CAC score category < <0.001 <0.001 < <0.001 <0.001 SPECT findings Small Moderate Large N=4897 symptomatic patients F/u: median 940 days Engbers, et al: Circ Imaging 2016
30 CAC in Patients Undergoing SPECT/PET-MPI Detects subclinical atherosclerosis Improves risk assessment Increases diagnostic certainty Improves identification of patients at highest risk Leads to greater change in patient management
31 CAC: Aid in Pre-test Likelihood of Coronary Stenosis CONFIRM Patients with no prior CAD Prevalence of Obstructive CAD with any CP symptom CAC CAC CAC CAC CAC N=8, % 40 70% % 0-49% 8 70% prox LAD or 50% LM CONFIRM: Unpublished 100
32 CAC: Aid in Pre-test Likelihood of Coronary Stenosis CONFIRM Patients with no prior CAD Prevalence of Obstructive CAD with any CP symptom CAC CAC CAC CAC CAC N=8, % 40 70% % 0-49% 8 70% prox LAD or 50% LM CONFIRM: Unpublished 100
33 CAC: Aid in Pre-test Likelihood of Coronary Stenosis CONFIRM Patients with no prior CAD Prevalence of Obstructive CAD with any CP symptom CAC CAC CAC CAC CAC % 0-49% N=8, % 70% % prox LAD or 50% LM CONFIRM: Unpublished
34 CAC: Aid in Pre-test Likelihood of Coronary Stenosis CONFIRM Patients with no prior CAD Prevalence of Obstructive CAD with any CP symptom CAC CAC CAC CAC CAC % 0-49% N=8, % 70% % prox LAD or 50% LM CONFIRM: Unpublished 2017 CAC 400: 35-54% have 70% stenosis 100
35 WIZMAL (2018) 65 F SOB; Abnl ECG Chol, DM, HTN; Regadenoson STRESS REST
36 WIZMAL (2018) 65 F SOB; Abnl ECG Chol, DM, HTN; Regadenoson STRESS REST CAC 0
37 STARIC (2018) 73 M Chol, HTN, FH No walk regadenoson STRESS REST
38 STARIC (2018) 73 M Chol, HTN, FH No walk regadenoson STRESS REST CAC 3056
39 STARIC (2018) 73 M Chol, HTN, FH No walk regadenoson STRESS REST CAC 3056 Staged PCI of LAD and LCX
40 PET-MPI + CAC: Improved Prediction of Obstructive CAD* Per-vessel CAD by Ischemic TPD (ITPD) and CAC category * 70% stenosis Per-vessel analysis 456 (152 patients) Brodov.Slomka, JNM, 2015
41 PET-MPI + CAC: Improved Prediction of Obstructive CAD* Per-vessel CAD by Ischemic TPD (ITPD) and CAC category * 70% stenosis Per-vessel analysis 456 (152 patients) Brodov.Slomka, JNM, 2015
42 CAC in Patients Undergoing SPECT/PET-MPI Detects subclinical atherosclerosis Improves risk assessment Increases diagnostic certainty Improves identification of patients at highest risk Leads to greater change in patient management
43 Underestimation of the Extent of CAD by SPECT MPI 101 consecutive SPECT-MPI pts with LM CAD ( 50% stenosis) Berman et al, JNC 2007
44 Underestimation of the Extent of CAD by SPECT MPI 101 consecutive SPECT-MPI pts with LM CAD ( 50% stenosis) Berman et al, JNC 2007
45 Underestimation of the Extent of CAD by SPECT MPI 101 consecutive SPECT-MPI pts with LM CAD ( 50% stenosis) Berman et al, JNC 2007
46 RJ 75 F ATA/SOB, DM, no walk regadenoson STRESS REST
47 RJ 75 F ATA/SOB, DM, no walk regadenoson STRESS REST CAC 1463
48 RJ 75 F ATA/SOB, DM, no walk regadenoson STRESS REST CAC 1463 LM: CABG
49 RJ 75 F ATA/SOB, DM, no walk regadenoson STRESS REST CAC 1463 CAC : Aids in identification of patients at high risk LM: CABG
50 CAC in Patients Undergoing SPECT/PET-MPI Detects subclinical atherosclerosis Improves risk assessment Increases diagnostic certainty Improves identification of patients at highest risk Leads to greater change in patient management
51 Impact of CAC Score on Preventive Medication Use Patients with Normal SPECT-MPI 1033 stable symptomatic patients *Adjusted for risk factors and baseline medication use Engbers, et al: Am Heart J 2017
52 Yearly Prevalence of Abnormal and Ischemic SPECT Myocardial Perfusion Imaging Studies between 1991 and % % Prevalence 40% 35% 30% 25% 20% 15% 10% 5% 0% Year % Ischemia N=39, 515 % Abnormal SPECT Rozanski, et al JACC 2012 (Cedars-Sinai)
53 CAC in Patients Undergoing SPECT/PET-MPI Detects subclinical atherosclerosis Improves risk assessment Increases diagnostic certainty Improves identification of patients at highest risk Leads to greater change in patient management JNC 2016
54 CAC in Patients Undergoing SPECT/PET-MPI Detects subclinical atherosclerosis Improves risk assessment Increases diagnostic certainty Improves identification of patients at highest risk Leads to greater change in patient management Should be considered in all patients without known CAD referred for SPECT/PET MPI Berman, Rozanski JNC 2016 JNC 2016
55 Thank you very much
56
57 During assigned to CTA were more CCTA follow-up, Standard care Oddsrpatients at i o likely than patients assigned to standard care alone to preventive therapies Preventivetherapies 19.4%(402/2037)have 14.7%(305/2037)commenced 1.40[1.19,1.65] Antianginaltherapies 13.2%(273/2037) 10.7%(221/2037) 1.27[1.05,1.54] Preventive therapies Antianginal therapies Odds ratio (95% CI) Preventive therapies Antianginal therapies CCTA Standard care Odds ratio 19.4% (402/2037) 13.2% (273/2037) 14.7% (305/2037) 10.7% (221/2037) 1.40 [1.19, 1.65] 1.27 [1.05, 1.54] Adapted from Newby et al, Engl J Med 2018
58 OPTION 1 CAC Distribution in Normal SPECT-MPI Patients CAC score Berman et al Engberg et al (AHJ 2017) 16% % 26% Patients (%) % He et al % 6% % JACC % % CAC distribution in normal SPECT-MPI patients Circulation %
59 OPTION 2 CAC Distribution in Normal SPECT-MPI Patients 0.50 Patients (%) CAC score Berman et al JACC 2000 He et al Circ 2004 Engberg et al AHJ 2017
60 Prevalence of Abnormal SPECT by CAC Score 4897 symptomatic patients Engbers, et al: Circ Imaging 2016
61 Impact of CAC on Prevention Increased exercise Dietary change Aspirin initiation Lipid lowering medications Blood pressure lowering medication Meta-anlaysis Gupta et al JACCi 2017
62 Impact of CAC on Lifestyle Changes Gupta et al; JACCi 2017
63 Impact of CAC on Preventive Medications Gupta et al; JACCi 2017
64 Prevalence of Abnormal SPECT by CAC Score 4897 symptomatic patients referred for SPECT-MPI Engbers, et al: Circ Imaging 2016
65 OPTION 1 CAC Distribution in Normal SPECT-MPI Patients CAC score Berman et al Engberg et al (AHJ 2017) 16% % 26% Patients (%) % He et al % 6% % JACC % % CAC distribution in normal SPECT-MPI patients Circulation %
66 CAC Score Increases Certainty of Interpretation of MPI N=151 SPECT/CT No prior MI Major interpretation change N=39 ICA 70% standard 24 correct change 15 incorrect change Mouden, et al: J Nucl Card 2014
67 CAC Score Increases Certainty of Interpretation of MPI N=151 SPECT/CT No prior MI Major interpretation change N=39 ICA 70% standard 24 correct change 15 incorrect change Mouden, et al: J Nucl Card 2014
Testing the Asymptomatic CAD Patient: When and Why?
Testing the Asymptomatic CAD Patient: When and Why? Timothy M. Bateman M.D. Co-Director, Cardiovascular Radiologic Imaging Mid America Heart Institute Professor of Medicine University of Missouri-Kansas
Multimodality Cardiac Imaging: Its Use in the Era of Value-based Reimbursement
Multimodality Cardiac Imaging: Its Use in the Era of Value-based Reimbursement Daniel S., MD Director, Cardiac Imaging Cedars-Sinai Heart Institute Professor of Medicine UCLA School of Medicine ACC DC
Financial Disclosures. Coronary Artery Calcification. Objectives. Coronary Artery Calcium 6/6/2018. Heart Disease Statistics At-a-Glace 2017
Coronary Artery Calcification Dharmendra A. Patel, MD MPH Director, Echocardiography Laboratory Associate Program Director Cardiovascular Disease Fellowship Program Erlanger Heart and Lung Institute UT
Current and Future Imaging Trends in Risk Stratification for CAD
Current and Future Imaging Trends in Risk Stratification for CAD Brian P. Griffin, MD FACC Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Disclosures: None Introduction
Coronary Artery Calcium. Vimal Ramjee, MD FACC The Chattanooga Heart Institute
Coronary Artery Calcium Vimal Ramjee, MD FACC The Chattanooga Heart Institute Disclosures I have no conflicts of interest to disclose. Objectives Recognize the utility of coronary artery calcium scoring
MD F A F C A C MAS A N S C
Myocardial Perfusion Imaging and Coronary Calcium Scoring: Complimentary or Competitive David Wolinsky MD FACC MASNC Section Head Nuclear Cardiology, Cleveland Clinic Florida Immediate Past President,
Conflict of Interest Disclosure
Comparative Advantages of PET Over SPECT: Is PET Really Better? Timothy M. Bateman M.D. Co-Director, Cardiovascular Radiologic Imaging Mid America Heart Institute Professor of Medicine University of Missouri-Kansas
Evaluation of Myocardial Viability: What Have We Learned from STICH? Professor of Medicine David Geffen School of Medicine at UCLA. Heart Failure (HF)
Evaluation of Myocardial Viability: What Have We Learned from STICH? Daniel S. Berman, MD Director, Cardiac Imaging Cedars-Sinai Heart Institute CSMC 2013 Professor of Medicine David Geffen School of Medicine
Recent Advances in Nuclear Cardiology, Cardiac CT, and Cardiac MRI: Applications for CAD in the Era of Value-based Imaging
Recent Advances in Nuclear Cardiology, Cardiac CT, and Cardiac MRI: Applications for CAD in the Era of Value-based Imaging Daniel S. Berman, MD Director, Cardiac Imaging Cedars-Sinai Heart Institute Professor
The Role of Nuclear Imaging in Heart Failure
The Role of Nuclear Imaging in Heart Failure Mouaz H. Al-Mallah, MD MSc FESC Associate Professor of Medicine Consultant Cardiologist and Division Head, Cardiac Imaging King Abdulaziz Cardiac Centre, National
2/20/2013. Why use imaging in CV prevention? Update on coronary CTA in 2013 Coronary CTA for 1 0 prevention: pros and cons Are we there yet?
Evolving Role of Coronary CTA in Primary Cardiovascular Disease Prevention: Are We There Yet? Ron Blankstein, M.D., F.A.C.C. Co-Director, Cardiovascular Imaging Training Program Associate Physician, Preventive
Coronary interventions
Controversial issues in the management of ischemic heart failure Coronary interventions Maciej Lesiak Department of Cardiology, University Hospital in Poznan none DECLARATION OF CONFLICT OF INTEREST CHF
Machine learning improves image analysis prognosis and diagnosis in cardiac imaging
Machine learning improves image analysis prognosis and diagnosis in cardiac imaging Some software described in this presentation is owned by Cedars-Sinai Medical Center, which receives or may receive royalties
ESC CONGRESS 2010 Stockholm, august 28 september 1, 2010
ESC CONGRESS 2010 Stockholm, august 28 september 1, 2010 CORONARY ARTERY DISEASE AND NUCLEAR IMAGING: AN UPDATE PERFUSION SCINTIGRAPHY IN HIGH-RISK ASYMPTOMATIC PATIENTS Pasquale Perrone Filardi Federico
Imaging ischemic heart disease: role of SPECT and PET. Focus on Patients with Known CAD
Imaging ischemic heart disease: role of SPECT and PET. Focus on Patients with Known CAD Hein J. Verberne Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands International Conference
Cardiac CT for Risk Assessment: Do we need to look beyond Coronary Artery Calcification
Cardiac CT for Risk Assessment: Do we need to look beyond Coronary Artery Calcification Matthew Budoff, MD, FACC, FAHA Professor of Medicine Director, Cardiac CT Harbor-UCLA Medical Center, Torrance, CA
Use of Nuclear Cardiology in Myocardial Viability Assessment and Introduction to PET and PET/CT for Advanced Users
Use of Nuclear Cardiology in Myocardial Viability Assessment and Introduction to PET and PET/CT for Advanced Users February 1 5, 2011 University of Santo Tomas Hospital Angelo King A-V Auditorium Manila,
Optimal testing for coronary artery disease in symptomatic and asymptomatic patients
Optimal testing for coronary artery disease in symptomatic and asymptomatic patients Alexandre C Ferreira, MD Clinical Chief of Cardiology Jackson Health System Director, Interventional Cardiology Training
Management of Stable Ischemic Heart Disease. Vinay Madan MD February 10, 2018
Management of Stable Ischemic Heart Disease Vinay Madan MD February 10, 2018 1 Disclosure No financial disclosure. 2 Overview of SIHD Diagnosis Outline of talk Functional vs. Anatomic assessment Management
CT or PET/CT for coronary artery disease
CT or PET/CT for coronary artery disease Rotterdam 2012 Juhani Knuuti, MD, PhD, FESC Turku PET Centre University of Turku Turku, Finland Juhani.knuuti@utu.fi Turku PET Centre University of Turku Åbo Akademi
Risk Stratification for CAD for the Primary Care Provider
Risk Stratification for CAD for the Primary Care Provider Shimoli Shah MD Assistant Professor of Medicine Directory, Ambulatory Cardiology Clinic Knight Cardiovascular Institute Oregon Health & Sciences
Hybrid cardiac imaging Advantages, limitations, clinical scenarios and perspectives for the future
Hybrid cardiac imaging Advantages, limitations, clinical scenarios and perspectives for the future Prof. Juhani Knuuti, MD, FESC Turku, Finland Disclosure: Juhani Knuuti, M.D. Juhani Knuuti, M.D. has financial
Potential recommendations for CT coronary angiography in athletes
Potential recommendations for CT coronary angiography in athletes B.K. Velthuis Dept. of Radiology UMC Utrecht, the Netherlands EuroPRevent 15 April 2011 Declaration of interest Philips Medical Systems
Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO!
Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO! Young-Hak Kim, MD, PhD Heart Institute, University of Ulsan College of Medicine Asan Medical Center,
Subclinical atherosclerosis in CVD: Risk stratification & management Raul Santos, MD
Subclinical atherosclerosis in CVD: Risk stratification & management Raul Santos, MD Sao Paulo Medical School Sao Paolo, Brazil Subclinical atherosclerosis in CVD risk: Stratification & management Prof.
Coronary Artery Calcium Scoring Mirvat Alasnag FACP, FRCP, FSCCT, FSCAI, FASE King Fahd Armed Forces Hospital, Jeddah. March 2017
Coronary Artery Calcium Scoring Mirvat Alasnag FACP, FRCP, FSCCT, FSCAI, FASE King Fahd Armed Forces Hospital, Jeddah March 2017 Newspapers Referrals 62 year old female CT chest and abdomen following
Benefit of Performing PCI Based on FFR
Benefit of Performing PCI Based on FFR William F. Fearon, MD Associate Professor Director, Interventional Cardiology Stanford University Medical Center Benefit of FFR-Guided PCI FFR-Guided PCI vs. Angiography-Guided
Calcium scoring Clinical and prognostic value
Calcium scoring Clinical and prognostic value Matthijs Oudkerk Professor and Chair of Radiology University Medical Center Groningen, University of Groningen Groningen, The Netherlands Sofia 2011 13 May
The Case for PCI as the Preferred Therapy in Most Patients with Chronic Stable Angina
The Case for PCI as the Preferred Therapy in Most Patients with Chronic Stable Angina Ajay J. Kirtane,, MD Columbia University Medical Center The Cardiovascular Research Foundation Conflict of Interest
FFR-CT Not Ready for Primetime
FFR-CT Not Ready for Primetime Leslee J. Shaw, PhD, MASNC, FACC, FAHA, FSCCT R. Bruce Logue Professor of Medicine Co-Director, Emory Clinical CV Research Institute Emory University School of Medicine Atlanta,
SPECT or PET for Cardiovascular Screening in High-Risk Patients
SPECT or PET for Cardiovascular Screening in High-Risk Patients Paeng, Jin Chul MD PhD Department of Nuclear Medicine Seoul National University Hospital Contents Recent Development in SPECT and PET Technology
Diagnostic and Prognostic Value of Coronary Ca Score
Diagnostic and Prognostic Value of Coronary Ca Score Dr. Ghormallah Alzahrani Cardiac imaging division, Adult Cardiology department Prince Sultan Cardiac Center ( PSCC) Madina, June 2 Coronary Calcium
MPS and Calcium Score in asymptomatic patient F. Mut, J. Vitola
MPS and Calcium Score in asymptomatic patient F. Mut, J. Vitola Nuclear Medicine Service, Asociacion Española Montevideo, Uruguay Quanta Diagnostico Nuclear Curitiba, Brazil Clinical history Male 63 y.o.,
Hybrid Imaging Improving Nuclear Cardiology Practice
Lippincott Williams & Wilkins, - Nuclear Medicine teaching File, 2009 Hybrid Imaging Improving Nuclear Cardiology Practice João V. Vitola, MD, PhD Cardiologist and Nuclear Medicine Physician Quanta Diagnostico
New Paradigms in Predicting CVD Risk
New Paradigms in Predicting CVD Risk Imaging as an Integrator of Lifetime Risk Exposure Michael J. Blaha MD MPH Presented by: Michael J. Blaha September 24, 2014 1 Talk Outline Risk factors vs. Disease
Is computed tomography angiography really useful in. of coronary artery disease?
Is computed tomography angiography really useful in screening patients with high risk of coronary artery disease? Myeong-Ki Hong, M.D. Ph D Professor of Medicine Division of Cardiology, Severance Cardiovascular
Welcome! To submit questions during the presentation: or Text:
Welcome! To participate in the interactive Q & A please do the following: 1. Download the Socrative Student App 2. Enter Teacher s Room Code: ZD0F3X5Q 3. Select Quiz: Intermountain Cardiac Stress Testing
Which Test When? Avoid the Stress of Stress Testing. Marc Newell, MD, FACC, FSCCT Minneapolis Heart Institute
Which Test When? Avoid the Stress of Stress Testing Marc Newell, MD, FACC, FSCCT Minneapolis Heart Institute Outline Understand the importance of coronary artery disease assessment Understand the basics
Molecular Imaging of Coronary Plaques
Molecular Imaging of Coronary Plaques Daniel S. Berman, MD Director, Cardiac Imaging Cedars-Sinai Heart Institute CSMC 20113 Professor of Medicine David Geffen School of Medicine at UCLA Zahi A. Fayad,
Εξελίξεις και νέες προοπτικές στην καρδιαγγειακή απεικόνιση CT. Σταμάτης Κυρζόπουλος Ωνάσειο Καρδιοχειρουργικό Κέντρο
Εξελίξεις και νέες προοπτικές στην καρδιαγγειακή απεικόνιση CT Σταμάτης Κυρζόπουλος Ωνάσειο Καρδιοχειρουργικό Κέντρο No conflict of interest to disclose Noninvasive Cardiac Imaging Unresolved Issues-Future
CARDIAC IMAGING FOR SUBCLINICAL CAD
CARDIAC IMAGING FOR SUBCLINICAL CAD WHY DON'T YOU ADOPT MORE SMART TECHNIQUE? Whal Lee, M.D. Seoul National University Hospital Department of Radiology We are talking about Coronary artery Calcium scoring,
Diabetes and Occult Coronary Artery Disease
Diabetes and Occult Coronary Artery Disease Mun K. Hong, MD, FACC, FSCAI Director, Cardiac Catheterization Laboratory & Interventional Cardiology St. Luke s-roosevelt Hospital Center New York, New York
Evidence-Based Management of CAD: Last Decade Trials and Updated Guidelines
Evidence-Based Management of CAD: Last Decade Trials and Updated Guidelines Enrico Ferrari, MD Cardiac Surgery Unit Cardiocentro Ticino Foundation Lugano, Switzerland Conflict of Interests No conflict
CT Coronary Angiography - Indications: From the guidelines to clinical practice
CT Coronary Angiography - Indications: From the guidelines to clinical practice Multimodality Working Group of Cardiovascular Imaging (Nuc C, CCT CMR) Hellenic Cardiology Society Seminars, Thessaloniki,
New Stable Chest Pain Guidance in the UK NICE to have, difficult to implement
New Stable Chest Pain Guidance in the UK NICE to have, difficult to implement Dr Tim Fairbairn MBChB, MRCP, PhD Consultant Imaging Cardiologist Liverpool Heart and Chest Hospital, United Kingdom 2010 Risk
Patient referral for elective coronary angiography: challenging the current strategy
Patient referral for elective coronary angiography: challenging the current strategy M. Santos, A. Ferreira, A. P. Sousa, J. Brito, R. Calé, L. Raposo, P. Gonçalves, R. Teles, M. Almeida, M. Mendes Cardiology
Conflict of Interest Disclosure
Challenges and Opportunities for SPECT & PET in 2013: Implementing Latest Acquisition and Processing Protocols Timothy M. Bateman M.D. Co-Director, Cardiovascular Radiologic Imaging Mid America Heart Institute
The 2016 NASCI Keynote: Trends in Utilization of Cardiac Imaging: The Coronary CTA Conundrum. David C. Levin, M.D.
The 2016 NASCI Keynote: Trends in Utilization of Cardiac Imaging: The Coronary CTA Conundrum David C. Levin, M.D. October 16, 2016 MPI Utilization Rates/1000[includes PET] total radiologists 2014 total
PET myocard perfusion & viability Riemer Slart
PET myocard perfusion & viability Riemer Slart Nuclear Medicine Physician Dept. of Nuclear Medicine and Molecular Imaging University Medical Center Groningen, the Netherlands Professor in Molecular Imaging,
Better CABGs vs Better PCI Devices
CABG vs PCI 2017 Multivessel Coronary Disease Better CABGs vs Better PCI Devices ACC New York, Dec 8, 2017 No Disclosures CABG vs PCI 2017 Stable Multivessel Coronary Disease 1. Are These The two Critical
63 yo woman with chest pain
63 yo woman with chest pain Coronary Microvascular Disease: Does It Exist? EA Amsterdam, MD Distinguished Professor Cardiology and Internal Medicine UC Davis School of Medicine and Medical Center Sacramento,
Global: Polypill Selective: Imaging
1 Imaging For Prevention? Role of Coronary Calcium Scoring in High Risk Asymptomatic Patients Coronary Artery Disease: Silent Killer Symptoms are a poor surrogate of risk! May 5, 2016 Ronald G. Schwartz,
Evaluating Clinical Risk and Guiding management with SPECT Imaging
Evaluating Clinical Risk and Guiding management with SPECT Imaging Raffaele Giubbini Chair and Nuclear Medicine Unit University & Spedali Civili Brescia- Italy U.S. Congressional Budget Office. Technological
State-of-the-Art SPECT/CT: Cardiac Imaging
State-of-the-Art SPECT/CT: Cardiac Imaging Ernest V Garcia*, PhD Endowed Professor in Cardiac Imaging Director, Nuclear Cardiology R&D Laboratory Disclosure: Dr. Garcia receives royalties from the sale
I have no financial disclosures
Manpreet Singh MD I have no financial disclosures Exercise Treadmill Bicycle Functional capacity assessment Well validated prognostic value Ischemic assessment ECG changes ST segments Arrhythmias Hemodynamic
Imaging the Vulnerable Plaque. David A. Dowe, MD Atlantic Medical Imaging
Imaging the Vulnerable Plaque David A. Dowe, MD Atlantic Medical Imaging Why is this so important? The Acute Situation Coronary disease-important Diagnosis of cardiovascular disease cost $148 billion in
Advanced Imaging MRI and CTA
Advanced Imaging MRI and CTA Who and why may benefit. Matthew W. Martinez, M.D. FACC Lehigh Valley Health Network Director, Cardiovascular Imaging Learning Objectives Review basics of CMR and CTA Review
Controversies in Coronary Revascularization. Atlanta CCU April 15, 2016
Controversies in Coronary Revascularization Atlanta CCU April 15, 2016 Habib Samady MD FACC FSCAI Professor of Medicine Director, Interventional Cardiology, Emory University Director, Cardiac Catheterization
Are We Ready for a Paradigm Shift From Risk Factors to Detection of Subclinical Coronary Atherosclerosis? Lessons From MESA. Khurram Nasir, MD MPH
Are We Ready for a Paradigm Shift From Risk Factors to Detection of Subclinical Coronary Atherosclerosis? Lessons From MESA Khurram Nasir, MD MPH Disclosures No disclosures. Burden of Cardiovascular Disease
New Insight about FFR and IVUS MLA
New Insight about FFR and IVUS MLA Can IVUS MLA Predict FFR
Khurram Nasir, MD MPH
Non-invasive CAD Screening Khurram Nasir, MD MPH Disclosures I have no relevant commercial relationships to disclose, and my presentation will not include off label or unapproved usage. HOW & WHAT WOULD
Coronary Artery Calcification
Coronary Artery Calcification Julianna M. Czum, MD OBJECTIVES CORONARY ARTERY CALCIFICATION Julianna M. Czum, MD Dartmouth-Hitchcock Medical Center 1. To review the clinical significance of coronary heart
New ACC/AHA Guidelines on Lipids: Are PCSK9 Inhibitors Poised for a Breakthrough?
New ACC/AHA Guidelines on Lipids: Are PCSK9 Inhibitors Poised for a Breakthrough? Sidney C. Smith, Jr. MD, FACC, FAHA Professor of Medicine/Cardiology University of North Carolina at Chapel Hill Immediate
The role of coronary artery calcium score on the detection of subclinical atherosclerosis in metabolic diseases
The role of coronary artery calcium score on the detection of subclinical atherosclerosis in metabolic diseases Eun-Jung Rhee Department of Endocrinology and Metabolism Kangbuk Samsung Hospital Sungkyunkwan
Disclosures CORONARY CALCIUM SCORING REVISITED. Learning Objectives. Scoring Methods. Consultant for M2S, Inc. Coronary Calcium Scoring: Software
CORONARY CALCIUM SCORING REVISITED Disclosures Consultant for M2S, Inc. Julianna M. Czum, MD Director, Division of Cardiothoracic Imaging Department of Radiology Dartmouth Hitchcock Medical Center Assistant
SPECT CT Current Status and Future Direction Nuclear Cardiology
SPECT CT Current Status and Future Direction Nuclear Cardiology BIR London 25 th February 2013 Nik Sabharwal Consultant Cardiologist Oxford Heart Centre nikant.sabharwal@ouh.nhs.uk No conflict of interest
Je bénéficie régulièrement de fonds privés, dans le cadre de projets de recherche ou d activités de formation.
Je bénéficie régulièrement de fonds privés, dans le cadre de projets de recherche ou d activités de formation. Ces fonds proviennent essentiellement d industriels travaillant dans les domaines de l imagerie
DECISION - CTO. optimal Medical Treatment in patients with. Seung-Jung Park, MD, PhD, FACC for the DECISION-CTO Study investigators
DECISION - CTO Drug-Eluting stent Implantation versus optimal Medical Treatment in patients with ChronIc Total OccluSION Seung-Jung Park, MD, PhD, FACC for the DECISION-CTO Study investigators Asan Medical
Stress only Perfusion Imaging
European Society of Cardiology Annual meeting, 2010, Stockholm, Sweden Stress only Perfusion Imaging Oliver Gaemperli, MD Cardiovascular Center, University Hospital Zurich, Switzerland Male patient, 48
Myocardial Perfusion: Positron Emission Tomography
Myocardial Perfusion: Positron Emission Tomography TH. Schindler, MD University Hospitals of Geneva, Cardiovascular Center, Geneva, Switzerland ESC 2010 Stockholm Personal Disclosure Research Grant support
The role of Cardiac CT
Detection of Coronary Artery Disease Anatomy or perfusion? The role of Cardiac CT Multimodality Working Group of Cardiovascular Imaging (Nuc C,CCT &, CMR) Hellenic Cardiology Society Seminars, Thessaloniki,
Disclosure Information
Coronary CTA Pearls and Pitfalls Ricardo C. Cury, MD, FSCCT, FAHA, FACC Chairman of Radiology Radiology Associates of South Florida Director of Cardiac Imaging Miami Cardiac and Vascular Institute Past-President
David A. Orsinelli, MD, FACC, FASE Professor, Internal Medicine The Ohio State University Division of Cardiovascular Medicine Columbus, Ohio
1 STABLE ISCHEMIC HEART DISEASE: A NON-INVASIVE CARDIOLOGIST S PERSECTIVE 2018 Cardiovascular Course for Trainees and Early Career Physicians APRIL 20, 2018 David A. Orsinelli, MD, FACC, FASE Professor,
Who Cares About the Past?
Risk Factors, the New Calcium Score, Rheology and Atherosclerosis Progression Arthur Agatston 2/21/15 The Vulnerable Plaque vs. Plaque Burden CT Angiogram Is There a Role for Coronary Artery Calcium Scoring
Management of stable CAD FFR guided therapy: the new gold standard
Management of stable CAD FFR guided therapy: the new gold standard Suleiman Kharabsheh, MD Director; CCU, Telemetry and CHU Associate professor of Cardiology, Alfaisal Univ. KFHI - KFSHRC Should patients
Malaysian Healthy Ageing Society
Organised by: Co-Sponsored: Malaysian Healthy Ageing Society CAD INVESTIGATIONS PHYSIOLOGICAL / FUNCTIONAL VS ANATOMICAL / STRUCTURAL Disclosure iheal medical centre is a one stop cardiac centre with
Stable Angina: Indication for revascularization and best medical therapy
Stable Angina: Indication for revascularization and best medical therapy Cardiology Basics and Updated Guideline 2018 Chang-Hwan Yoon, MD/PhD Cardiovascular Center, Department of Internal Medicine Bundang
James M. Kirshenbaum, MD, FACC
James M. Kirshenbaum, MD, FACC Associate Professor of Medicine Harvard Medical School Co-Director, Clinical Cardiology Director, Acute Interventional Cardiology Brigham and Women s Hospital Boston, MA
FFR-Guided PCI. 4 th Imaging and Physiology Summit October 29 th, 2010 Seoul, Korea. Stanford
4 th Imaging and Physiology Summit October 29 th, 2010 Seoul, Korea FFR-Guided PCI William F. Fearon, M.D. Associate Professor Division of Cardiovascular Medicine University Medical Center Disclosure Statement
Hospital, 6 Lukon Road, Lukong Town, Changhua Shien, Taiwan 505, Taiwan.
Volume 1, Issue 1 Image Article Resolution of Inferior Wall Ischemia after Successful Revascularization of LAD Lesion: The Value of Myocardial Perfusion Imaging in Guiding Management of Multi-vessel CAD
FFR in Multivessel Disease
FFR in Multivessel Disease April, 26 2013 Coronary Physiology in the Catheterization Laboratory Location: European Heart House, Nice, France Pim A.L. Tonino, MD, PhD Hartcentrum, Eindhoven, the Netherlands
Typical chest pain with normal ECG
Typical chest pain with normal ECG F. Mut, C. Bentancourt, M. Beretta Nuclear Medicine Service, Asociacion Española Montevideo, Uruguay Clinical history Male 41 y.o. Overweight, hypertension, high cholesterol,
CASE from South Korea
CASE from South Korea Bon-Kwon Koo, MD, PhD, Seoul, Korea Outpatient clinic of a non-interventional cardiologist F/56 Chief complaint: Angina with recent aggravation, CCS II~III Brief history: # Stroke
PCI vs. CABG From BARI to Syntax, Is The Game Over?
PCI vs. CABG From BARI to Syntax, Is The Game Over? Seung-Jung Park, MD, PhD Professor of Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea PCI vs CABG Multi-Vessel Disease
2013 Lipid Guidelines Practical Approach. Edward Goldenberg, MD FACC,FACP, FNLA Medical Director of Cardiovascular Prevention CCHS
2013 Lipid Guidelines Practical Approach Edward Goldenberg, MD FACC,FACP, FNLA Medical Director of Cardiovascular Prevention CCHS EVIDENCE BASED MEDICINE Case #1 - LB 42 yo Asian/American female who was
Test in Subjects with Suspected CAD Anatomic Study is Better
Test in Subjects with Suspected CAD Anatomic Study is Better Hyuk Jae Chang MD, PhD Division of Cardiology Severance Cardiovascular Hospital Seoul Korea Functional Test Two Issues Accuracy of stress-tests
The Latest on CT Fractional Flow Reserve. Dimitris Mitsouras, Ph.D.
The Latest on CT Fractional Flow Reserve Dimitris Mitsouras, Ph.D. Assistant Professor of Radiology Harvard Medical School Director, Applied Imaging Science Lab Brigham and Women s Hospital Disclosures
Revascularization in Severe LV Dysfunction: The Role of Inducible Ischemia and Viability Testing
Revascularization in Severe LV Dysfunction: The Role of Inducible Ischemia and Viability Testing Evidence and Uncertainties Robert O. Bonow, MD, MS, MACC Northwestern University Feinberg School of Medicine
2/17/2010. Grace Lin, MD Assistant Professor of Medicine University of California, San Francisco
Modern Management of Patients with Stable Coronary Artery Disease Grace Lin, MD Assistant Professor of Medicine University of California, San Francisco Scope of the Problem Prevalence of CAD: 17.6 million
MEDICAL POLICY SUBJECT: CORONARY CALCIUM SCORING
MEDICAL POLICY PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy criteria are not applied.
Coronary Artery Imaging. Suvipaporn Siripornpitak, MD Inter-hospital Conference : Rajavithi Hospital
Coronary Artery Imaging Suvipaporn Siripornpitak, MD Inter-hospital Conference : Rajavithi Hospital Larger array : cover scan area Detector size : spatial resolution Rotation speed : scan time Retrospective
Reducing the Population Health Burden of Cardiovascular Disease
Reducing the Population Health Burden of Cardiovascular Disease Joseph A. Ladapo, MD, PhD Assistant Professor of Medicine Department of Population Health NYU School of Medicine Disclosures: K23 HL116787
COURAGE to Leave Diseased Arteries Alone
COURAGE to Leave Diseased Arteries Alone Spencer King MD MACC, FSCAI St. Joseph s s Heart and Vascular Institute Professor of Medicine Emeritus Emory Univ. Atlanta, USA Conflict: I am an Interventionalist
Incidence and Treatment for LM In-Stent
Incidence and Treatment for LM In-Stent Restenosis Corrado Tamburino, MD, PhD Full Professor of Cardiology, Director of Postgraduate School of Cardiology Chief Cardiovascular Department, Director Cardiology
Trial. International Study of Comparative Health Effectiveness with Medical and Invasive Approaches
Trial International Study of Comparative Health Effectiveness with Medical and Invasive Approaches Stable Ischemic Heart Disease What is the best initial management strategy for patients with SIHD? What
Update on Lipid Management in Cardiovascular Disease: How to Understand and Implement the New ACC/AHA Guidelines
Update on Lipid Management in Cardiovascular Disease: How to Understand and Implement the New ACC/AHA Guidelines Paul Mahoney, MD Sentara Cardiology Specialists Lipid Management in Cardiovascular Disease
Integrated Use of IVUS and FFR for LM Stenting
Integrated Use of IVUS and FFR for LM Stenting Gary S. Mintz, MD Cardiovascular Research Foundation Four studies have highlighted the inaccuracy of angiography in the assessment of LMCA disease Fisher
Nuclear Cardiology Cardiac Myocardial Perfusion with 82 Rb. Dominique Delbeke, MD, PhD Vanderbilt University Medical Center Nashville, TN
Nuclear Cardiology Cardiac Myocardial Perfusion with 82 Rb Dominique Delbeke, MD, PhD Vanderbilt University Medical Center Nashville, TN VUMC PET/CT conference 2009 82 Rb Cardiac Perfusion PET 82 Rb is
Screening for Asymptomatic Coronary Artery Disease: When, How, and Why?
Screening for Asymptomatic Coronary Artery Disease: When, How, and Why? Joseph S. Terlato, MD FACC Clinical Assistant Professor, Brown Medical School Coastal Medical Definition The presence of objective
ACC/AHA GUIDELINES ON LIPIDS AND PCSK9 INHIBITORS
ACC/AHA GUIDELINES ON LIPIDS AND PCSK9 INHIBITORS Ziyad Ghazzal MD, FACC, FSCAI Professor of Medicine Deputy Vice President/Dean Associate Dean for Clinical Affairs American University of Beirut Adjunct