The heart of the matter

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 - Lisa Fratt - Portrait
Lisa Fratt, Editor

Although the staggering statistics about the economic and clinical impact of coronary heart disease are troubling, advances in imaging promise improvements in diagnosis, prognosis and treatment.

Coronary heart disease packs a wallop to the nation’s wallet and costs the U.S. $108.9 billion each year, according to the American Heart Association. This total includes the cost of healthcare services, medications and lost productivity. Heart disease is responsible for one in four deaths in the U.S.

One of the major advances of the last several years has been cardiac CT angiography (CCTA). Its pluses are plentiful. CCTA promises a non-invasive diagnostic alternative to conventional invasive diagnostic catheterization. It may streamline care by speeding evaluation of patients who present to the emergency department with suspected acute coronary syndrome. Its potential as a noninvasive alternative to conventional catheterization that also cuts costs accounts for its hefty appeal.

However, CCTA is not a panacea. An analysis of 243 CCTA studies performed in a large community hospital in 2006 showed that 43.2 percent were classified as inappropriate, while another 39.1 percent were categorized as uncertain, according to a study published in September's Journal of American College of Radiology. A revision of the guidelines in 2010 re-categorized many uncertain studies as appropriate; however, the proportion of inappropriate studies remained similar.

John R. Lesser, MD, president of the Society of Cardiovascular Computed Tomography (SCCT), has identified a related concern— potentially insufficient training in cardiac CT. The society has launched a survey to determine if a problem exists.

Although various stakeholders are working to reduce radiation exposure from cardiac CT exams and have found some success (even dropping pediatric exams to the sub-mSv level), radiation exposure remains a concern. That’s why Robert S. Balaban, PhD, scientific director of the National Heart, Lung and Blood Institute's (NHLBI) division of intramural research, referred to the successful use of MR for right heart catheterization as “the first chapter of a big story.”

The cardiac MR story is multifaceted, and provides the capability to assess numerous parameters of cardiovascular anatomy and function, which has driven an uptick in exams at some sites. However, some experts point to the long-established roles for stress echo and stress nuclear tests, as well as the cost of MR, as significant barriers. How adoption will play out remains to be seen.

Meanwhile, other cardiac modalities also are in a state of flux. Although CardioGen-82 (Bracco Diagnostics) was re-introduced to the market in February with a boxed warning, CardioGen-82 generator cycles have been extended to seven weeks (as opposed to the four- to six-week cycles), which means all face at least one week without service, because the maximum life of a generator is 42 days. It’s critical information for cardiac imagers.

RSNA is a great place to stay current on these and other essential clinical, practice and economic news that cardiac imagers require. The Health Imaging editorial team has compiled a preview of this year’s must-attend sessions in oncology imaging. If you can’t make the conference, our team will be at McCormick Place and posting live online coverage from Nov. 25-30. The wrap-up will continue in our daily newsletter through December and in the January/February issue of Health Imaging magazine.    

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Lisa Fratt, editor