The international journal of cardiovascular imaging
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Int J Cardiovasc Imaging · Mar 2010
Comparative StudyReduction in downstream test utilization following introduction of coronary computed tomography in a cardiology practice.
To compare utilization of non-invasive ischemic testing, invasive coronary angiography (ICA), and percutaneous coronary intervention (PCI) procedures before and after introduction of 64-slice multi-detector row coronary computed tomographic angiography (CCTA) in a large urban primary and consultative cardiology practice. We utilized a review of electronic medical records (NotesMD) and the electronic practice management system (Megawest) encompassing a 4-year period from 2004 to 2007 to determine the number of exercise treadmill (TME), supine bicycle exercise echocardiography (SBE), single photon emission computed tomography (SPECT) myocardial perfusion stress imaging (MPI), coronary calcium score (CCS), CCTA, ICA, and PCI procedures performed annually. Test utilization in the 2 years prior to and 2 years following availability of CCTA were compared. ⋯ Over the same period, there were no significant changes in measures of practice volume (office and hospital) or the annual incidence of PCI (405 cases in 2004 vs. 326 cases in 2007) but a higher percentage of patients with significant disease undergoing PCI 19% in 2004 vs. 29% in 2007 P < 0.01. Implementation of CCTA resulted in a significant decrease in ICA and a corresponding significant increase in the percentage of ICA cases requiring PCI, indicating that CCTA resulted in more accurate referral for ICA. The reduction in unnecessary ICA is associated with avoidance of potential morbidity and mortality associated with invasive diagnostic testing, reduction of downstream SPECT MPI and TME as well as substantial savings in health care dollars.
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Int J Cardiovasc Imaging · Oct 2009
ReviewEchocardiographic evaluation of right heart function and pulmonary vascular bed.
The aim of this review was to describe the different ultrasonic modalities to non-invasively evaluate right cardiac chambers and pulmonary vascular bed function. M-Mode, 2-D, conventional pulsed doppler, tissue doppler imaging (TDI), strain rate imaging (SRI) and 3D echocardiography are illustrated in order to obtain both regional and global right heart and pulmonary function. ⋯ The hemodynamic profile obtained consent to anatomically and functionally characterize PH. But, other experiences performed on more wide range of healthy and PH patients are necessary to confirm the described results.
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Int J Cardiovasc Imaging · Mar 2009
ReviewCoronary CT angiography in emergency department patients with acute chest pain: triple rule-out protocol versus dedicated coronary CT angiography.
Immediate coronary catheterization is mandatory for high risk patients with typical chest pain in the emergency department (ED). In contrast, in ED patients with acute chest pain but low to intermediate risk, traditional management protocol includes serial ECG, cardiac troponins and radionuclide perfusion imaging. However, this protocol is time-consuming and expensive, and definite treatment of unstable angina is often delayed. ⋯ In ED patients with atypical chest pain and low to intermediate risk, the triple rule-out protocol may be preferred, especially in older patients who have relatively lower risk of lifelong radiation-induced cancer. However, the increased radiation dose resulting from the extended volume coverage with this protocol should be fully considered prior to performing this protocol. Therefore, in ED patients who have a low clinical suspicion of pulmonary embolism and acute aortic syndrome, especially younger patients, dedicated coronary CT angiography accompanied by modifications to reduce radiation dose is recommended.