Cardiac Imaging News

Congestive Heart Failure & Coronary Heart Disease can be Diagnosed …

Measuring the often overlooked ‘aortic pressure’ enables better patient prognosis and preventative medicine Prof. Uwe Nixdorff from the European Prevention Centre, Düsseldorf advocates cardiologists combine IMT measurement with ALOKA’s pulse wave intensity function to check for unseen coronary heart disease: “This technique is currently seldom used, however in my experience it provides a more complete picture and enables me to treat patients earlier for life-threatening conditions that are often missed using conventional approaches” 12 December 2011 - ALOKA is collaborating with Prof. Uwe Nixdorff of the European Prevention Centre, Düsseldorf to advocate cardiologists worldwide begin using new functionalities for earlier diagnosis of coronary heart disease - enabling a preventative rather than reactionary approach to this pandemic disease. The problem with exclusively using older conventional techniques, like checking a patient’s blood pressure, is that it only enables the clinician to see what is happening externally and does not necessarily exposure dangerous pre-clinical risk factors acting on the heart itself. However, by combining IMT (intima media thickness) - the thickness of the arterial walls - with pulse wave intensity, which is the level of stress felt by the heart muscle (diastolic and systolic left ventricular function), and how this translates to blood flow behavior the clinician will be able to get a simultaneous overview of both the heart’s functional and physical properties for the first time. This provides an invaluable insight into the early stages of heart failure and preclinical artery disease, enabling appropriate treatment to start more quickly, potentially saving lives. For example, if the patient has the early stages of atherosclerosis (hardened and narrower arteries) it forces the myocardium muscle (heart muscle) to work increasingly hard, building it up (left ventricular hypertrophy) and resulting in increased pressure on the heart walls when ejecting blood (afterload). Over time the heart’s increased muscle mass will also cause difficulty re-filling during the diastole stage (diastolic relaxation dysfunction) and these factors collectively will result in systemic or pulmonary hypertension, and ultimately heart failure. ALOKA’s e-flow technology provides a new blood flow imaging mode which permits high spatial and temporal resolution. Combined with e-tracking technology, ALOKA’s unique analytical system, this facilitates the cardiologist in simultaneous access to vital information on the previously unforeseen aortic pressure - an early warning sign of possible CHD.Prof. Nixdorff, added: “The ability to provide a complete pathophysiological perspective of atherosclerosis as a systemic process is unique to ALOKA systems, and it enables for a comprehensive understanding of the entire ventriculoarterial function. The crucial difference with e-tracking is that it’s so accurate that it can even detect sub-clinical levels of vascular disease, making it ideal for earlier diagnosis and screening programmes. If we are able to see disease before it has taken hold of patients we can quickly move to an appropriate drug regimen - like ace inhibitors or AT-II receptor antagonists - and prevent unnecessary deaths from this pandemic disease”. The only current impendent to widespread adoption of these newer more accurate predictive techniques is appropriate training, and in order to eliminate ‘user dependence’ Prof. Nixdorff and ALOKA are running training initiatives around the globe and at major conferences throughout the year. Prof. Nixdorf presented his findings and experiences at this year’s EuroEcho in December (7-10), 2011. About ALOKA Europe ALOKA has been the world’s leading pioneer of ultrasound systems for the medical and health science industries for the last 60-years. Providing solutions to the Obstetrics/Gynaecology, General Imaging, Cardiovascular, Surgical and Endoscopic Ultrasound fields through an array of cutting edge medical imaging techniques, ALOKA is dedicated to excellence providing the systems needed to ensure the best quality of life for patients. Its international headquarters is located in Tokyo, Japan, the U.S. headquarters in Wallingford, CT and its European headquarters in Zug, ... Read more

Interventional Workflow at Royal Albert Edward …

Siemens Healthcare system enables greater precision Royal Albert Edward Infirmary in Lancashire, part of the Wrightington, Wigan and Leigh NHS Foundation Trust, has installed an Artis zee™ floor mounted system with a 20 x 20 detector for use in interventional cardiology. Building upon experience gained with the existing Artis dFC, staff expect this latest addition to deliver workflow efficiencies within the newly opened interventional laboratory. The Artis zee offers fast image acquisition and post-processing with high system reliability and its compact design also allows flexible positioning for easy patient access. The ergonomically designed tableside controls streamline workflow and enable the clinical team to function more efficiently. It also provides excellent image quality at the lowest achievable doses with the latest CARE (Combined Applications to Reduce Exposure) and CLEAR post-processing algorithms enabling further dose reduction without compromising image quality. The system also comes with the new Megalix CAT Plus tube featuring unique flat emitter technology that allows fluoroscopy of up to 250 mA, making it ideal for cardiac interventional examinations. IC stent is also delivered with the Artis zee to enable significantly enhanced visualisation of the structure of deployed stents during coronary interventions. With enhanced imaging results and improved workflow efficiencies, the department anticipates it will see an increase in patient throughput. “The Artis zee sits well within the new interventional lab as it is easy-to-use and helps our staff to build on existing skills. The new interventional lab is a great asset and complements the existing invasive and interventional work already taking place in the existing Siemens Artis dFC lab, which has been operational for over six years. Quicker examinations and better image quality have helped to streamline workflow within the department,” said Ken Prow, Superintendent Radiographer at Royal Albert Edward Infirmary. “We are still in the early stages following installation, but we anticipate that the system will deliver more accurate images to enhance the standard of care delivered to patients in the region.” “Using the latest Artis zee system, staff at Royal Albert Edward Infirmary are able to realise even greater workflow efficiencies and increased confidence during interventional procedures,” said Jane Whittaker, Angiography Business Manager at Siemens Healthcare. About Siemens Healthcare The Siemens Healthcare Sector is one of the world's largest suppliers to the healthcare industry and a trendsetter in medical imaging, laboratory diagnostics, medical information technology and hearing aids. Siemens offers its customers products and solutions for the entire range of patient care from a single source – from prevention and early detection to diagnosis, and on to treatment and aftercare. By optimising clinical workflows for the most common diseases, Siemens also makes healthcare faster, better and more cost-effective. Siemens Healthcare employs some 51,000 employees worldwide and operates around the world. In fiscal year 2011 (to September 30), the Sector posted revenue of 12.5 billion euros and profit of around 1.3 billion euros. For further information please visit: www.siemens.com/healthcare. For more information or images please contact: Georgina Wright / Thomas O’Neill Media Safari T: 01225 471202 E: thomaso@mediasafari.co.uk Siemens Healthcare Laura Bennett T: 01276 696374 E: laura.bennett@siemens.com W: ... Read more


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Phillipsburg, NJ - November 3, 2011 -INFINITT North America , a leader in image and information management technologies for healthcare, announced today that their Xelis™ Cardiac product has received clearance from the U.S. Food and Drug Administration, and is now widely available to the North American market. Xelis Cardiac is a 2D, 3D and 4D display and analysis tool for Coronary CT Angiography (CTA) and Left Ventricle Analysis (LVA). It is one of several Advanced Visualization tools for specialized clinical applications that INFINITT markets under the Xelis™ name. Xelis™ Cardiac can be used as an integrated solution with Infinitt's web-based PACS or as a stand-alone solution, allowing any third-party PACS user to query,view and analyze DICOM studies. According to INFINITT, Xelis™ Cardiac includes three diagnostic modules: Vessel Analysis (VA), Functional Ventricle Analysis (FA) and Calcium Scoring (Ca). Xelis™ Vessel Analysis: Xelis Vessel Analysis is a sophisticated software program designed to improve visualization and analysis of coronary arteries, improving detection of abnormalities such as stenosis, soft plaque and aneurysms. Key Features of VA:     Automatic removal of rib cage, auricle and ventricle     Intelligent detection and labeling of coronary vessel     Vessel boundary extraction     4D VR / MPR display and multi-phase handling     CPR / C-CPR (Curved Planar Reconstruction) for the traced vessels and 90 degree rotation     Stenosis analysis     Soft plaque analysis     Vessel protection from sculpting tool     Exports images and report in MS Word or DICOM Send back to PACS Xelis™ Functional Analysis     Xelis Cardiac Functional Analysis provides quantitative analysis of heart function. Xelis FA analyzes ventricular volume, Ejection Fraction (EF), Ventricle and Wall Thickness. Key Features of FA:     Automatic removal of rib cage, auricle and ventricle     Automatic Segmentation of LV Contours in all views (HLA,VLA,SA)     Automatic LV Boundary with manual editing     Auto selection of End Diastole (ED) and End Systole (ES) phases     Bull's Eye View with resulting values     Cardiac Functional Analysis of:     ED/ES Wall Thickness     ED/ES Wall Intensity     Wall Thickening     Wall Motion     Exports images and report in MS Word or DICOM Send back to PACS About INFINITT North America INFINITT North America, located in Phillipsburg, New Jersey, is a wholly-owned subsidiary of INFINITT Healthcare, a global company with upwards of 2100 PACS installations worldwide. Infinitt's web-based image and information management solutions include RIS, PACS, Cardiology PACS, Mammo PACS and 3D/Advanced Visualization software operating on a single database ? simplifying workflow, increasing system reliability, and reducing cost and support requirements. For more information, contact Infinitt at marketing@infinittna.com or visit www.infinittna.com. Media Contact: Deborah Reed Marketing Manager INFINITT North America Tel.: +1 908 387 ... Read more

MRI Offers Powerful Research Tool for Assessing …

MRI scans might give researchers a powerful new tool for monitoring the effectiveness of lipid therapies for coronary or carotid artery disease, a new study shows. Led by Dr. Xue-Qiao Zhao, of the University of Washington, Seattle, the researchers sought to determine if cholesterol-lowering drugs deplete plaque lipid content. Zhao told the Hub by e-mail that they used MRI as a tool to make direct assessment of the plaque tissue composition during treatment. The study appears in the October issue of the Journal of the American College of Cardiology: Cardiovascular Imaging. The CPC Study (Carotid Plaque Composition by MRI During Lipid-Lowering), co-authored by Loyola University Health System cardiologist Dr. Binh An P. Phan, was a randomized, double blind, and partial placebo-controlled study. The three-fold objective was to test two hypotheses regarding the effects of lowering LDL cholesterol and raising HDL cholesterol with medications. Specifically the research team wanted to know if intensive lipid therapy would deplete plaque lipid content. In addition, they also wanted to know how two strategies for lowering LDL cholesterol and raising HDL cholesterol compared in terms of plaque depletion. "In the future, MRI scans may become important and powerful tools to see how medication therapy is working inside arteries," Phan said. "However, our study is just the first step. Additional studies will be needed." In the study, conducted at the University of Washington where Phan was completing a cardiovascular clinical and research fellowship, 123 patients were randomly assigned to receive one of three cholesterol treatments: Lipitor® alone Lipitor plus Niaspan®  Lipitor plus Niaspan and colesevelam. After three years of intensive lipid therapy, the 33 patients with measurable carotid plaques had a significant reduction in the cholesterol within the plaque. The volume of cholesterol dropped from an average of 60.4 cubic millimeters to 37.4 cubic millimeters, and the percentage of plaque volume consisting of cholesterol dropped from 14.2 percent to 7.4 percent. Among the 123 subjects enrolled in the study, mean age was 55 years, mean body mass index was 30 kg/m2, 73 percent were male, 43 percent had a family history of premature cardiovascular disease, 37 percent had a previous myocardial infarction, 80 percent had clinically established coronary artery disease. In addition, 52 percent had hypertension and 12 percent had diabetes. Over the three years of the study, MRI scans were done on patients' carotid arteries, rather than on their coronary arteries. The researchers noted that they used the carotid arteries because they are closer to the surface of the body and easier to image. They do not move as much as the coronary arteries of a beating heart. All subjects were followed up monthly for the first 6 months and then bimonthly for the remaining 30 months of the 36-month protocol. A total of 21 visits per subject was conducted for this study. At these visits, subjects underwent questioning about side effects and symptomatic state as well as a targeted cardiovascular examination. The carotid MRI scans were obtained at baseline, and at one, two, and three years. There were 33 subjects with measurable lipid-rich necrotic core (LRNC), or the buildup of lipid behind the plaque formation that could be measured by MRI at baseline who completed three-year follow-up scans with acceptable image quality for comparison. Six subjects were excluded because of poor image quality. Another 81 subjects had no measurable LRNC at baseline and were excluded from the analysis. Finally, three subjects with LRNC at baseline did not complete three-year follow-up scans and were excluded. The researchers said that because there were only 33 patients in the final analysis, they were unable to make statistically significant comparisons of the differing effects of the treatment strategies. They will continue enrolling patients and they hope to investigate fully the differential treatment effect. “These findings suggest a potential mechanism for plaque stabilization associated with intensive lipid therapy,” the authors concluded. “Furthermore, these results highlight the importance of selection of subjects with a LRNC in future trials examining the effect of therapy on plaque regression.” By Michael O’Leary, contributing writer, Health Imaging ... Read more

MRI Of Vessel Wall Thickness Links Pericardial Fat …

Using MRI to measure plaque in coronary arteries, researchers have determined that fat around the heart is a better predictor of atherosclerosis than BMI and waist circumference in asymptomatic men but not women. When the researchers made adjustments for BMI, waist circumference, C-reactive protein level and coronary artery calcium content, the relationship between pericardial fat and coronary atherosclerosis remained significant in men but not in women. Senior author Dr. David Bluemke, director of Radiology and Imaging Sciences at theNIH Clinical Center, told The Hub in an e-mail interview that the results remained consistent with early results presented at the American Heart Association (AHA) 2009 Scientific Sessions. “We did both men and women at that time as well,” Bluemke said. “The effects are larger in men than women.  This is usually because at any particular age, women usually act as if they are about 10 years younger than men, with less plaque, lower calcium scores, etc.” In the current study, the researchers conclude that pericardial fat volume was positively related to coronary atherosclerotic plaque burden in asymptomatic individuals. “This relationship was stronger in men than in women—possibly because of the greater atherosclerotic disease burden in men,” they wrote. The study was published online Aug. 16 in the journal Radiology. The researchers used a subgroup of 183 participants in the Multi-Ethnic Study of Atherosclerosis, or MESA trial, to determine the relationship between pericardial fat and plaque buildup in coronary arteries. There were 89 women and 94 men with an average age of 61 who took part between October 2005 and February 2008. None had symptoms of atherosclerosis, and all underwent a chest CT scan at the start of the study to assess coronary artery calcification. Patients then underwent MR angiograms and cross-sectional MR imaging of coronary artery walls. Those with image quality grades 2 or 3 were analyzed by an unblinded observer, who traced the inner and outer coronary walls to measure artery wall thickness. Pericardial fat volumes were measured from the cardiac CT scans. The researchers then compared the atherosclerosis with the calcium scores, C-reactive protein levels and pericardial fat volume. A total of 387 coronary artery wall images were rated grade 2 or 3 for image quality and evaluated for wall thickness, of these 203 were in men and 184 in women. The men had significantly greater average coronary artery wall thickness, average 2.0 mm compared to 1.9 mm for women. They then looked at the relationship between pericardial fat and plaque eccentricity. Bluemke explained that plaque eccentricity measures the ratio of the thick side of the vessel wall to the normal side. “Plaque in the arteries forms very irregularly,” Bluemke said. “Usually one side of the vessel has the plaque, the other side is more normal.  So one measure of disease, is to look at the ratio of the abnormal thick side, to the more normal thin side,” he said. No significant difference in mean minimal coronary artery wall thickness or mean coronary plaque eccentricity was observed between the men and women. Nor was there any significant difference in mean wall thickness, mean maximal wall thickness, or mean plaque eccentricity between the left main, left anterior descending, and right coronary arteries. In the men pericardial fat volume was positively linked to plaque eccentricity. For every increment of 1 standard deviation in pericardial fat volume was associated with a 0.3 increase in plaque eccentricity. In women pericardial fat volume was also positively correlated with plaque eccentricity but not as strongly. When they controlled for BMI, waist size and coronary calcium scores the relationship between pericardial fat and plaque remained significant in men, but not in women. The researchers theorized that this difference may be that men are at greater risk of for increased plaque. “Our results in these asymptomatic individuals are consistent with findings in patients with advanced atherosclerotic disease—namely, that a large amount of pericardial fat is significantly associated with measures of atherosclerotic disease,” they concluded. By Michael O’Leary, contributing writer Health Imaging ... Read more

Siemens Improves its Artis Zee Angiography Systems …

Siemens Healthcare, a leading company providing medical imaging systems, has recently added the navigation technology, MediGuide, to its Artis zee angiography systems. MediGuide technology was developed by St. Jude Medical. The new technology uses magnetic targeting to determine the position of catheter during cardiac interventional procedures. It also shows the exact location of catheter in real-time on a previously generated fluoroscopy image of the patient. MediGuide also helps in reducing radiation doses delivered to the patients as there is no need to continuously scan patients with angiography systems to review the movement of the catheter. Siemens has become the first company to use St. Jude Medical’s MediGuide with its systems. Siemens’ Artis zee systems are now able to offer better catheter navigation during interventional procedures. Dr. Heinrich Kolem, Head of the Angiography & Interventional X-ray business unit at Siemens Healthcare, said "With the MediGuide Technology, we have expanded our CARE dose-reduction initiative with a critical functionality," adding "We are convinced that our customers will achieve better clinical results, especially during complex procedures, and at the same time will be able to save both dose and time." The new Artis zee supported with MediGuide technology has been successfully used for the first time at the Heart Center Leipzig in Germany. Professor Dr. Gerhard Hindricks, Director of the Rhythmology Department, said "The low-radiation, precise localization of the catheter tip onto the pre-recorded fluoroscopy image is a most impressive function, because the system is able to compensate the motion from heart beat and breathing," He continued "Our clinical experience now includes more than 50 patients. The technology will have a significant impact in the field of catheter ablation, but also for the placement of left ventricular leads for cardiac ... Read more

New Cardiac CT Technique Reduces Radiation Sevenfold …

Beta blockade combined with newer multi-detector CT angiography (MDCTA) reduced radiation exposure sevenfold compared to older scanners a new study shows. The new method may be the safest for coronary imaging for certain pediatric patients. In a retrospective study of all coronary CTAs performed on patients less than 18 years of age at Minneapolis Heart Institute®, researchers found that not only did newer CTA techniques use lower doses of radiation than early CTA, the heart rate reduction using beta blockers allowed radiation doses significantly lower than conventional cardiac catheterization. Led by Dr. Kelly Han, a pediatric cardiologist at Minneapolis Heart Institute® at Abbott Northwestern Hospital, the researchers presented their findings at the Sixth Annual Scientific Meeting of the Society of Cardiovascular Computed Tomography (SCCT) in Denver, this week. One barrier to applying coronary CTA in children has been their relatively high heart rates, which require a higher radiation dose. Han told The Hub that by slowing the heart rate you can use a lower radiation dose. “The scan mode you use is dependent on the heart rate and the lower the heart rate, the lower the radiation dose per scan,” she said in a phone interview. “Using a combination of medication to slow the heart rate and the new scanner technology, we have been able to obtain excellent images of the coronary arteries in patients as young as five months of age." In the study, Han’s team compared radiation exposure, anesthesia use and diagnostic accuracy between first generation single-source, standard-pitch spiral CT scanners and second generation high-pitch, dual-source CT scanners for image quality and radiation risk in a pediatric population. At the time of the presentation they had reviewed 76 consecutive MDCTA scans from a single practice over a 2-year period (June 2007 through February 2011). Patients ranged in age from three days to 18 years. Patients were separated by scan mode into three groups:    Group one included 22 first-generation, dual-source CT scanner with retrospective ECG gating (spiral scan mode).    Group two included 35 second-generation, dual-source CT scanner with prospective ECG gating (sequential scan mode).    Group three included 19 second-generation, dual-source CT using prospective ECG gating with high pitch (flash scan mode). The researchers compared the imaging results in the three groups. Image quality was graded on a four-point scale, with 4 defined as excellent image quality. Groups were compared using the Kruskal Wallis test. There was no significant difference in image quality between the groups. The difference is radiation dose, however, was significant. The age-adjusted radiation dose in group one (spiral mode) was 1.8 mSv, in group two (sequential mode) it was 1.05 mSv, and the age adjusted dose in group three (flash scan) was 0.34 mSv. “That is a sevenfold reduction in radiation dose compared to the spiral mode and that’s why it is important to get the heart rate down whenever you can,” Han said. "For patients who need coronary artery imaging the important thing is try to obtain a diagnostic image with the least risk to the patient. In patients where you can use a flash mode you can get great pictures with high quality at very low doses. So when indicated it is a wonderful tool." Han summarized the subset of pediatric patients for whom coronary CT imaging is indicated. Patients with an anomalous coronary artery, and patients with Kawasaki’s disease, which is an acquired disease of children where they have a chance of getting coronary artery aneurysms and stenosis may benefit from CT imaging. The third indication is for patients who have had a coronary artery implant as part of a surgical procedure because some of them can have coronary artery narrowing at the site of the surgery later in life.  by Michael O'Leary, contributing writer, Health Imaging ... Read more

Stress Echocardiography Predictive of Heart Attack or …

HIV patients with abnormal results on a ultrasound stress test have nearly a 10 times higher risk of a heart attack or cardiac death than the normal population, and more than three times the risk of people without HIV who have an abnormal stress echocardiogram a new study shows. Senior author of the study, Dr. Farooq Chaudhry, associate professor of medicine, and colleagues at Columbia University College of Physicians and Surgeons in New York City performed stress echo tests on 311 HIV patients with suspected or known heart disease. They reported their findings online before the July 12, 2011 print issue of Circulation: Cardiovascular Imaging. The researchers looked at whether stress echo can help predict risk of heart attack and death in a high-risk population, in this case HIV patients with known or suspected heart disease. HIV infection and the drugs used to treat it have been associated with accelerated coronary artery disease and cardiovascular events in prior research. While stress echocardiography is an accepted method of diagnosis, risk evaluation and prognosis of coronary artery disease, its prognostic value in HIV-positive patients is unknown. "Although we did not study which treatments are most effective for these patients, HIV patients who have abnormal stress echocardiography should probably be monitored and treated more aggressively to prevent heart attack and death," said Chaudhry in a prepared statement. "Conversely, patients with a normal stress echo might not need such aggressive interventions." The 311 patients studied were an average of 52 years old, and 80 of them (26 percent) had an abnormal stress echo. During the average 2.9-year follow-up, 17 experienced nonfatal heart attacks and 14 died of cardiac causes. When they analyzed the data they found that the prognosis for HIV patients who had normal stress was good. The average risk for these patients was 1 percent per year, the same as that for the general healthy population. The risk of cardiac death or myocardial infarction rose dramatically for HIV patients with an abnormal stress echo test result. Their average annual risk was nearly 12 percent per year, 10 times higher than the average for the normal population and nearly three times higher than the non-HIV population with abnormal stress echo results. Similarly 100 percent of HIV patients with normal stress echo survived at one year and 98 percent at four years, which is in stark contrast to HIV patients with an abnormal stress echo test. For these patients 92 percent survived at one year but that number dropped dramatically to 62 percent at four years. The researchers noted that limitations of the study include the subjective nature of interpreting stress echocardiography, which may limit the study's application to centers with more experience. In addition, the results of the test may have influenced management of the patients, including referral for revascularization, they noted. By Michael O’Leary, contributing writer, Health Imaging ... Read more

CT Angiography in Low-risk Patients Leads to More …

Undergoing a coronary CT angiography (CCTA) often leads to greater use of medications and significantly more additional testing including invasive catheterizations in low-risk patients compared to similar patients who did not undergo CT angiography, a new study shows. In the first large population study to look at both patient and physician behavior following a CT scan screening test for coronary stenosis, researchers led by Dr. John McEvoy, a cardiology fellow at Johns Hopkins Medical Center in Baltimore compared testing and medication prescription and use following the screening test in 2,000 Korean men and women who took part in a health promotion trial. McEvoy told The Hub in a phone interview from Ireland that the study grew out of a collaboration dating back to 2009 between Dr. Roger Blumenthal, director of the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins, and Dr. Hyuk-Jae Chang at Yonsei University in South Korea. “The study Dr. Chang was conducting was looking at the association of risk factors with different plaque types,” McEvoy said. “We thought that, given the opportunity of studying low-risk, asymptomatic patients who undergo a CT angiography, it would be interesting to look at the downstream medical treatment they received following screening.” What they found suggests that low-risk patients without symptoms don't benefit in the short term from knowing whether or not plaque has been detected using CT angiography. Not surprisingly physicians may be inclined to be more aggressive with prescriptions or follow up tests. “It is intuitive that if someone undergoes a scan and some disease is found that there will additional testing and treatment,” McEvoy said. “So we weren’t surprised by the study results. We were more interested in carefully documenting just how much medication and additional testing was done after the test.” In the study published online ahead of print publication in the Archives of Internal Medicine the researchers compared 1,000 asymptomatic participants in the SNUBH health-screening program in South Korea who elected to undergo the CT angiography, with a matched group of 1,000 participants in the program who elected not to undergo CT angiography. The average age for both groups was 50, and 63 percent were men. Both groups had similar baseline heart disease risk factors and none had experienced angina or other symptoms. Their current use of statins, aspirin, anti-hypertensive, and oral hypoglycemic drugs were documented at the index visit, as were BMI, history of hypertension, diabetes, and total cholesterol. For the CCTA group, their scans were analyzed by experienced independent investigators who documented plaque deposits that were larger than 1 millimeter squared within or adjacent to the vessel lumen. Those in the CCTA group were given their results, and all 2,000 patients were followed over 18 months. In both groups, the treating physicians ordered all prescriptions and additional testing. Study follow-up exams were scheduled at 90 days and 18 months after the initial visit. In the CCTA group 785 screening scans (79 percent) were negative. The remaining 215 patients (21 percent) were defined as CCTA positive. There were 392 narrowed segments in 215 patients. A total of 52 patients (5 percent) had greater than 50 percent stenosis, and 21 patients (2 percent) had greater than 75 percent stenosis. While there was no difference in the two groups at baseline for statin use, following CCTA, statins were prescribed more often among those with a positive CCTA compared to the control group that did not undergo CCTA. At the 90-day follow-up visit 34 percent of the CCTA group positive for stenosis were taking statins compared to 8 percent of those who did not undergo CT angiography. At the 18-month visit statin use declined to 20 percent of the CCTA group remaining on statins compared to 6 percent of the non-CCTA group. Inversely, those with a negative CCTA were less likely to be on statins at the 90-day and 18-month follow-up visits than patients in the control group. Similarly, those with a positive CCTA were nearly 7 times more likely to be taking aspirin at the 90-day visit compared to those in the non-CCTA group, and that too declined at the 18-month visit with the positive CCTA group 4 times more likely to be taking aspirin compared to the non-CCTA group. There were no significant differences in use of anti-hypertensive and oral hypoglycemic drugs between the two groups. A total of 55 patients (5.5 percent) in the CCTA group underwent additional tests including invasive catheterization compared to 22 patients (2.2 percent) of the non-CCTA group at 90 days. At 18 months there was one patient admitted to the hospital in the CCTA group for unstable angina and 1 cardiac death occurred in the control group. McEvoy said that they had wanted to look at cardiac events as part of the follow-up study, but that 18 months in this low-risk group was too short for that. What they could say was that screening CCTA suggesting coronary atherosclerosis was associated with a sustained increase in aspirin and statin use. In addition, an abnormal result was also associated with more resource-intensive secondary tests and invasive revascularizations outside of evidence-based guidelines. In terms of implications of the study for screening low-risk patients, co-author Blumenthal, noting that a CT angiography test can cost between $600 and $1,000, said the results affirm the current guidelines for CT angiography of the American Heart Association. “Before we advocate for a particular screening test, we need to demonstrate its potential benefit and define the patient populations for whom the test would be useful,” Blumenthal said. McEvoy emphasized that the people in this study had these scans as part of a study of plaques so it was not at all the common scenario of patients seeing their cardiologist and being given a CT scan. Nevertheless there is some evidence of increasing use of CT angiography in low-risk, asymptomatic patients. “No one knows how many low-risk patients are undergoing these scans,” McEvoy said. “Because of the non-invasiveness and the quality of the result it may be tempting for a cardiologist to consider the test in certain patients without symptoms but who might have other factors that are associated with heart disease. But most cardiologists would consider other tests first because the cost, radiation and contrast bolus used for CT angiography make the risk-to-benefit ratio too high.” By Michael O’Leary, contributing writer, Health Imaging ... Read more

Cooper Clinic Offers New 4D Cardiac Echo Imaging…

Cooper Clinic Cardiologists in Fort Smith has recently invested in a 4D Cardiac Echo technology which offers new options for diagnosis of heart diseases. "Our physicians have decided to invest in the latest piece of state of the art tech so they can deliver that care," says Chief Medical Officer Dr. Rebecca Fleck. Other than Arkansas Children's Hospital in Little Rock, Cooper clinic is the only facility in the state that offers what they call “the new gold standard" for echocardiograms. "It's really 3D imaging but has been tapped 4D because this particular unit is able to get those three dimensional images in a single heartbeat," says Board Certified Cardiologist Timothy Waack, M.D. In contrast to traditional ultrasound images that are "pieced" together, the 4D Cardiac Echo technology from Siemens Healthcare captures pictures of the patient's entire heart in real time. "We're also able to look at the structure of the valves, in a way that we have not been able to see them before to better determine why they are leaking to get a better idea for the surgeons when it comes time to start thinking about repairing or replacing these valves," Dr. Waack said. "It's a big difference. Because if that wall is not moving, like it should that means there's probably something that happened to it like a blockage, caused a heart attack, a small one. So it helps us pick up very subtle changes," he explained. Waack also believes it will give patients higher confidence in their diagnosis. "The better we see things, the better we deal with them," he said. According to Cardiac Sonographers, having the test in 4D can add an extra five to ten minutes to the exam ... Read more

Half-dose SPECT Cardiac Perfusion Yields Excellent …

Performing SPECT myocardial perfusion to image coronary arteries at half the usual radiation exposure yielded good or excellent images 95 percent of the time according to researchers in Israel. The study led by Dr. Nili Zafrir, of the Rabin Medical Center in Petah Tikva, Israel, used special imaging software to produce the enhanced images that were comparable to full-dose protocols. She presented her study results at the ICNC10 - Nuclear Cardiology and Cardiac CT meeting being held in Amsterdam, Netherlands this week. "It's our view that myocardial perfusion imaging is feasible with significant radiation dose reduction," Zafrir said in a prepared statement. "We found that image quality using the new processing software was similar to that in conventional protocols. Indeed, the clinical results identified with the half-dose protocol were equivalent to those determined by full dose imaging. But significantly, the half dose protocol reduced radiation exposure to a minimum of 1.9 mSv in one-third of our patients, far below the dose range we see in conventional perfusion scanning.” SPECT or single-photon emission computed tomography is a nuclear medicine imaging technique using gamma rays to produce an image in sections that are assembled by computer into a 3D image. SPECT scans are significantly less expensive than PET scans, in part because they are able to use longer-lived more easily-obtained radioisotopes than PET. The down side is that SPECT using a radioisotope such as technetium-99m is limited to an imaging scan of 14 to 30 minutes because the radiation dose in that time can be as high as 25 millisieverts (mSv). In the study, Zafrir’s team randomly assigned 218 patients referred for myocardial perfusion imaging with 109 assigned to the half-dose protocol and 109 to the full-dose protocol. The groups were well matched with an average age of 66, an average weight of 174 pounds, an average BMI of 28kg/m2. A total of 56 percent were male. All patients had a history of myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft. Patients in the full-dose protocol received standard injections of technetium doses ranging between 12 and 32 milicurries (mCi) depending on patient weight. Patients in the half-dose group received doses ranging between 5 and 17 mCi. Images from the half-dose group were processed using imaging software originally designed to reduce the time needed to acquire a full diagnostic image. The goal of this study was to use the software to test the feasibility of reducing the tracer dose instead of reducing the acquisition time. The image analysis showed that 94 percent of the images from the half-dose protocol were judged as “excellent to good,” with little or no loss of image quality or diagnostic accuracy. Overall, the total effective dose for the stress-rest studies was 7.19 mSv in the half-dose group compared to 14.4 mSv in the standard dose protocol. In addition, 38 of the patients in the half-dose group had only single stress-only testing which resulted in an average radiation exposure of only 1.9 mSv, which the researchers noted as being far below the dose range used in conventional perfusion scanning. Zafrir cautioned that this is preliminary study primarily aimed at looking at the feasibility of using half the radiation dose, and that more research will be needed to confirm diagnostic accuracy. "Clearly, we cannot be certain what the long-term benefit of reducing radiation exposure might be, but theoretically it would seem important," she said. By Michael O’Leary, contributing writer, Health Imaging ... Read more


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Volcano Corporation, a major developer and manufacturer of precision guided therapy tools designed to improve the treatment of coronary and peripheral vascular disease, announced the signing of a supply agreement with ev3, a Covidien company. According to the contract, Volcano will supply its proprietary Intravascular Ultrasound (IVUS) technology for use in ev3's Plaque Excision Systems. Using the digital IVUS transducer incorporated in Volcano's market leading EagleEye® catheter product line, this new product will have the ability to run on Volcano's global installed base of 5,000 systems. Scott Huennekens, President and CEO of Volcano, said: "At Volcano, our imaging and physiology tools provide a level of precision that angiography alone simply cannot match. In addition to our internally developed image guided therapy products, such as the VIBE® RX Imaging Balloon (commercially available in the EU only), we have looked to other medical device industry leaders to join us in differentiating therapeutic devices by adding integrated imaging capabilities. Covidien is an innovative company that recognizes the value of onboard visualization and is committed to bringing these new, more precise therapies to market to help improve patient outcomes. This agreement also exemplifies the value of our one system, many solutions strategy facilitated by our multi-modality platform." Plaque Excision Systems, also called atherectomy devices, are catheters that remove plaque which blocks arteries and hinders blood flow. Instead of compressing plaque against the vessel wall as occurs with balloon and stent therapy alone, plaque excision systems remove the obstruction from the vessel, thus restoring blood flow and reducing damage to the vessel wall. IVUS integration offers advantages for immediate evaluation of the plaque to better guide therapy. Stacy Enxing Seng, President, Peripheral Vascular, Covidien, said: "By partnering with Volcano, we continue to lead atherectomy therapy, enabling physicians to visualize the diseased portion of the artery for optimal plaque excision. This is particularly important as we believe preparing and treating the vessel for drug delivery, whether via drug coated balloon or stent, will create a breakthrough in treating lower extremity peripheral arterial ... Read more

GRS Selects MedStar Health Research Institute (MHRI) …

Global Research Services, LLC (GRS), an international cardiovascular Clinical Research Organization (CRO), announced its partnership with MedStar Health Research Institute (MHRI)’s Cardiovascular Core Laboratories, a major provider of cardiovascular imaging research services. MHRI is known by its reputation in cardiovascular corelab services, cardiac imaging technology and established experience in research. According to the agreement, GRS offers clients direct and secure data transfer of cardiac imaging information from MHRI for incorporation into Sponsors’ Phase I-IV investigational drug and device clinical development programs. The agreement ensures GRS’ expansion in clinical trials that require evaluation of cardiovascular endpoints. MHRI will act as the preferred corelab for cardiac evaluations that will include 2D and 3D echocardiography, cardiac MRI, multi-slice CT, carotid intima-media thickness (IMT), intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA). Bruce Garrett, MD, President and CEO, GRS, stated: “GRS has a 25 year history in cardiovascular clinical trial conduct. We wanted to work with MHRI to offer our clients the top international service provider for professional and accurate cardiac evaluations that seamlessly integrate into our organizational systems.” Internationally recognized expert in cardiac ultrasound Neil Weissman, MD, FACC, FAHA, FASE, President, MHRI, added: “The working agreement with GRS fits our mission of providing top cardiac imaging services to advance healthcare. We both benefit from working together and achieving excellence in trial conduct on behalf of our ... Read more

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