Journal review: Societies collaborate on cardiac CT and MR appropriateness criteria

No fewer than eight medical specialty societies, including the American College of Radiology and a section of the American College of Cardiology, signed off on a report covering clinical appropriateness criteria for cardiac CT and MR. In other reports, a cardiologist proposes an imaging fellowship for cardiology, and a radiologist describes a strategy to win the coronary CT angiography turf war.

Appropriateness criteria

2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology (ACR), Society of Cardiovascular Computed Tomography (SCCT), Society for Cardiovascular Magnetic Resonance (SCMR), American Society of Nuclear Cardiology (ASNC), North American Society for Cardiac Imaging (NASCI), Society for Cardiovascular Angiography and Interventions (SCAI), and Society of Interventional Radiology (SIR)

J Am Coll Cardiol 2006;48:1475-1497

All the relevant professional authorities in radiology and cardiology signed off on this report covering clinical appropriateness criteria for cardiac CT and MRI.

Coronary artery disease

Pre-operative computed tomography coronary angiography to detect significant coronary artery disease in patients referred for cardiac valve surgery

J Am Coll Cardiol 2006;48:1658-1665

Multislice CT may eventually replace conventional coronary angiography for routine coronary artery evaluation preceding valve surgery if the results of this small prospective trial are confirmed. Dr. Willem Meijboom and colleagues in the cardiology and radiology departments of Erasmus Medical Center in Rotterdam, the Netherlands, found that 64-slice CTA identified significant coronary artery disease (defined as 50% or greater stenosis) in 25.7% of 145 patients awaiting valve disease. On a per-patient basis, the sensitivity, specificity, and positive and negative predictive values were 100%, 92%, 82%, and 100%, respectively. The authors conclude that CTA can serve as a gatekeeping for invasive cardiac catheterization for these patients.

Education

A proposal for an advance cardiovascular imaging training track

J Am Coll Cardiol 2006;48:1299-1303

Expressing a viewpoint sure to raise blood pressures at the American College of Radiology, cardiologist Dr. George A. Beller of the University of Virginia in Charlottesville proposed a new cardiology fellowship track for advanced training in cardiovascular imaging. Conceived as a formal fourth year of training leading to board certification and a certificate of added qualification, the advanced CV imaging program would cover imaging physics, instrumentation, interpretation and quantification of imaging variables, multimodality imaging, molecular and vascular imaging, and clinical guidelines with appropriateness criteria for all technologies.

Minimally invasive interventional therapy

Radiofrequency ablation outperforms electric cardioversion preceding amiodarone therapy for treatment of first episode symptomatic atrial flutter

Circulation 2006: Published online 10/9/06

Results from the prospective multicenter Loire-Arèche-Drôme-Isère-Puy-de-Dôme (LADIP) trial favor radiofrequency ablation as first-line treatment for arrhythmia soon after the first episode of symptomatic atrial flutter (AFL). Thirteen-month follow-up found AFL recurrence in 3.8% of 52 patients who underwent atrial RFA after first episode of AFL compared with a 29.5% recurrence rate for 52 patients who underwent sinus restoration using electric intracardiac stimulation and amiodarone therapy. No adverse events from RFA were seen despite the average patient age of 78 years. About 10% of the sinus restoration group experienced adverse events in the year following treatment. However, neither approach appears to reduce atrial disease progress. The rate of symptomatic significant atrial fibrillation was 10% and the rate of overall symptomatic or asymptomatic significant episodes was nearly 25% in the year after RFA. These rates were not significantly different from those for patients who received sinus restoration.

Patient safety

Clinical utility and safety of a protocol for noncardiac and cardiac magnetic resonance imaging of patients with permanent pacemakers and implantable cardioverter defibrillators at 1.5 tesla

Circulation 2006;114:1277-1284

Johns Hopkins University researchers, including cardiologist Dr. Saman Nazarian and radiologist Dr. David A. Bluemke, concluded from a study of 55 patients who underwent 68 MR exams that given appropriate precautions, MRI can be safely performed in patients with selected implantable pacemaker and defibrillator systems.

Acute myocardial infarction: safety of cardiac magnetic resonance imaging after percutaneous revascularization with stents

Radiology 2006;240:647-680

The Duke University cardiovascular MR group concluded that cardiac MRI shortly after coronary stent implantation for acute myocardial infarction appears safe. No adverse cardiovascular events occurred among 66 patients in the six months following installation of drug-eluting stents and follow-up cardiac MRI to evaluate cine function, perfusion, and viability.

Turf

How to win the coronary CTA turf war

AJR: 187(4): 849-851

Dr. David Dowe, a radiologist with Atlantic Medical Imaging in Galloway, NJ, outlines steps he says will enable radiologists to maintain a key role in the provision of coronary CT angiography. Radiologists have the noncardiac referrals necessary to make 64-slice CT scanners profitable and are recognized by noncardiologist referrers as CT imaging experts. But to maintain their edge, radiologists will need to put extra effort into maximizing image quality, creating unique and outstanding service models, and marketing themselves to the sources from which they are most likely to receive referrals.

Valvular disease

Prevalence and clinical importance of aortic valve calcification detected incidentally on CT scans: comparison with echocardiography

Radiology 2006;241(1):76-82

Dr. Ralf Koos and colleagues at the University of Aachen in Germany examined the prevalence and grade of aortic valve calcifications that sometimes appear as incidental findings in MSCT chest scans. The abnormalities were noted in 18% of 402 exams. The grading of their severity, determined from CT findings, substantially agreed with blinded assessments performed with echocardiography.