Dear Cardiac Insider,
Much has been made of the use of initial coronary CT angiography for evaluation of patients with suspected coronary disease, but other approaches, including so-called standard care with invasive angiography serving as the initial imaging test if warranted, remain common throughout the world. A third approach for patients presenting with chest pain is initial perfusion MRI before considering coronary angiography, or fractional flow reserve before angiography.
How do the costs stack up? Researchers presenting at the European Society of Cardiology compared the price tag of initial MR versus sending patients straight to the cath lab, versus fractional flow reserve plus angio. They found some surprises -- and some broad cost variations -- between several European countries and the U.S.
MR is also uniquely qualified for follow-up after acute myocardial infarction, according to a German team. In particular, the presence of left-ventricular thrombi at cardiac MR makes all the difference in recovery, they report here.
Meanwhile, coronary artery calcium scoring with CT remains one the best predictors of coronary events and mortality, and many physicians recommend its routine use in individuals at risk. The test has even been found to boost the predictive value of Framingham and other risk predictors. But the semiautomated scoring test takes time to perform well, and that can be a burden.
Dutch researchers have taken a new tack, building an algorithm that identifies and quantifies coronary artery calcium from CT scans, paving the way for faster deployment of a test that is increasingly important in gauging the likelihood of adverse events. Get the story on automated scoring here.
Performing cardiac MR on patients with pacemakers can be dangerous if the device isn't certified as MR-safe. Unsatisfied with the guidelines issued two years ago by the European Society of Cardiology, German researchers have recently issued guidelines of their own. The subject of MRI-safe and MRI-conditional pacemakers is a complex one, according to the German Radiology Cardiovascular Diagnosis Working Group, which published the new position paper, and deserves more nuanced treatment. Get the rest of the story here.
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