Interview with Thomas Maddox, M.D., MSc, FACC, the chairman of the American College of Cardiology (ACC) Science and Quality Committee, which recently created the ACC document on novel coronavirus (COVID-19) clinical guidance for the cardiovascular care team. He explains the document and what cardiologists and the cardiac care team needs to know about caring for COVID-19 patients. The document points out COVID-19 combined with the comorbidity of cardiovascular disease has the mortality of any comorbidity, as high as 10.5 percent.

He explains the need for more serious attention to protective equipment, cardiovascular complications seen in COVID-19 (SARS‐CoV‐2) patients, suggestions on how to mitigate exposure if an echo or cath is required, and other considerations for the CV care team. He said the document will be updated on a regular bases and the committee is drafting other sets of related COVID-19 guidelines for cardiology departments.

Updates regarding COVID-19 and cardiology will be posted on the ACC COVID-19 Hub page.

Maddox is also the executive director of the Healthcare Innovation Lab of BJC Healthcare and Washington University School of Medicine, St. Louis. He is also an assistant professor of cardiology at Washington University.

Read more on ACC COVID-19 recommendations for the cardiovascular care team.

Additional COVID-19 Resources for Clinicians:

   World Health Organization (WHO) COVID-19 situation reports

   World Health Organization (WHO) coronavirus information page

   U.S. Food and Drug Administration (FDA) COVID-19 information page

   Centers for Disease Control (CDC) COVID-19 information page

   Centers for Medicare and Medicaid Services (CMS) frequently asked questions and answers (FAQs) for healthcare providers regarding COVID-19 related payments
 

Related COVID-19 Content:

The Cardiac Implications of Novel Coronavirus

ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

CT Provides Best Diagnosis for Novel Coronavirus (COVID-19)

Radiology Lessons for Coronavirus From the SARS and MERS Epidemics

Deployment of Health IT in China’s Fight Against the COVID-19 Epidemic

Emerging Technologies Proving Value in Chinese Coronavirus Fight

Radiologists Describe Coronavirus CT Imaging Features

Coronavirus Update from the FDA

CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia

CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)

Chest CT Findings of Patients Infected With Novel Coronavirus 2019-nCoV Pneumonia 

Karen Ordovas, M.D., MAS, professor of radiology and cardiology at the University of California San Francisco (UCFS) School of Medicine and a Society of Cardiac Magnetic Resonance (SCMR) board member, explains how cardiac MRI can help in women's heart disease and to better define complex congenital heart anatomy. She spoke at the 2019 Radiological Society of North America (RSNA) meeting. 

She specializes in cardiac and pulmonary imaging, and has particular expertise in using CT and MRI techniques in cardiovascular imaging and the differences of presentation in imaging between male and female cardiac patients. Ordovas is helping advance education around heart disease in women and bring great awareness of quality tools to diagnose heart disease and how heart MRI can help. She also is heavily involved in the use of heart MRIs for pregnant women, since there is no radiation,  and patients with congenital heart disease where detailed imaging of the complex anatomy is required.

The use of cardiac MRI in congenital heart disease is common in serial imaging of patients with Tetralogy of Fallot (TOF), one of the most common congenital heart diseases for which patients are referred for post-operative magnetic resonance (MR) imaging evaluation. In the past few decades, surgery has proved successful, but most patients require repeat imaging throughout their lives and MRI can offer more detailed soft tissue imaging without the use of radiation. 

Related Cardiac MRI Content:

Cardiac MRI Becoming More Widely Available Thanks to AI and Reduced Exam Times

VIDEO: Advances in Cardiac MRI Technology — Interview with James Carr, M.D.

Cardiac MRI Delivers Accurate Diagnosis for Frontline Chest Pain Evaluation

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Advantages and New Applications of Cardiac MRI

Will Cardiac MRI Expand?

Mahadevappa Mahesh, Ph.D., chief of medical physicist and professor of radiology and medical physics, Johns Hopkins University, Baltimore, treasurer of the American Association of Physicists in Medicine (AAPM),a board member of the American College of Radiology (ACR), presented a late-breaking study on how medical imaging radiation dose has started to drop over the past decade. He is the co-chair of the National Council on Radiation Protection and Measures Report (NCRP), and presented the most recent NCRP data analysis at the 2019 Radiological Society of North America (RSNA) meeting.

The new NCRP 184 report covers the period between 2006 and 2016, the period of the most current CMS data. It shows a decrease of about 20 percent in the radiation dose the U.S. population receives from medical imaging, compared to the NCRP 160 that covered the period of up to 2006.

Key findings of the study include:

   • CT dose dropped about 6 percent, despite a 20 percent increase CT scans since 2006;

   • Drop of more than 50 percent for nuclear imaging scans, mainly due to fewer procedures begin performed;

   • A 15-20 percent decrease across X-ray imaging modalities.

Mahesh says this shows the impact of using "as low as reasonably achievable" (ALARA) principals, new dose guidelines outlined jointly by numerous medical societies, and dose reduction initiatives like Image Wisely, Image Gently, and the American College of radiology (ACR) Dose Index Registry.

He said there was growing concern a decade ago when the last council report was published, which show a steep increase in radiation dose. This was mainly due to a rapid increase in the use of computed tomography (CT) and other types of X-ray based and nuclear radiotracer medical imaging. This prompted the ACR top create the Image Wisely program and push for the use of more thoughtful imaging doses based on patient size, using the "as low as reasonably achievable” (ALARA) principle. While CT dose was lowered, he said the biggest decline was in nuclear imaging.

DAIC Editor Dave Fornell and Imaging Technology News (ITN) Consulting Editor Greg Freiherr offer a post-game report on the trends and technologies they saw on the expo floor of 2019 Radiological Society of North America (RSNA) annual meeting. This includes artificial intelligence (AI), augmented reality, holographic imaging, cybersecurity, and advances in digital radiography (DR) with a glassless detector plate, X-ray tomosynthesis, dual-energy X-ray and dynamic DR imaging. 

Find RSNA news and other videos

Piotr J. Slomka, Ph.D., FACC, research scientist in the Artificial Intelligence in Medicine Program, Department of Medicine at Cedars-Sinai, and professor of medicine in-residence of the David Geffen School of Medicine, UCLA. He explains how his team at Cedars-Sinai is working on intelligent patient risk prediction algorithms that will automatically extract information from medical imaging. He spoke on artificial intelligence (AI) development for medical imaging in sessions at the 2019 American Society of Nuclear Cardiology (ASNC) annual meeting. 

Find more articles and video on AI

Rupa Sanghani, M.D., FASNC, associate professor, Rush Medical College, director of nuclear cardiology and stress laboratory, Rush University Medical Center, and associate director, Rush Heart Center for Women, explains how to create a high-volume cardiac positron emission tomography (PET) imaging program. She spoke on this topic at the 2019 meeting of the American Society Nuclear Cardiology (ASNC) and led a tour for attendees of the PET-CT system at Rush, which was located close to the conference. 

Sanghani said the advantages of PET myocardial perfusion imaging include faster exam times and allowing additional information from coronary reserve flow assessments to better understand if revascularization will help a patient's heart recover. The 16-slice CT scanner is used not only to attenuate the PET images, but to perform a CT calcium scoring exam to assess the patient's risk for future cardiovascular events. The Rubidium-82 radiotracer used for PET exams only has a 75 second half life, so it can help increase the number of exams a center is able to perform each day. At higher volume centers, PET is optimized to handle all the patients who require pharmacological stress exams. 

In the video, Sanghani  outlines what Rush did to design its room, covers basics on training, what to look for in a scanner and other considerations when creating a PET program.

Read the article How to Start a Cardiac PET-CT Imaging Program, which includes more information from the Rush PET program.
 

Find more coverage of the ASNC

Find more news on nuclear imaging

Sunil Rao, M.D., chief of cardiology, Durham VA Health System and a professor at Duke University, and Prashant Kaul, M.D., director of the cath lab, Piedmont, Atlanta, discuss trends in radial access at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) annual meeting. They discuss how radial access adoption has grown rapidly in the past few years and now makes up between 40-50 percent of percutaneous coronary intervention (PCI) procedural volume in the United States. They also discuss recent clinical trial data and the new concept of using distal radial access. 

Related Radial Access Content:

SCAI Updates Expert Consensus Statement on Best Practices for Transradial Access

Transradial Access Celebrates 25 Years

VIDEO: History of Radial Artery Access — Interview with Ferdinand Kiemeneij, M.D.

Incorporating Distal Radial Artery Access Into Clinical Practice

VIDEO: New Frontiers in Radial Access — Interview with Mladen I. Vidovich, M.D.

Find more news and on transradial access technique and technology

Radial Access Adoption in the United States
 

Roxana Mehran, M.D., FACC, FACP, FCCP, FESC, FAHA, FSCAI, professor of medicine and director of interventional cardiovascular research and clinical trials at the Zena and Michael A. Wiener Cardiovascular Institute at Mount Sinai School of Medicine, explains the use of short dual antiplatelet therapy (DAPT) in minorities from the PLATINUM Diversity Trial. The first trial data was released in 2017, and she presented new data from the study at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. 

The study looked at use of the Promus Element Plus Post-Approval Study and the clinical impact of dual-antiplatelet therapy (DAPT) cessation within 12 months of drug-eluting stent implantation in caucasians and minorities. It is one of the first large trials to stress the importance of diversity in clinical trials, which tent to reflect a population of older white men.

Find more news and videos from TCT 2019

Vivian Ng, M.D., assistant professor of medicine and an interventional cardiologist at the NewYork-Presbyterian/Columbia University Medical Center Structural Heart and Valve Center, helped organize the first Women in Structural Heart (WISH) event at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. The evening session was standing room only and highlighted structural heart case presentations and discussion panels made up of all women. The session panelists and presenters were a whose-who of well known women in cardiology. The event was organized as a way to break the glass ceiling in the subspecialty of interventional cardiology, where women make up less than 5 percent of the operators.

Previous Video Interviews With Speakers and Panelists Involved in the WISH Session:

VIDEO: The Importance of the Neo-LVOT in Transcatheter Mitral Valve Replacement — Interview with Dee Dee Wang, M.D.

VIDEO: The Value of the Cardiovascular Service Line — Interview with Linda Gillam, M.D.,

VIDEO: Can We Live in 3-D Echo? — Interview with Lissa Sugeng, M.D.

VIDEO: Tricuspid Valve Imaging and Interventions Developing Hand-in-hand — Interview with Rebecca Hahn, M.D.

VIDEO: Strategies to Avoid Acute Kidney Injury Caused by Cath Lab Contrast — Interview with Roxana Mehran, M.D.,

Find more news and videos from TCT 2019

Roxana Mehran, M.D., FACC, FACP, FCCP, FESC, FAHA, FSCAI, professor of medicine and director of interventional cardiovascular research and clinical trials at the Zena and Michael A. Wiener Cardiovascular Institute at Mount Sinai School of Medicine, explains insights from the Ticagrelor With Asprin or Alone in High-Risk patients after Coronary Intervention (TWILGHT) Trial. She presented this late-breaking study at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. Here is a link to the article on the TWILIGHT Trial.

Related Short DAPT Content:

VIDEO: Overview of Short DAPT in High-risk Bleeding Patients Who Receive Stents — Interview with AHA President Robert Harrington, M.D. at TCT 2019 

Onyx ONE: A Randomized Trial of a Durable-Polymer Drug-Eluting Stent vs a Polymer-Free Drug-Coated Stent in Patients at High Risk of Bleeding Treated With 1-Month DAPT - TCT 2019 late-breaker

IDEAL-LM: A Randomized Trial of a Bioabsorbable Polymer DES With 4-Month DAPT vs a Durable Polymer DES With 12-Month DAPT in Patients With Left Main Coronary Artery Disease - TCT 2019 late-breaker 

EVOLVE Short DAPT: A Single Arm Study of 3-Month DAPT in Patients at High Bleeding Risk Treated a Bioabsorbable Polymer-Based Everolimus-Eluting Stent - TCT 2019 late-breaker 

New Directions and Trends in Coronary Metallic Stents

Questions Remain on DAPT Prolongation

Find more TCT late-breaking news and video

American Heart Association President Robert Harrington, M.D., interventional cardiologist and the Arthur L. Bloomfield Professor of Medicine and chairman of the Department of Medicine at Stanford University, explains the reasons for shorter duration dual-antiplatelet therapy (DAPT) in high-risk bleeding patients. Newer-generation drug-eluting stents are designed for faster vessel healing and endothelialization, so the time required for DAPT can be reduced from 12 months to a shorter time period. At the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting there were several late-breaking trials that looked at shorter duration DAPT or use of mono-therapy with ticagrelor. 

Related Short DAPT Content:

TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy vs Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing PCI - TCT 2019 late-breaker

Onyx ONE: A Randomized Trial of a Durable-Polymer Drug-Eluting Stent vs a Polymer-Free Drug-Coated Stent in Patients at High Risk of Bleeding Treated With 1-Month DAPT  - TCT 2019 late-breaker

IDEAL-LM: A Randomized Trial of a Bioabsorbable Polymer DES With 4-Month DAPT vs a Durable Polymer DES With 12-Month DAPT in Patients With Left Main Coronary Artery Disease - TCT 2019 late-breaker

EVOLVE Short DAPT: A Single Arm Study of 3-Month DAPT in Patients at High Bleeding Risk Treated a Bioabsorbable Polymer-Based Everolimus-Eluting Stent  - TCT 2019 late-breaker

There was a 77 percent increase in survival in cardiogenic shock patients treated using a new protocol in the National Cardiogenic Shock Initiative. The data was presented at the 2018 Transcatheter Cardiovascular Therapeutics (TCT) meeting. The details are discussed here with Babar Basir, D.O., and William O'Neill, M.D., from Henry Ford Hospital. 

Watch the related VIDEO: Overview of the National Cardiogenic Shock Initiative

Watch the related VIDEO: Support Protocols at Henry Ford Hospital

Additional articles and videos on Henry Ford Hospital 

(Editor's note - this video was originally published in September 2018 and was revised September 2019)

An example of Siemens' photo-realistic Cinematic image reconstruction. This image is from a CTA exam from a Siemens Force CT scanner. 

Vendors who offer this realistic type of CT image rendering say it is not used for diagnostics. However, the technology can be helpful when explaining things to the patient and their family, educating physicians and staff, and for surgeons, since it offers a realistic view of the anatomy that is easier for most people to understand who are not familiar with cardiac anatomy as it appears in traditional CT multiplanar reconstruction (MPR) images. 

This example of software was demonstrated on the expo floor at the 2019 Society of Cardiovascular Computed Tomography (SCCT) meeting. 

Find more news and videos from the SCCT meeting

This is an example of an automated calcium scoring software to speed review of coronary artery calcium (CAC) scoring cardiac computed tomography (CT) scans. This advanced visualization software from Ziosoft uses artificial intelligence to segment the coronary vessels, identify valves and the aorta and then color code tag the calcium deposits and quantify the amount of calcified plaque in each vessel. It tallies the score into a table and computes an overall Agatston risk score. This risk score correlates to that patient's risk for a heart attack in the future. The software notes calcium in the heart outside the coronaries in valve leaflets and the aorta, but excludes this data. This type of automation is now offered by most advanced visualization and CT system vendors. This automation can save a large amount of post-processing time and make it easier for hospitals to offer low-cost CAC CT screening programs. 

CAC scans can be used to determine if a patient needs to go on statin therapy. An Agatston score of zero means the patient has no risk of coronary disease. 

Calcium in arteries is a marker for damage caused by vessel wall inflammation from atherosclerosis. Calcium can form from previously ruptured necrotic, lipid core plaques, also referred to as vulnerable plaques. These are the types of plaque responsible for heart attacks. When the core of these plaques rupture, the blood reacts to the exposed core similar to a wound and begins to clot, forming a thrombus in the vessel, which can block the blood flow. When the vessel heals over time it calcifies, leaving behind an easily identifiable marker on CT imaging. 

This example of software was demonstrated on the expo floor at the 2019 Society of Cardiovascular Computed Tomography (SCCT) meeting. 

Related CT Calcium Scorining Content:

VIDEO: The History of CT Calcium Scoring — Interview with Arthur Agatston, M.D.

VIDEO: New Cholesterol Guidelines Support CT Calcium Scoring for Risk Assessment — Interview with Matthew Budoff, M.D.

CT Calcium Scoring Becoming a Key Risk Factor Assessment

ACC and AHA Release Updated Cholesterol Guidelines for 2018

VIDEO: CT Calcium Scoring to Screen For Who Should Take Statins — Interview with Matthew Budoff, M.D.

Nate Bachman, graduate research assistant in the Human Cardiovascular Physiology Lab of the Dept. of Health and Exercise Science at Colorado State University, describes how he and fellow researchers used multiple types of cardiac imaging to evaluate the cardiovascular health of athletes who compete in endurance events lasting six hours or more, and what the results may suggest for future screening.

Andrew Choi, M.D., FACC, FSCCT, co-director, cardiac CT and MRI, assistant professor of medicine and radiology, George Washington University, Division of Cardiology, Washington, D.C., explains the role of social media to extend the reach of cardiovascular research from peer review journals. He spoke on this topic in multiple sessions at the Society of Cardiovascular Computed Tomography (SCCT) 2019 meeting.

Find more SCCT news and videos

Joao Cavalcante, M.D., FSCCT, director of structural heart CT and cardiac MRI, Minneapolis Heart Institute, discusses transcatheter mitral valve replacement (TMVR) imaging requirements at the Society of Cardiovascular Computed Tomography (SCCT) 2019 meeting. SCCT held its first TMVR planning hands-on workshop, which he was involved in. TMVR is expanding with currently FDA cleared valve-in-valve (VIV) and valve-in-ring (VIR) procedures.

Related TMVR Content:

Interventional Imagers: The Conductors of the Heart Team Orchestra

VIDEO: The Importance of the Neo-LVOT in Transcatheter Mitral Valve Replacement  — Interview with Dee Dee Wang, M.D.

VIDEO: Transcatheter Structural Heart Procedure Navigation Technology Advances  — Interview with Stephen Little, M.D.

Recent Advances in Transcatheter Valve Technology

Abbott Begins Tendyne Transcatheter Mitral Valve U.S. Pivotal Trial

VIDEO: The Essentials of CT Transcatheter Valve Imaging — Interview with Jonathon Leipsic, M.D.,

New LAMPOON Technique Reduces LVOT Obstruction in Transcatheter Mitral Valve Replacement

Find more SCCT news and videos

Ron Blankstein, M.D., director of cardiac computed tomography, Brigham and Women's Hospital, and associate professor of medicine and radiology, Harvard Medical School, and current SCCT president, offers an overview of the recent trends in cardiac CT and some of the new highlights at the Society of Cardiovascular Computed Tomography (SCCT) 2019 meeting. The  said key topics included integration of artificial intelligence into CT systems, the integration of CT calcium scoring into the 2018 American Heart Association (AHA) cholesterol management guidelines, structural heart assessments for transcatheter valve and left atrial appendage (LAA) occlusion, and partner sessions with TCT and HRS that explain the roll of CT in interventional cardiology and electrophysiology.

Find more SCCT news and videos

This is an example of a cardiac echocardiography exam performed using an iPhone and the Butterfly IQ ultrasound transducer and app. The company is exhibiting at the American Society Of Echocardiography (ASE) 2019 meeting. This is the first “ultrasound system on a chip.” The Butterfly IQ ultrasound system consists of a transducer that connects to an iPhone or iPad to record ultrasound exams. The system has 18 different applications for specialized images, including cardiac imaging, vascular, lung, abdominal and others. The apps allow for quantification and offers many of the features of larger cart-based systems. The company is working on incorporating artificial intelligence technologies to automate some processes, such as auto ejection fractions.

This technology was picked as one of the big ultrasound advances in the VIDEO: 4 Recent Advances in Echocardiography Technology and in the VIDEO: Editor's Choice of the Most Innovative New Technology at RSNA 2018.

Federico Asch, M.D., FASE, director of cardiac imaging research and director of the cardiovascular imaging lab, MedStar Health Research Institute, Washington, D.C., spoke about the cardiovascular impact of chagas disease and the symptoms that should be considered for patients who are from, or visited, South or Central America. He spoke on the topic at the 2019 American Society Of Echocardiography (ASE) meeting.

Chagas, also called trypanosomiasis, is a tropical parasitic disease caused by the protist Trypanosoma cruzi. It is spread through the bite of the triatominae insect, which is also known as the "kissing bug." Link to the Center for Disease Control (CDC) page on Chagas.

Asch served as the co-chair of the group that created the guidelines to image Chagas disease.

Read the guidelines at "Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC).

Find more news and video from ASE 2019