pulseTV

VIDEO: Overview of Drug-coated Balloons

Drug-Eluting Balloons | September 09, 2020

Juan F. Granada, M.D., CEO of the Cardiovascular Research Foundation (CRF) worked on preclinical development work for a couple drug-eluting balloons (DEBs) and offers an overview on the technology. 

Granada also sheds some light on the biggest question regarding drug-coated balloons (DCBs) with the 2019 U.S. Food and Drug Administration warning that the devices might cause higher mortality, based on a December 2018 meta-analysis of trial data that showed an increased mortality signal. This was a big topic of discussion at TCT 2019 and again at SCAI in 2020 and more recent study data has shown there is no safety issue. 

The basic DCB technology is also discussed by Granada, who explains how the excipients used to carry to anti-proliferative drug on the balloon surface and the crystalline structure of the drug are key differentiators. He said these two elements are key in how much drug is delivered and the duration of its elution in the vessel wall.
 

Related Drug-eluting Balloon Content:

Recent Developments in Drug-Coated Balloons

Comparison Chart of Drug-eluting Balloons (requires login but is free to signup)

Positive Data for the Ranger Drug-coated Balloon and Eluvia Vascular Stent

LEVANT Trial Data Shows Safety of Drug-Coated Balloon Shown

Drug-coated Balloon Maintains Good Outcomes in 4-Year IN.PACT Global Study Data

No Difference Between Drug-coated Balloons and Plain Balloons After Laser Atherectomy

Philips Shares Three-Year Results for Stellarex .035 Drug-Coated Balloon

VIDEO: SCAI Prospective on Key Takeaways at TCT 2019 — Interview with Chandan Devireddy, M.D., including discussion of the LEVANT study results

Cath Lab

Drug-Eluting Balloons | September 09, 2020

Juan F. Granada, M.D., CEO of the Cardiovascular Research Foundation (CRF) worked on preclinical development work for a couple drug-eluting balloons (DEBs) and offers an overview on the technology. 

Granada also sheds some light on the biggest question regarding drug-coated balloons (DCBs) with the 2019 U.S. Food and Drug Administration warning that the devices might cause higher mortality, based on a December 2018 meta-analysis of trial data that showed an increased mortality signal. This was a big topic of discussion at TCT 2019 and again at SCAI in 2020 and more recent study data has shown there is no safety issue. 

The basic DCB technology is also discussed by Granada, who explains how the excipients used to carry to anti-proliferative drug on the balloon surface and the crystalline structure of the drug are key differentiators. He said these two elements are key in how much drug is delivered and the duration of its elution in the vessel wall.
 

Related Drug-eluting Balloon Content:

Recent Developments in Drug-Coated Balloons

Comparison Chart of Drug-eluting Balloons (requires login but is free to signup)

Positive Data for the Ranger Drug-coated Balloon and Eluvia Vascular Stent

LEVANT Trial Data Shows Safety of Drug-Coated Balloon Shown

Drug-coated Balloon Maintains Good Outcomes in 4-Year IN.PACT Global Study Data

No Difference Between Drug-coated Balloons and Plain Balloons After Laser Atherectomy

Philips Shares Three-Year Results for Stellarex .035 Drug-Coated Balloon

VIDEO: SCAI Prospective on Key Takeaways at TCT 2019 — Interview with Chandan Devireddy, M.D., including discussion of the LEVANT study results

Cardiac Imaging | August 12, 2020

Advanced visualization company Medis recently purchased Advanced Medical Imaging Development S.r.l. (AMID), which developed software to automatically track and measure strain in echocardiograms. That technology is now being adapted for strain imaging in CT and MRI. Using this imaging data, the software also can noninvasively derive pressure gradient loops and curves, similar to using invasive pulmonary arterial (PA) hemodynamic pressure catheters. This information is useful in monitoring critically ill patients on hemodynamic support and to monitor worsening severity of heart failure. 

The technology was discussed at the 2020 Society of Cardiovascular Computed Tomography (SCCT) virtual meeting. Examples of this technology are presented in this video. 
 

Find more news and video from SCCT 2020

VIDEO: Photon Counting Detectors Will be the Next Major Advance in Computed Tomography
 

TCT | August 01, 2020

With COVID-19 forcing all medical conferences to go virtual in 2020, Juan F. Granada, M.D., CEO of the Cardiovascular Research Foundation (CRF) explains how this year's Transcatheter Cardiovascular Therapeutics (TCT) 2020 meeting is being structured and some of the advantages of the virtual format. He also shares how the virtual format was actually very helpful at CRF's Transcatheter Valve Therapeutics (TVT) Structural Heart Summit earlier this summer.

Virtual cardiology meetings so far in 2020 have found the format enables much more participation by international physicians than in the past. TCT is using this idea to focus sessions aimed at Asia and Europe at different parts that correspond to the end of the work day in those parts of the world. Granada said U.S. focused sessions will take place toward the end of the day across the United States to accommodate more attendees during the sessions, since many will be attending after they are finished for the day, rather than take days off to attend.

Virtual Cardiology Meetings During COVID-19 Allowing More International Attendance

VIDEO: Insights Into How HRS Organized its Virtual Meeting — a discussion with Krahn after the HRS 2020 virtual meeting on lessons learned.

Left Atrial Appendage (LAA) Occluders | July 24, 2020

Devi G. Nair, M.D., FHRS, director of cardiac electrophysiology, St. Bernards Heart and Vascular Center, Jonesboro, Ark., was an investigator in the PINNACLE FLX clinical trial for the Boston Scientific Watchman FLX left atrial appendage (LAA) occluder device. 

The newest iteration of the Watchman was cleared by the U.S. Food and Drug Administration (FDA) in July 2020. Read more about the Watchman FLX 

The transcatheter implant is used in close the LAA, a pouch that forms part of the left atrium. The LAA is implicated in the formation of blood clots that cause stroke in patients with atrial fibrillation (AF). The Watchman FLX is indicated to reduce the risk of stroke in patients with non-valvular AF (NVAF) who need an alternative to oral anticoagulation therapy by permanently closing off the left atrial appendage.

Nair is currently involved with another trial of the Watchman FLX, OPTION FLX trial, which is examining the use of LAA occlusion in post-ablation patients.

Nair is also chairman for the Heart Rhythm Society (HRS) member engagement sub-committee and is a board member of the Arkansas chapter of the American College of Cardiology (ACC).
 

Watch Nair in this interview — VIDEO: Impact of COVID-19 on Electrophysiology Programs

 

Cardiogenic Shock | July 15, 2020

Navin Kapur, M.D., FAHA, FACC, FSCAI, director, Acute Mechanical Circulatory Support Program and executive director of The Cardiovascular Center for Research and Innovation (CVCRI), Tufts Medical Center, explains the research being done by the Cardiogenic Shock Working Group, which is headed by Tufts. 

The Cardiogenic Shock Working Group (CSWG) has created a patient registry now includes 15-20 centers in the United States and data on more than 2,000 patients who suffered shock either from heart failure or acute myocardial infarction (MI). It also includes hemodynamic data on more than 1,100 patients. It also includes all types of mechanical circulatory support devices, from intra-aortic balloon pump (IABP),  incrementally higher levels with a percutaneous Impella pump, TandemHeart, and extracorporeal membrane oxygenation (ECMO).

Research last year showed three types of phenotype profiles in cardiogenic shock patients, including non-congested, cardio-renal and cardio-renal-hepatic. Kapur also said there is evidence that there is venous involvement that needs to be considered in future research.

The large amount of variables in the patient data from the CSWG is partly examined by artificial intelligence (AI), which helped identify the three shock phenotype profiles.

 

 

Related Cardiogenic Shock and Hemodyanmic Support Content:

VIDEO: Door-to-Unloading (DTU) Trial May Change STEMI Care

VIDEO: Tufts Uses a Hemodynamic Support Algorithm to Determine What Devices to Use

VIDEO: Hemodynamic Support Protocols at Henry Ford Hospital

VIDEO: Cardiogenic Shock Initiative Continues to Reduce Mortality by 50 Percent

 

VIDEO: How to Reduce Cardiogenic Shock Mortality by 50 Percent

SCAI Releases New Consensus Document on Classification Stages of Cardiogenic Shock

Cardiogenic Shock Survival Rates Improve in Three Years Since Impella FDA Approval

VIDEO: The Importance of Ventricular Unloading in AMI and Cardiogenic Shock

 

VIDEO: Escalation of Support and Algorithms for Cardiogenic Shock

10 Reasons Why it is Time to Learn More About Cardiogenic Shock

New Approaches to Reduce Cardiogenic Shock Mortality

 

Find more content on Tufts Medical Center 

 

Cath Lab | July 15, 2020

Richard Botto, CVT, RCSA, chief cardiovascular technologist, division of cardiology, cardiac cath lab, offers an overview of the interventional catheterization laboratories at Tufts Medical Center in Boston. 

Botto also explains the latest hybrid cath lab completed in 2018. The state-of-the-art Cath Lab Room 3, licensed as a hybrid operating room, is used by Tufts interventionalists and surgeons to perform some of the most advanced therapeutic procedures, including transcatheter aortic valve replacement (TAVR), MitraClip mitral valve leaflet repairs and acute mechanical circulatory support procedures. Two babies also were delivered in this room due to extremely high-risk pregnancies. Tufts is the only facility in Boston to have a fully-functional operating room geographically located within the cardiac catheterization laboratory. 
 

Additional Videos From Tufts Medical Center:

VIDEO: Tufts Uses a Hemodynamic Support Algorithm to Determine What Devices to Use

VIDEO: Overview of the Structural Heart Program at Tufts Medical Center

VIDEO: Tufts Medical Center Spearheads Innovation With its Preclinical Cath Lab

VIDEO: Developing a Heart Failure Care Team

VIDEO: Overview of the TAVR Program at Tufts Medical Center

Additional videos and articles on Tufts Medical Center Channel

 

 

Cath Lab | July 13, 2020

The Vieussens’ arterial ring (VAR) is a connection between the conus artery and the left anterior descending (LAD) coronary artery’s proximal right ventricular branch. VAR is present in about 48 percent of the population as an embryonic conotruncal ring remnant. This ring can be exploited as an alternative coronary artery revascularization route in patients where this anatomy is present. Guidewires can be navigated from the right coronary artery through the conus to the LAD.

Jay Mohan, D.O., RPVI, interventional cardiology fellow at William Beaumont Hospital, Royal Oak, Michigan, created this video to briefly explain the use of the Vieussens’ arterial ring in interventional cardiology.  

Mohan is board certified in cardiology, internal medicine, echocardiography and nuclear cardiology. He also serves as vice president of the Dr. Ramesh Kumar Foundation

Mohan shares regular updates on Twitter about recent cardiology technology devices, takeaway points from conferences and short educational videos he produces. Follow or contact him via Twitter or Instagram at @cardiologyoncall.

 

Related Cardiovascular Educational Videos Created by Jay Mohan, D.O.:

VIDEO: The Latest Data on COVID-19 and Cardiovascular Disease

VIDEO: Creating a Home COVID-19 Decontamination Area for the Clinician

 

Hemodynamic Support Devices | June 05, 2020

This is a quick animation demonstrating how the new 9 French Abiomed Impella ECP expands to approximately 18 French and provides peak flows of 3.5 L/min. The device was approved for a U.S. FDA investigational device exemption (IDE) first-in-human trial in June 2020. Read more on the IDE. It uses a collapsible cannula instead of the fix size cannula used on the current generation of Impella devices. The design addresses issues with needing large bore vascular access and associated bleeding complications.

The Impella series of hemodynamic support devices from Abiomed are percutaneously delivered, catheter-based heart pumps that offer temporary ventricular assist support.  

 

Related Impella Video Content:

VIDEO: Demonstration of the Impella Percutaneous Hemodynamic Support Device

VIDEO: Door-to-Unloading (DTU) Trial May Change STEMI Care — Interview with Navin Kapur, M.D.

VIDEO: Hemodynamic Support Protocols at Henry Ford Hospital — Interview with William O'Neill, M.D.

VIDEO: Tufts Uses a Hemodynamic Support Algorithm to Determine What Devices to Use — Interview with Navin Kapur, M.D.

Photo Gallery of the Abiomed Impella Production Line

VIDEO: Justification for Hemodynamic Support in Complex PCI — Interview with Jeffrey J. Popma, M.D.

VIDEO: How to Reduce Cardiogenic Shock Mortality by 50 Percent — Interview with William O'Neill, M.D.

VIDEO: The Importance of Ventricular Unloading in AMI and Cardiogenic Shock — Interview with Navin Kapur, M.D.

VIDEO: Analysis of Outcomes for 15,259 U.S. Patients with AMICS Supported with the Impella Device — Interview with William O'Neill, M.D.

VIDEO: The Door-to-Unloading (DTU) STEMI Safety and Feasibility Trial — Interview with Navin Kapur, M.D.

VIDEO: Cardiogenic Shock Case with Impella CP Support — Case study with Michael Amponsah, M.D.

 

 

Coronavirus (COVID-19) | May 29, 2020

Jay Mohan, D.O., RPVI, interventional cardiology fellow at William Beaumont Hospital, Royal Oak, Michigan, created this video. It shows other clinicians how he set up his home COVID-19 decontamination area where he changes clothes, shoes and sterilizes before entering his house in order to protect his family. He has been involved with direct care of COVID-19 patients the past two months.

Since the start of the SAR-CoV-2 pandemic, clinicians and first-responders who are in contact with, or possible contact with, COVID-19 patients have developed ways to not bring and viral contamination home with them. This often includes on transition spot in the garage or designed room where they can change out of work clothing and shoes and into new clothing and shoes. Shoes and coats are separated into ones used for home and those dedicated for use at work only. Those who wear and reuse N95 masks also have developed ways to take the mask off by the straps only so they do not touch it and strapping it over a tupperware container that can then be sealed, or stored inside a disposable paper or plastic bag.

Mohan is board certified in cardiology, internal medicine, echocardiography and nuclear cardiology. He also serves as vice president of the Dr. Ramesh Kumar Foundation

Mohan shares regular updates on Twitter about recent cardiology technology devices, takeaway points from conferences and short educational videos he produces. Follow or contact him via Twitter or Instagram at @cardiologyoncall.

Watch a video animation he created — VIDEO: The Latest Data on COVID-19 and Cardiovascular Disease.
 

Find more cardiovascular related COVID-19 content

HRS | May 22, 2020

Interview with Andrew D. Krahn, M.D., FHRS, head of the division of cardiology at St. Paul’s Hospital, and professor of medicine at the University of British Columbia. He is also vice president of the Heart Rhythm Society (HRS). He moderated the late-breaking sessions at 2020 HRS virtual meeting and explains the highlights of the new technologies and data presented. 

Technologies include a nasal spray to stop supraventricular tachycardia, pulsed field ablation technology that may offer improvement over current technology, subcutaneous ICD (S-ICD) technology performing as well as traditional transvenous lead ICDs, contact force sensing ablation improves outcomes, use of smart watches to help atrial fibrillation patients adhere to oral anticoagulation therapy, and the first pacemaker to interface with the patient's smart phone.

Watch another interview with Krahn in the VIDEO: Insights Into How HRS Organized its Virtual Meeting.

Find a complete list of the Heart Rhythm 2020 meeting late-breaking studies with links to articles on each.

Find more news and video from the Heart Rhythm Society.
 

Coronavirus (COVID-19) | May 01, 2020

Thomas Maddox, M.D., MSc, FACC, the chair of the American College of Cardiology (ACC) Science and Quality Committee, explains concerns by ACC in a large drop in ST-elevation myocardial infarction (STEMI) heart attacks and strokes since the U.S. spread of COVID-19. 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.

The ACC is concerned about the 35-40 percent drop in STEMI and stroke patients presenting to emergency rooms across the U.S. and internationally since the start of the novel coronavirus (COVID-19, SARS-CoV-2) pandemic. Maddox is alarmed by the drop in cases and suspects patients are deciding to stay home rather than go to the hospitals out of fear about catching COVID-19. ACC launched a public relations campaign April 14, 2020, aimed at the public to get them to call 911 or go to hospitals if they have symptoms of stoke of a heart attack. Maddox said hospitals are still seeing and treating non-COVID-19 patients and the cardiovascular departments are still activating their cath labs to handle and acute cardiac cases that come in. 

He said Spain, which was hit earlier than the U.S. by the virus, saw a STEMI case decrease of about 40 percent. Based on limited U.S. data, he said U.S. cath lab activations are down about 35 percent. A clearer picture of the actual numbers of STEMI and other PCI cases will not be known from the ACC National Cardiovascular Data Registry (NCDR) until later this year, since most hospitals pull this data quarterly.

ACC is offering resources for the public  at www.cardiosmart.org/Coronavirus to evaluate their symptoms and help decide it they should go to the hospital or call 911.

Read the related article "Rapid Drop in Heart Attacks and Stroke at Hospitals Concerns ACC."

Watch another interview with Maddox in the VIDEO: What Cardiologists Need to Know about COVID-19.

 

Coronavirus (COVID-19) | April 22, 2020

Ehtisham Mahmud, M.D., FSCAI, president of the Society for Cardiovascular Angiography and Interventions (SCAI) and chief, Division of Cardiovascular Medicine at UC San Diego Medical Center, explains the SCAI precaution guidelines for treating patients in the cath lab under the COVID-19 pandemic.

He explains the how cardiology departments in the U.S. are operating to treat acute patients during novel coronavirus (COVID-19, SARS-CoV-2) containment efforts. 

The guidelines are outlined in the document "Considerations for Cardiac Catheterization Laboratory Procedures During the COVID‐19 Pandemic" can be accessed online in the SCAI journal Catheterization and Cardiovascular Interventions.[1]

 

Other Impact of COVID-19 on Cardiology Content:

How to Manage AMI Patients During the COVID-19 Pandemic

VIDEO: Impact of COVID-19 on the Interventional Cardiology Program at Henry Ford Hospital — Interview with William O'Neill, M.D.

VIDEO: 9 Cardiologists Share COVID-19 Takeaways From Across the U.S.

VIDEO: Multiple Cardiovascular Presentations of COVID-19 in New York — Interview with Justin Fried, M.D.

Image Gallery Showing Impact of the COVID-19 Pandemic

ACC COVID-19 Clinical Guidance For the Cardiovascular Care Team

VIDEO: COVID-19 Precautions for Cardiac Imaging — Interview with Stephen Bloom, M.D.

Rapid Drop in Heart Attacks and Stroke at Hospitals Concerns ACC 

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — an interview with SCCT President Ehtisham Mahmud, M.D.

VIDEO: Telemedicine in Cardiology and Medical Imaging During COVID-19 — Interview with Regina Druz, M.D.

The Cardiac Implications of Novel Coronavirus

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

Reference:

1. Molly Szerlip  Saif Anwaruddin  Herbert D. Aronow, et al. Considerations for Cardiac Catheterization Laboratory Procedures During the COVID‐19 Pandemic Perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates. Catheterization and Cardiovascular Interventions. First published:25 March 2020. https://doi.org/10.1002/ccd.28887.

 

Coronavirus (COVID-19) | April 17, 2020

DAIC Editor Dave Fornell has conducted numerous video interviews remotely from his home office in March and April 2020 with nine cardiologists from around the United States. After each interview he asked how COVID-19 has impacted their hospital and them personally. This video offers a candid overview of their thoughts in the fight against the novel coronavirus.

Each was interviewed for other videos and some of the comments used here were from a questions after the main interview on how novel coronavirus (COVID-19, SARS-CoV-2) is impacting them, their patients or their cardiology departments. 

Insights include the following doctors. Click on the names to see their videos from March and April 2020:

   • Thomas Maddox, M.D., Washington University School of Medicine, St. Louis
   • Ehtisham Mahmud, M.D., UC San Diego Medical Center
   • William O’Neill, M.D., Henry Ford Hospital, Detroit
   • Regina Druz, M.D., Integrative Cardiology Center of Long Island, N.Y.
   • Justin Fried, M.D., Columbia University Irving Medical Center, New York City
   • Hicham Skali, M.D., Brigham and Women’s Hospital, Boston
   • Stephen Bloom, M.D., FASNC, Midwest Heart and Vascular Associates, Overland Park, Kansas
   • Michael Mack, M.D., Baylor Scott and White, Dallas, Texas
   • Basel Ramlawi, M.D, Heart and Vascular Center at Valley Health System in Virginia

Find more videos and news on the impact of COVID-19 on cardiology

 

 

Coronavirus (COVID-19) | April 14, 2020

Ehtisham Mahmud, M.D., FSCAI, president of the Society for Cardiovascular Angiography and Interventions (SCAI) and chief, Division of Cardiovascular Medicine at UC San Diego Medical Center, explains the new American College of Cardiology (ACC) and SCAI precaution guidelines for treating transcatheter aortic valve replacement (TAVR) patients in the cath lab during the COVID-19 pandemic.

He explains recommendations for how structural heart programs can continue to treat acutely ill patients during novel coronavirus (COVID-19, SARS-CoV-2) containment efforts. The key message in the guidelines is to defer patients who can wait until containemnt efforts loosen in the coming months, while acute patients who are very sick should be treated.

The guidelines are outlined in the document "Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the Coronavirus Disease 2019 (COVID‐19) Pandemic: An ACC /SCAI Consensus Statement." can be accessed online in the SCAI journal Catheterization and Cardiovascular Interventions.[1]

 

Related COVID-19 Cardiology Content:

VIDEO: Impact of COVID-19 on the Cardiovascular Program at Henry Ford Hospital — Interview with William O’Neill, M.D.

First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

New York City Physicians Note Multiple Cardiovascular Presentations of COVID-19

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — Interview with Ehtisham Mahmud, M.D.

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

FDA Approves ECMO to Treat COVID-19 Patients

COVID-19 STEMI Registry Created to Study Acute Cardiovascular Effects of the Virus

Image Gallery Showing Impact of the COVID-19 Pandemic

VIDEO: Best Practices for Nuclear Cardiology During the COVID-19 Pandemic

The Cardiac Implications of Novel Coronavirus

 

 

Reference:

1. Pinak B. Shah, Frederick G.P. Welt, Ehtisham Mahmud, et al. Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the Coronavirus Disease 2019 (COVID‐19) Pandemic: An ACC /SCAI Consensus Statement. Catheterization and Cardiovascular Interventions. First published:06 April 2020 https://doi.org/10.1002/ccd.28910.

Coronavirus (COVID-19) | April 10, 2020

Detroit, Michigan, has been one the hardest hit regions with a large number of COVID-19 cases. William O’Neill, M.D., medical director of the Center for Structural Heart Disease at Henry Ford Hospital, explains the impact of novel coronavirus (COVID-19, SARS-CoV-2) on the cardiology program and his takeaways on COVID-19 cardiovascular involvement based on cases he has seen.

O'Neill said ST-elevated myocardial infarction (STEMI) cases have mysteriously dropped off significantly since quarantines began, a reflection of a nationwide trend. He also said he has not seen a lot of myocarditis or cardiogenic shock COVID-19 patients, except for a small handful. These conditions have been reported elsewhere in COVID-19 patients, but O'Neill said the patients he has seen die of COVID-19 usually have an onset of a cytokine storm, lose vascular integrity and then all their organs fail. He has not seen a primary cardiac component involved in most of the critically ill patients where hemodynamic support would have helped. 

 

Related COVID-19 Cardiology Content:

First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

New York City Physicians Note Multiple Cardiovascular Presentations of COVID-19

AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

FDA Approves ECMO to Treat COVID-19 Patients

COVID-19 STEMI Registry Created to Study Acute Cardiovascular Effects of the Virus

Image Gallery Showing Impact of the COVID-19 Pandemic

VIDEO: Best Practices for Nuclear Cardiology During the COVID-19 Pandemic

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — Interview with Ehtisham Mahmud, M.D.

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

 

 

Structural Heart | April 03, 2020

Basel Ramlawi, M.D., chairman of The Heart and Vascular Center at Valley Health System in Virginia, director of the Advanced Valve and Aortic Center, and co-principal investigator for an American College of Cardiology (ACC) 2020 Scientific Session late-breaking trial that looks at the clinical implications of TAVR in patients who have bicuspid aortic valve leaflets offers an overview of the data from ACC.20.

Patients with bicuspid, or two-leaflet, aortic valves who undergo transcatheter aortic valve replacement (TAVR) procedures had a high rate of success and low risk of death or disabling stroke at 30 days, according to new data presented at the ACC 2020. The session was part of the virtual, online late-breaking presentations, since the live meeting was cancelled due to the spread of COVID-19. 

TAVR has become increasingly popular in recent years as a less-invasive alternative to open-heart valve replacement surgery. However, few studies have examined its safety in patients with a bicuspid valve, a genetic variation of the aortic valve in some patients, rather than the typic three-leaflet valve. The condition affecting roughly 2-5 percent of people in which two of the three flaps in the aortic valve are fused together.

A bicuspid valve is more likely to become stenosis. Valve replacement, either through TAVR or open-heart surgery, is the main treatment option available for people with severe aortic stenosis, which causes fatigue and other symptoms and raises the risk of other heart problems when left untreated. The new study is the first to prospectively examine TAVR’s safety for treating severe aortic stenosis in relatively young, healthy patients—in whom open-heart surgery would pose a low risk—who have a bicuspid valve. It also is one of the first studies involving such patients in which doctors used a newer self-expanding artificial valve.

“This clearly has clinical implications with patients with bicuspid valves who want TAVR," said Basel Ramlawi, M.D., cardiothoracic surgeon at Valley Health System in Virginia and the study’s co-principal investigator. "TAVR with a self-expanding prosthesis is a very viable and safe procedure in low-risk bicuspid patients and achieved excellent early results. Though additional follow-up is necessary to determine long-term outcomes, early results suggest this procedure can be performed successfully in low-risk individuals with a good outcome.” 

The study prospectively tracked 150 patients who underwent TAVR at 25 medical centers in the U.S. 

Read the aricle on the study

 

Find more ACC news and video

 

 

Structural Heart | April 01, 2020

A review of the PARTNER 3 Low-Risk Trial with Michael Mack, M.D., chairman, cardiovascular service line,  Baylor Scott and White Health, Dallas Texas, chairman of the board of the BSW Health Research institute, Dallas, and co-principal investigator of the trial. The PARTNER 3 Low-Risk Trial two-year data were presented as a late-breaking study at the virtual American College of Cardiology (ACC) 2020 annual meeting. The trial offers additional evidence that TAVR performs as well as surgery in select low-risk patients. 

Mack said the trial included patients over the age of 65, and there is still a question about long-term durability of the Sapien 3 TAVR valve used in trial before it is used in younger patients. He said patients in this trial will be tracked out to 10 years, which will offer a lot of information on durability of the current iteration of this valve. In the video, he also elaborates on TAVR issues involved with bicuspid aortic valves and other patient selection issues.

PARTNER 3 enrolled 1,000 patients with severe aortic stenosis and a Society of Thoracic Surgeons (STS) risk score of less than 4 percent. All patients had a tricuspid aortic valve. Half of the participants were randomly assigned to undergo TAVR and half underwent surgery. At two years, 11.5 percent of patients receiving TAVR and 17.4 percent of those receiving surgery died, suffered a stroke or were rehospitalized for cardiovascular problems, a difference in the composite primary endpoint that researchers reported as showing non-inferiority, meaning neither treatment was superior to the other.

In a secondary analysis, rates of death and stroke were found to be not significantly different between the two groups. Death occurred in 2.4 percent of those receiving TAVR and 3.2 percent of those receiving surgery, while stroke occurred in 2.4 percent of those receiving TAVR and 3.6 percent of those receiving surgery. Rehospitalization rates showed a significant difference in favor of TAVR; 8.5 percent of those receiving TAVR and 12.5 percent of those receiving surgery were rehospitalized for cardiovascular reasons during the study period. 

Read more details about this trial 

Read the one year trial results from ACC 2019

Find other ACC news and videos
 

FFR Technologies | March 26, 2020

James Udelson, M.D., chief of the division of cardiology, Tufts Medical Center, explains how cardiac computed tomography (CT) scans are being used to create image-derived fractional flow reserve (FFR) values to determine if a coronary lesion is flow limiting. The FFR-CT can help determine if the patient needs a stent, or if the disease can be treated with medication. Tufts uses FFR-CT evaluations on non-emergency chest pain patients to reduce the need for diagnostic catheterizations. 

 

Related FFR-CT Content:

Image-based FFR May Replace Pressure Wires and Adenosine

New Technology Directions in Fractional Flow Reserve (FFR)

8 Cardiovascular Technologies to Watch in 2020

VIDEO: Using FFR-CT in Everyday Practice

FFR-CT is Ready for Prime-time Evaluation of Coronary Disease

6 Hot Topics in Interventional Cardiology at TCT 2019

FFR-CT: Is It Radiology or Cardiology?

 

Find more news and video from Tufts Medical Center

 

 

Structural Heart Occluders | March 24, 2020

Interview with Carey Kimmelstiel, M.D., FACP, FACC, director, cardiac catheterization laboratory, director, interventional cardiology, Tufts Medical Center, discusses the patent foramen ovale (PFO) closure program at Tufts.  

Tufts was the lead enrollment site in the Gore and Amplatzer PFO closure device trials. The center works very closely with neurology to select patients who might benefits from PFO closure to help prevent cryptogenic stroke and or migraine headaches. Tufts uses structural heart transcatheter occluders in various anatomical positions and in the left atrial appendage (LAA).

 

Related PFO Closure Content:

VIDEO: How Transcatheter PFO Closure Can Reduce Cryptogenic Stroke — Interview with John Rhodes, M.D.

SCAI Offers Recommendations for Safe Use of PFO Closure Technologies

VIDEO: An Overview of PFO Closure to Treat Cryptogenic Stroke — Interview with Karen Orjuela, M.D.

VIDEO: Demonstration of a Transcatheter PFO Occluder Implantation

VIDEO: Addressing Adult Congenital Heart Referrals — Interview with Ami Bhatt, M.D.

VIDEO: Transcatheter Closure of Holes in the Heart — Interview with Ziyad Hijazi, M.D.
 

Find more videos and content on the Tufts Medical Center

 

Coronavirus (COVID-19) | March 20, 2020

An interview with Ehtisham Mahmud, M.D., FSCAI, chief, Division of Cardiovascular Medicine, executive director of medicine, Cardiovascular Institute, director of  interventional cardiology and cardiac cath lab at UC San Diego Medical Center, and president of the Society for Cardiovascular Angiography and Interventions (SCAI). He explains the how cardiology departments in the U.S. are now postponing cardiovascular procedures due to novel coronavirus (COVID-19, SARS-CoV-2) containment efforts and new guidelines from Medicare calling for delay of all elective procedures in the country. 

Mahmud explains how patients are being prioritized, with acute myocardial infarction patients or others with acute, life-threatening conditions, or at high risk for a near term hospital admission, will still receive cardiac catheterizations, cardiovascular surgery or structural heart procedures for MitraClip and transcatheter aortic replacement (TAVR) under certain circumstances. All other procedures are being postponed until further notice based in the spread and infection rates of COVID-19. He said most hospitals, including his own, are moving to telehealth visits via phone or online to continue clinic work with patients, including those with chronic conditions such as heart failure.

The Centers for Medicare and Medicaid Services (CMS) announced March 18, 2020, that all elective surgeries, and non-essential medical, surgical and dental procedures should be delayed during the coronavirus outbreak. This move is three-fold. 
   1. It is to help with containment efforts by reducing patient and family travel to hospitals, which are at the center of the COVID-19 outbreak. 
   2. Delaying procedures will help preserve and inventory of personal protective equipment (PPE), hospital beds and ventilators and other medical supplies. 
   3. With the start of social distancing and the shut down of all large gatherings, this has severely impacted blood drives and other blood donations, so the nation's blood banks have severely limited supplies.

“The reality is clear and the stakes are high — we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

This will not only preserve equipment but also free up the healthcare workforce to care for the patients who are most in need. Additionally, as states and the nation as a whole work toward limiting the spread of COVID-19, healthcare providers should encourage patients to remain home, unless there is an emergency, to protect others while also limiting their exposure to the virus. 

Read Mahmud's SCAI President's letter The Evolving Pandemic of COVID-19 and Interventional Cardiology

 

Related Cardiology Related COVID-19 Content:

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

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

VIDEO: Imaging COVID-19 With Point-of-Care Ultrasound (POCUS)

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 

 

Additional COVID-19 Resources for Clinicians:

   ACC COVID-19 Hub page   

   Johns Hopkins Coronavirus Resource Center with inteavtive map of cases in U.S. and worldwide 

   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
 

 

Heart Failure | March 13, 2020

Interview with Navin Kapur, M.D., FAHA, FACC, FSCAI, executive director, The CardioVascular Center for Research and Innovation (CVCRI), and director of Cardiac Biology Research Center, Molecular Cardiology Research Institute (MCRI), Tufts Medical Center, Boston. He explains how temporary occlusion of the superior vena cava (SVC) appears to help reset the heart to normal function in heart failure patients. Kapur is currently involved in a trial using the PreCardia device pioneered at Tufts Medical Center.

Read more about the first late-breaking presentation of this technology at SCAI 2019 — Novel Therapeutic Approach Effective at Reducing Pressure for Heart Failure Patients
 

Find more videos and content on the Tufts Medical Center

Structural Heart | February 27, 2020

Charles D. Resor, M.D., MSc, assistant director, cardiac catheterization lab, Tufts Medical Center and assistant professor of medicine, Tufts University School of Medicine, explains the structural heart program at Tufts Medical Center. He outlines the centers' use of a variety of transcatheter interventional devices, including the MitraClip to repair mitral valve and tricuspid valve; occluders to seal congenital holes in the heart; PFO closure to prevent cryptogenic stroke; and the Watchman device to close the left atrial appendage (LAA) in atrial fibrillation patients.

 

VIDEO: Overview of the TAVR Program at Tufts Medical Center — Interview with Andrew Weintraub, M.D.

VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

 

Find more content on Tufts Medical Center

 

Tufts Medical Center | February 26, 2020

Lara Reyelt, veterinary technician and preclinical surgeon at the Interventional Research Laboratories (SIRL) at Tufts Medical Center, Boston, explains how research at her lab has helped advance human cardiovascular device technologies. 

Tufts Medical Center is unique in that it has a preclinical cath lab at the hospital, which allows for very close working relationships between the preclinical and the clinical teams, speeding up the collaboration and translational procedures. An example of this collaboration was the development of a new technique to treat congestive heart failure by temporarily occluding the SVC, which helps "reset" the heart. The lab also pioneered a novel approach now being used in the FDA DTU Trial to treat STEMI heart attacks with Impella hemodynamic support first, followed by 30 minutes of hemodynamic support prior to revascularizing the patient with percutaneous coronary intervention (PCI). The lab also performed preliminary work with the HeartMate PHP System to determine protocols for the now ongoing SHIELD II clinical trial. The lab also was used to test several new device technologies prior clinical trials, including the Impella 5.5 device. 

Find more videos and content on the Tufts Medical Center

 

Heart Valve Technology | February 18, 2020

Andrew Weintraub, M.D., FACC, associate director, of the Interventional Cardiology and Vascular Center, medical director of the Vascular and Structural Heart Center, Tufts Medical Center, discusses the use of temporary pacing in transcatheter aortic valve replacement (TAVR) patients. Implantation of TAVR valves can cause pressure from the valve against the septal wall of the heart, causing conduction delays. These delays do not necessarily mean the patient needs a permanent pacemaker.

Instead, Tufts Medical Center uses temporary pacing leads, a small catheter with two electrodes, placed in the right ventricle of the heart through a vein in the groin or neck. The lead is then connected to an external pacemaker allowing a physician to monitor and control a patient’s heart rate for up to several days.  The center uses the BioTrace Medical Tempo Lead, which incorporates a novel active fixation mechanism, bipolar electrodes and a soft tip. Stabilizers provide secure fixation and maintain stable pace capture. An elastomeric balloon may be inflated to aid passage of the lead through the venous vasculature and into the right ventricle, and  aids in wall apposition during deployment of the stabilizers. This design helps secure and stabilize the cardiac pacing lead with the goal of reducing complications and allowing patients to ambulate sooner after procedures.

 

Related Content:

VIDEO: Overview of the TAVR Program at Tufts Medical Center — Interview with Andrew Weintraub, M.D.

VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

VIDEO: Overview of the Structural Heart Program at Tufts Medical Center — Interview with Charles D. Resor, M.D.,

 

Find more content on Tufts Medical Center

 

 

 

Antiplatelet and Anticoagulation Therapies | February 18, 2020

Carey Kimmelstiel, M.D., FACP, FACC, director, interventional cardiology, director, cardiac catheterization lab, Tufts Medical Center, explains research on platelet inhibition agents used in the interventional lab. He discusses research and optimization of GP IIb IIIa inhibitors, changing protocols for tirofiban and the use of bivalirudin. 

Watch another interview with Kimmelstiel — VIDEO: Septal Ablation to Treat Hypertrophic Cardiomyopathy.
 

Find more content on Tufts Medical Center 

Heart Failure | February 10, 2020

Interview with James Udelson, M.D., chief of the division of cardiology at Tufts Medical Center, Boston. The hospital created a team of heart failure experts to work together to provide the best care options for patients to help improve outcomes.

The Tufts heart failure program offers various levels of hemodynamic support, up to left ventricular assist devices (LVAD) and heart transplants. The center is also using several cutting edge device technologies, including intra-atrial shunt device and controlling baroreceptors with a pacemaker type device. Tufts is also using devices in clinical trials, including a short term aortic pump to augment blood flow, and balloon occlusion of the superior venacava (SVC) to mitigate some heart failure symptoms. 

Find more content on Tufts Medical Center

Hemodynamic Support Devices | February 07, 2020

Interview with Navin Kapur, M.D., FAHA, FACC, FSCAI, executive director, The CardioVascular Center for Research and Innovation (CVCRI), director, Acute Mechanical Circulatory Support Program; director, interventional research laboratories; director of Cardiac Biology Research Center, Molecular Cardiology Research Institute (MCRI), Tufts Medical Center. He explains the Door-to-Unloading (DTU) Trial, which is using Impella hemodynamic support to unload the heart 30 minutes prior to percutaneous coronary intervention (PCI) in ST-elevated myocardial infarction (STEMI) patients. 

Data from a pilot trial and pre-clinical testing showed early hemodynamic support prior to PCI helps reduce or eliminate the ischemia and limits myocardial damage due to ischemia. It also appears to help reduce the no-reflow phenomenon, reperfusion injury that  occurs in some heart attack patients who are revascularized, but the restoration of blood flow does not immediately help the patient. The DTU Trial is investigating if immediate hemodynamic support improves outcomes in STEMI patients. If it does, this could be a paradigm shift in therapy for these patients.

 

Related Door-to-unloading Content:

FDA Approves Initiation of STEMI DTU Pivotal Randomized Controlled Trial

VIDEO: The Door-to-Unloading (DTU) STEMI Safety and Feasibility Trial — Interview Nevin Kapur, M.D.

VIDEO: The Importance of Ventricular Unloading in AMI and Cardiogenic Shock — Interview Nevin Kapur, M.D.

VIDEO: Tufts Uses a Hemodynamic Support Algorithm to Determine What Devices to Use — Interview Nevin Kapur, M.D.

VIDEO: Hemodynamic Support Protocols at Henry Ford Hospital — Interview with William O'Neill, M.D. 

Find more content on Tufts Medical Center 

 

Heart Valve Technology | January 28, 2020

Interview with Andrew Weintraub, M.D., FACC, associate director, of the Interventional Cardiology and Vascular Center, medical director of the Vascular and Structural Heart Center, Tufts Medical Center, and assistant professor of medicine, Tufts University School of Medicine. He explains the Tufts Medical Center transcatheter aortic valve replacement (TAVR) program.

Weintraub said TAVR usage has been increasing the past few years, and in 2019 the U.S. Food and Drug Administration (FDA) cleared the use of TAVR in all patient surgical risk categories, opening the procedure to all patients. He explained this will increase TAVR volumes in the coming years. 

Tufts Medical Center has been using the balloon-expandable Edwards Lifesciences Sapien valve for several years, but is plans to start using the self-expanding Medtronic Corevalve as well, because it may offer better outcomes in some types of patients. 

Learn how the pacemaker implant rate was reduced at Tufts Medical Center in the VIDEO: Use of a Temporary Pacing Lead in TAVR.

Watch the related VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

 

Find more content on Tufts Medical Center

 

Cath Lab | January 24, 2020

Interview with Carey Kimmelstiel, M.D., FACP, FACC, director, cardiac catheterization laboratory, director, interventional cardiology, Tufts Medical Center, and professor of medicine at Tufts University School of Medicine. He explains how septal ablation is used to treat hypertrophic cardiomyopathy (HCM). The Tufts Medical Center HCM program is the largest in New England. 

Tufts Medical Center performs septal ablation to treat medication-refractory HCM. They use a heart team approach to determine which patients are best served by surgical septal myectomy or alcohol septal ablation.

When drug treatments are ineffective, the center offers several procedures to treat HCM:
   
   • Implantable cardioverter defibrillators (ICDs) to prevent sudden cardiac death in high risk patients. 

   • Surgical septal myectomy for patients who experience significant limitation during physical activity and are unresponsive to medical drug treatment. This operation may be performed along with the Maze procedure to lessen the chances of recurrent atrial fibrillation.

   • Alcohol septal ablation for patients who are generally not ideal candidates for the myectomy operation. This procedure takes place in the catheterization laboratory without general anesthesia, and mimics the beneficial effects of surgery. 

   • Ablation for recurrent atrial fibrillation performed in the catheterization laboratory to lessen the likelihood for additional episodes.

   • Heart transplant for the some patients without obstruction who experience severe symptoms and are unresponsive to drug treatment.

 

Find more content on Tufts Medical Center 

 

 

 

Hemodynamic Support Devices | January 24, 2020

Navin Kapur, M.D., FAHA, FACC, FSCAI, director, Acute Mechanical Circulatory Support Program and executive director of The CardioVascular Center for Research and Innovation (CVCRI), Tufts Medical Center, explains how Tufts determines the level of hemodynamic support a patient needs. They use an algorithm to determine if low levels of support are needed with an intra-aortic balloon pump (IABP), or incrementally high levels with a percutaneous Impella pump, TandemHeart, extracorporeal membrane oxygenation (ECMO), or a surgically implanted ventricular assist device (VAD).


Related Cardiogenic Shock and Hemodyanmic Support Content:

VIDEO: Door-to-Unloading (DTU) Trial May Change STEMI Care

VIDEO: Tufts Uses a Hemodynamic Support Algorithm to Determine What Devices to Use

VIDEO: Hemodynamic Support Protocols at Henry Ford Hospital

VIDEO: Cardiogenic Shock Initiative Continues to Reduce Mortality by 50 Percent

 

VIDEO: How to Reduce Cardiogenic Shock Mortality by 50 Percent

SCAI Releases New Consensus Document on Classification Stages of Cardiogenic Shock

Cardiogenic Shock Survival Rates Improve in Three Years Since Impella FDA Approval

VIDEO: The Importance of Ventricular Unloading in AMI and Cardiogenic Shock

 

VIDEO: Escalation of Support and Algorithms for Cardiogenic Shock

10 Reasons Why it is Time to Learn More About Cardiogenic Shock

New Approaches to Reduce Cardiogenic Shock Mortality

 

Find more content on Tufts Medical Center 

Robotic Systems | January 20, 2020

This video shows the first robotic percutaneous coronary interventions (PCI) performed in Germany with the Robocath R-One robotic catheter guidance system. The first procedures were performed by Professor Michael Haude, director of Medical Clinic I at Rheinland Klinikum Neuss Lukaskrankenhaus, and his team. read more in the article First Robotic Coronary Angioplasties Performed With Robocath System in Germany.

 

Related Robocath Content:

Robocath Successfully Carries Out First Robotic Coronary Angioplasties in Humans

Robocath Receives $1.5 Million in Capital for Advancement of R-One Robotic System 

 

Cath Lab | January 09, 2020

Haval Chweich, M.D., medical director of the cardiac critical care unit (CCU) at Tufts Medical Center, and assistant professor at Tufts University School of Medicine, explains the role of intensivists on the cardiac care team. 

Chweich is an intensivist specialized in pulmonary and critical care. He interfaces with Tuft's cardiac surgeons and interventional cardiologists to care for patients as they transition after procedures into the CCU. He also plays a key role as part of the team caring for cardiogenic shock patients. 

Find VIDEOS and articles on Tufts cardiology program

Hemodynamic Support Devices | January 09, 2020

Richard Botto, CVT, RCSA, chief cardiovascular technologist, division of cardiology, cardiac cath lab, and Melissa Smith, RT, at Tufts Medical Center, Boston, explain the use of technology to remotely access data and waveforms on patients' temporary hemodynamic support system control consoles. 

Tufts Medical Center was one of the first hospitals to begin using the Abiomed Impella Connect technology, which enables remote smartphone access to Impella consoles. This allows a quick, remote check on patients using temporary hemodynamic support. The technology also is connected to a support center at Abiomed, so if a console or patient is experiencing issues out of the ordinary, techs can remote into the patient's Impella control console to take a look. Tuft's intensivists in the cardiac care unit (CCU) use the app to check on their patients' consoles without needing to walk into each room. 

Find VIDEOS and articles on Tufts cardiology program

 

Radiation Dose Management | December 19, 2019

 

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.

 

 

RSNA | December 18, 2019

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

Radial Access | October 22, 2019

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
 

 

Vascular Closure Devices | October 17, 2019

Ashish Pershad, M.D., chief of interventional cardiology, Banner University Medical Center, Phoenix, explains the trend of using closure devices to seal larger vascular access sites from the use of TAVR, EVAR, TMVR and hemodynamic support devices at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. He was one of the moderators on a session on this topic at TCT 2019.

 

Related Large Bore Vascular Closure Device Content:

VIDEO: How to Achieve Hemostasis With Large Bore Device Access — Interview with Philippe Genereux, M.D.

First-in-Human Results Show Early Bird Device Effective in Early Detection of Internal Bleeding

Advances and Trends in Vascular Closure Devices

Manta Large-Bore Vascular Closure Device Cleared by the FDA

PerQseal Large Bore Closure Device Launches in Europe

Teleflex Acquires Essential Medical

 

Related Content With Dr. Pershad:

National Coverage Determination Will Make TAVR Available to More Patients at More Centers

VIDEO: Comparison Between Watchman vs. Amulet LAA Occluders
 

Antiplatelet and Anticoagulation Therapies | October 17, 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 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

Hemodynamic Support Devices | October 16, 2019

Jeffrey J. Popma, M.D., director of interventional cardiology clinical services at Beth Israel Deaconess Medical Center, professor of medicine at Harvard Medical School, explains the results of the PROTECT II and the new PROTECT III Study at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. PROTECT III is the follow up to PROTECT II RCT and the largest-ever FDA study of hemodynamically supported, high-risk PCI patients. 

He discusses the PROTECT II and PROTECT III studies, and real-life patient data from the Impella IQ Database. 

 

Find more news and videos from TCT 2019

Structural Heart | October 16, 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