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VIDEO: Why QT-prolongation Occurs in COVID-19 Patients on Hydroxychloroquine and Azithromycin

Coronavirus (COVID-19) | May 28, 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, and vice president of the Heart Rhythm Society (HRS). He is an expert in long QT syndrome (LQTS) and is involved with the National Long QT Registry. He explains the issues with the drugs being used to treat coronavirus (COVID-19, SARS-CoV-2) patients and why these combined with the cardiac impact of the virus is causing prolonged ECG QT segment prolongation, leading to deadly arrhythmias. COVID-19 can cause myocarditis that causes QT prolongation and the front-line COVID drugs hydroxychloroquine and azithromycin also cause QT prolongation.

The U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication April 23, 2020, reminding doctors there are serious side effects when using hydroxychloroquine and chloroquine in the off-label use to treat COVID-19 patients. This includes potentially life-threatening heart rhythm problems. The FDA said case reports from the FDA Adverse Event Reporting System database, published medical literature and the American Association of Poison Control Centers National Poison Data System are reporting serious heart-related adverse events and patient deaths. Read more about this alert.

The FDA warning confirmed fears from the American Heart Association (AHA), the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS). These societies April 8 jointly published a new guidance, “Considerations for Drug Interactions on QTc in Exploratory COVID-19 (Coronavirus Disease 19) Treatment,” to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19. The societies warned that use of  these agents in a large number of patients in combination would results in arrhythmias and deaths. Read more.

However, there are numerous advocates that argue hydroxychloroquine needs to be used in less sick patients who are not already hypoxic to treat COVID, but it is being used primarily in very sick patients where it is not effective. Advocates also argue the drug can be used to help prevent coronavirus, similar to the drug's effect in preventing malaria. In terms of drug safety, advocates argue the drug has been used in millions of patients for more than 50 years without a high risk of arrhythmias. Several trials are now underway in the United States to test its use against COVID-19, but enrollment has been hampered because of the FDA warning. There will likely be more interest in hydroxychloroquine after it was revealed May 18, 2020, that President Trump is taking the drug for prophylaxis against COVID-19.

 

Related Hydroxychloroquine Content:

FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine for COVID-19

WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

VIDEO: Overview of Hydroxychloroquine and FDA Warning in its use to Treat COVID-19 — Interview with Marianne Pop, Pharm.D.

WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

COVID-19 Hydroxychloroquine Treatment Brings Prolonged QT Arrhythmia Issues

 

FDA Reports of Deaths and Injuries From Use of Antimalarial hydroxychloroquine in COVID-19 Patients

VIDEO: Cardiologists Manage Trial Testing if Hydroxychloroquine Protects Clinicians From COVID-19 — Interview with William O'Neill, M.D.

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

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

Conference Coverage

Coronavirus (COVID-19) | May 28, 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, and vice president of the Heart Rhythm Society (HRS). He is an expert in long QT syndrome (LQTS) and is involved with the National Long QT Registry. He explains the issues with the drugs being used to treat coronavirus (COVID-19, SARS-CoV-2) patients and why these combined with the cardiac impact of the virus is causing prolonged ECG QT segment prolongation, leading to deadly arrhythmias. COVID-19 can cause myocarditis that causes QT prolongation and the front-line COVID drugs hydroxychloroquine and azithromycin also cause QT prolongation.

The U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication April 23, 2020, reminding doctors there are serious side effects when using hydroxychloroquine and chloroquine in the off-label use to treat COVID-19 patients. This includes potentially life-threatening heart rhythm problems. The FDA said case reports from the FDA Adverse Event Reporting System database, published medical literature and the American Association of Poison Control Centers National Poison Data System are reporting serious heart-related adverse events and patient deaths. Read more about this alert.

The FDA warning confirmed fears from the American Heart Association (AHA), the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS). These societies April 8 jointly published a new guidance, “Considerations for Drug Interactions on QTc in Exploratory COVID-19 (Coronavirus Disease 19) Treatment,” to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19. The societies warned that use of  these agents in a large number of patients in combination would results in arrhythmias and deaths. Read more.

However, there are numerous advocates that argue hydroxychloroquine needs to be used in less sick patients who are not already hypoxic to treat COVID, but it is being used primarily in very sick patients where it is not effective. Advocates also argue the drug can be used to help prevent coronavirus, similar to the drug's effect in preventing malaria. In terms of drug safety, advocates argue the drug has been used in millions of patients for more than 50 years without a high risk of arrhythmias. Several trials are now underway in the United States to test its use against COVID-19, but enrollment has been hampered because of the FDA warning. There will likely be more interest in hydroxychloroquine after it was revealed May 18, 2020, that President Trump is taking the drug for prophylaxis against COVID-19.

 

Related Hydroxychloroquine Content:

FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine for COVID-19

WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

VIDEO: Overview of Hydroxychloroquine and FDA Warning in its use to Treat COVID-19 — Interview with Marianne Pop, Pharm.D.

WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

COVID-19 Hydroxychloroquine Treatment Brings Prolonged QT Arrhythmia Issues

 

FDA Reports of Deaths and Injuries From Use of Antimalarial hydroxychloroquine in COVID-19 Patients

VIDEO: Cardiologists Manage Trial Testing if Hydroxychloroquine Protects Clinicians From COVID-19 — Interview with William O'Neill, M.D.

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

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

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.
 

Cardiovascular Education | May 22, 2020

Andrew D. Krahn, M.D., FHRS, head of the division of cardiology at St. Paul’s Hospital, professor of medicine  at the University of British Columbia and vice president of the Heart Rhythm Society (HRS), explains how HRS organized its virtual meeting after its in-person meeting was cancelled by the COVID-19 pandemic.  

Due to the continued global escalation of the novel coronavirus (COVID-19, SARS-CoV-2), HRS has cancelled its large annual in-person electrophysiology meeting in late-March and began planning for a virtual meeting instead. HRS broke its annual meeting into three online learning sessions over the course of May June and July. The first, which included the late-breaking sessions, was held May 5-9, 2020. Others will be held June 12 and July 1.

Using its online learning platform, Heart Rhythm 365 available on the www.hrsonline.org website, HRS is offering all its sessions at no cost.

Watch another interview with Krahn in the VIDEO: Top New EP Technologies at Heart Rhythm Society 2020.
 

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

 

Coronavirus (COVID-19) | May 07, 2020

Interview with Geoffrey Rose, M.D., president of Sanger Heart and Vascular Institute with Atrium Health, in Charlotte, North Carolina, and a board member with the American Society of Echocardiography (ASE). He explains the impact of COVID-19 (SARS-CoV-2) on the cardiovascular service line and cardiac imaging. He said the virus has led to use of computed tomography (CT) not only as the frontline cardiovascular imaging modality to evaluate chest pain, but also for COVID-19 pneumonia imaging.

Rose said cardiac ultrasound is still used, but requires full personal protective equipment (PPE) and often abbreviated exams because of the close proximity of the sonographer and patient when performing echocardiograms. This has given rise to using dedicated point-of-care ultrasound (POCUS) systems to answer specific clinical questions quickly. Smart-phone based POCUS systems that use an app and a transducer plugged into the phone enable basic echo exams or evaluation of other parts of the anatomy quickly without the need to immediately sterilize an entire cart-based ultrasound system. These small systems also can be completely enclosed inside a transducer sheath and the phone and single transducer are much easier and faster to wipe down. He said the quality of the exams are not as good as fully enabled echocardiography systems, but it allows for quick assessments of ejection fractions and to triage if the patient needs more advanced imaging if the basic questions cannot be answered.

Since hospitals have shut down now for about two months, postponing normal checkups, and elective exams and procedures, Rose said doctors still need to visit with patients who have chronic conditions. Sanger and Atrium Heath modified its ambulatory electronic medical record (EMR) and is using video conferencing to perform virtual appointments now for the majority of these patients. He said telemedicine was not widely used before COVID-19 in his hospital system, but the pandemic will likely alter the care model for the future, with more telemedicine visits being used even after epidemic is over. He said use of POCUS and CT as frontline cardiac imaging modalities will also likely remain in place after the pandemic because of the efficiencies in care these technologies offer.

 

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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.

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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.

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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 18, 2020

Stephen Bloom, M.D., FASNC, director of nonivasive cardiology (cardiac CT, nuclear cardiology and echocardiography) at Midwest Heart and Vascular Associates, Overland Park, Kansas. He is also a member of the American Society of Nuclear Cardiology (ASNC) Board of Directors, explains some of the issues involved and protocols used for cardiac imaging during the COVID-19 pandemic. His discussion includes computed tomography, cardiac ultrasound and nuclear imaging.

Right now, Bloom said it is difficult to test everybody and there is a shortage of masks, gowns and other personal protective equipment (PPE), and the imaging equipment needs to be sanitized each time it is used. He said it is just is not possible to image all the patients who need imaging right now. Hospitals also are trying to limit the number of healthy people people coming into hospitals for routine visits and tests to reduce their potential exposure to the novel coronavirus (COVID-19, SARS-CoV-2) and help containment efforts. 

"The tests should be done, very simply, if it changes the care of the patient. If it doesn't change the care of the patient, and it can be postponed, it should be postponed," Bloom explained. "I would say 80 percent of our cardiac imaging exams have stopped. It has been very dramatic."

 

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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]

 

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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 04, 2020

Hicham Skali, M.D., a staff cardiologist and member of the Non-invasive Cardiovascular Imaging Program at Brigham and Women’s Hospital (BWH), and at Brigham and Women’s / Massachusetts General Health Care Center at Foxborough, explains the new recommendations from the American Society of Nuclear Cardiology (ASNC) and from imagers in China and Singapore. The ASNC created a best practices document for nuclear cardiology laboratories during the novel coronavirus (COVID-19, SARS-CoV-2) pandemic. The suggestions in the guidelines can ally to any imaging modality, including computed tomography (CT), MRI and ultrasound. 

Skali elaborates on the following points in his discussion, which are specific recommendations in the ASNC and SNMMI COVID-19 guidance document:
   • Rescheduling non-urgent visits
   • Rescheduling elective surgeries and procedures
   • Using separate spaces for patients with known or suspected COVID-19 to prevent spread
   • Ensuring supplies are available
   • Promoting use of telehealth
   • Screen staff, patients and visitors before they enter the department
   • Minimize non-essential visitors into the department
   • Record symptoms at the start of the shift
   • Use personal protective equipment (PPE)for healthcare personnel
   • If available, use PPE for patients due to concern of asymptomatic transmission of COVID-19
   • Maintain strict hand hygiene
   • Maintain 6 feet distance in all patient/staff interactions when possible
   • Work remotely whenever feasible, especially with ready studies
   • Rotating staff schedules for on-site and off-site work
   • Use of rest only studies if possible
   • Use of half-time SPECT to speed exam times
   • Use of PET if available to speed exam times

Skali served as the moderator in for the ASNC on demand webinar COVID-19 Preparedness for Nuclear Cardiology Labs: Insights from the US, China and Singapore.

VIDEO: Telemedicine in Cardiology and Medical Imaging During COVID-19 — Interview with Regina Druz, M.D., an ASNC Board member and also a speaker during the ASNC webinar.

Find more news and video on relating to COVID-19 and its impact on cardiology

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
 

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

 

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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
 

 

Coronavirus (COVID-19) | March 17, 2020

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 

RSNA | January 13, 2020

DAIC/ITN Editor Dave Fornell takes a tour of some of the most innovative new medical imaging technologies displayed on the expo floor at the Radiological Society of North America (RSNA) 2019 meeting. 

Technology examples include a robotic arm to perform remote ultrasound exams, integration of artificial intelligence (AI) to speed or automate radiology workflow, holographic medical imaging display screens, a new glassless digital radiography (DR) X-ray detector, augmented reality for transesophageal echo (TEE) training, moving DR X-ray images, 3-D printed surgical implants created from a patient's CT imaging, DR X-ray tomosynthesis datasets, radiation dose management and analytics software, and new computed tomography (CT) technologies.

 

Find more videos and news from RSNA 2019

 

Magnetic Resonance Imaging (MRI) | January 06, 2020

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

VIDEO: Dedicated Cardiac MRI Use at the Baylor Scott White Heart Hospital

Advantages and New Applications of Cardiac MRI

Will Cardiac MRI Expand?

 

Magnetic Resonance Imaging (MRI) | December 20, 2019

James Carr, M.D., chair of the Department of Radiology, Northwestern University, and incoming 2020 President of the Society of Cardiac Magnetic Resonance (SCMR), explains why MRI is an ideal cardiac imaging modality, at the 2019 Radiological Society of North America (RSNA) meeting.

Heart MRI offers advantages over computed tomography (CT) and echocardiography because of its excellent soft tissue delineation and its ability to offer information beyond anatomical imaging, such as perfusion, morphology and metabolism. MRI can be technically challenging and the exams requiring a long time, but recent advances have helped cur cardiac imaging times down significantly. Automation and artificial intelligence (AI) also is making post-processing and quantification mush faster, brining it closer to the time it takes to scan and post-process CT imaging.

Northwestern is was one of the early adopters of cardiovascular MRI. Carr said heart MRI was not common in regular clinical use until the past decade at some luminary centers. In 2005, Carr was given the opportunity to develop a clinical cardiac MRI program at Northwestern.
 
He said MRI scanners have improved, and now much faster than a decade ago. They are also more optimized for cardiac imaging. While heart MRI is well known in large hospital centers, Carr said it still needs to develop and expand to community hospitals and rural hospitals outside major population centers. 

Artificial intelligence is playing a significant role in cardiac MRI automation of speeding workflow and quantification. Carr said these technologies will become mainstream in the next few years. AI also will play an increasing role in risk prediction based on new image analysis algorithms in development.

For more information on cardiac MRI, visit SCMR's website www.heartmri.org.

 

Related Cardiac MRI Content:

Cardiac MRI Delivers Accurate Diagnosis for Frontline Chest Pain Evaluation

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

VIDEO: Dedicated Cardiac MRI Use at the Baylor Scott White Heart Hospital — Interview with Haojie Wang, M.D.

VIDEO: Dedicated Cardiac MRI Use at the Baylor Scott White Heart Hospital

Advantages and New Applications of Cardiac MRI

Will Cardiac MRI Expand?

VIDEO: Use of Cardiac MRI in Congenital and Women's Heart Disease — Karen Ordovas, M.D., 
 

 

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.

 

 

Cardiovascular Ultrasound | December 19, 2019

This is an example of an augmented reality (AR) training system for transesophageal echo (TEE) created by the simulation company CAE. Rather than just looking at an overhead screen, this system allows the user to use a HoloLens visor to see the impact their probe manipulation has on the imaging and better shows the orientation of the ultrasound probe, the 2-D ultrasound image slice and the relation to the anatomy. It was displayed at the 2019 Radiological Society Of North America (RSNA) meeting.

Read more about this technology.

Find more technology news and video from the RSNA meeting

 

 

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

Nuclear Imaging | November 07, 2019

Rob Beanlands, M.D., FASNC, 2019 American Society of Nuclear Cardiology (ASNC) president, shares a couple trends he sees in cardiac nuclear imaging. He is the Vered Chair and division head of cardiology and director of the National Cardiac PET Centre at the University of Ottawa Heart Institute, Canada.

He said overall trends he sees in nuclear cardiology include the use of better myocardial reserve quantification so it is clear whether revascularization would help patients. Beanlands also said there is increasing interest in positron emission tomography (PET) imaging because of its superior image quality and increasing access to PET radiotracers. New tracers on the horizon will also increase the image quality and flexibility of PET to accommodate exercise stress.

He spoke on artificial intelligence (AI) development for medical imaging in sessions at the 2019 American Society of Nuclear Cardiology (ASNC) annual meeting. 

Artificial Intelligence | November 07, 2019

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

 

Nuclear Imaging | November 06, 2019

Robert C. Hendel, M.D., explains some of the new cardiac radiotracers in the pipeline that were discussed in sessions at the American Society of Nuclear Cardiology (ASNC) 2019 meeting. Hendel is a professor of medicine and radiology and the Sidney W. And Marilyn S. Lassen Chair in Cardiovascular Medicine, Tulane University. He also serves as the chief of the section of cardiology and director of the Tulane University Heart and Vascular Institute. 

He outlined three new radiotracers that may impact cardiac imaging:

   • Flurpiridaz F-18 PET perfusion agent that offers high quality images and can be used with exercise stress;

   • MIBG imaging to help better assess heart failure classes and if patients may need an ICD;

   • New F-18 agents to image cardiac amyloidosis; and

   • Nuclear agents to enable annexin imaging, allowing direct vsualization of myocardial apoptotic cells.

 

PET-CT | October 30, 2019

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

 

 

Cardiac Diagnostics | October 29, 2019

Clyde Yancy, M.D., MSc, cardiology chief and vice dean for diversity and inclusion at Northwestern University, Feinberg School of Medicine, was a keynote speaker at the 2019 American Society of Nuclear Cardiology (ASNC) annual meeting. He said the traditional biases of seeing a patient and automatically making clinical assumptions because they are a certain race or gender are obsolete. For example, he said not all black patients have hypertension. Yancy added that genetics, especially with racial intermarriage over the past several generations, no longer predisposes patients to what is typically assumed for certain ethnic or racial backgrounds.

Yancy also said new research is showing how diet plays a major role in patient health and disease progression for things previously thought to be based on genetics. This includes the people who live in "food deserts" in urban areas where there are no sources of fresh food and vegetables, so they consume large amounts of packaged and processed foods that contain high levels of salt, phosphates and preservatives. He said these chemicals and diet may be the root cause of hypertension and diabetes in black populations in low income areas, rather than genetics as previously thought.

 

Related Content: 

VIDEO: Reducing Hypertension Among African-Americans — Interview with Kim Allan Williams, Sr., M.D.

VIDEO: Use of Plant-Based Diet to Reduce Cardiovascular Disease Risk — Interview with Kim Allan Williams, Sr., M.D.

VIDEO: New PLATINUM Diversity Data Shows Early DAPT Cessation OK in Minorities With New Generation Stent — Interview with Roxana Mehran, M.D., 

 

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

Antiplatelet and Anticoagulation Therapies | October 11, 2019

Ajay J. Kirtane, M.D., associate professor of medicine at Columbia University Irving Medical Center and director of the cardiac catheterization laboratories at NewYork-Presbyterian (NYP) Hospital, shares the findings of the late-breaking EVOLVE Short DAPT study presented as a late-breaking trial at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. It evaluated the safety of early dual antiplatelet therapy (DAPT) discontinuation in patients with high bleeding risk treated with the a Boston Scientific Synergy bioabsorbable polymer coated drug-eluting stent (DES).

With the advancement of new DES technologies using thinner struts and new types of drug-carrier polymer techniques, the risk of late-stent thrombosis has been greatly reduced, meaning there is less need for long-term DAPT. For patients who are at high risk for bleeding, who have ulcers or other types of gastrointestinal (GI) bleeding, or those going into surgery, it would be beneficial to reduce the time period for DAPT, and several late-breaking trials examined this at TCT 2019.
 

Here are the other late-breaking DAPT studies:

 

Find more news and videos from TCT 2019

Antiplatelet and Anticoagulation Therapies | October 10, 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

Heart Valve Technology | October 09, 2019

Torsten Vahl, M.D., director of experimental and translational research, Structural Heart and Valve Center and at the Center for Interventional Vascular Therapy at NewYork-Presbyterian Hospital/Columbia University Medical Center, explains the current state of transcatheter aortic valve replacement (TAVR) following the U.S. Food and Drug Administration (FDA) clearance of TAVR in all surgical risk patient categories. Europe also cleared the use of the Sapien 3 device for low risk patients in November 2019.

He spoke on TAVR at the Transcatheter Cardiovascular Therapeutics (TCT) 2019 meeting. In August 2019, the FDA cleared the use of TAVR in all surgical risk classes of patients using the Edwards Sapien 3 and Medtronic CoreValve devices. This means the heart team made up of a cardiac surgeon, interventional cardiologist and cardiac imaging specialist can determine if surgical aortic valve replacement (SAVR) or TAVR should be used. It is widely expected TAVR use will rapidly rise in the next five years to take over 50 to 70 percent of the aortic valve replacement procedural volume. It is expected surgical volumes will drop to about 20 percent of patients who do not qualify for TAVR because of anatomic issues or other variables that make SAVR a safer option.

 

Related Transcatheter Valve Content:

FDA Approves TAVR for Low-risk Patients Creates A Paradigm Shift in Cardiology

Edwards Sapien 3 TAVI Granted European Approval to Treat Low-risk Patients

VIDEO: Tracking Transcatheter Valve Outcomes in the STS-ACC TVT Registry — John Carroll, M.D.

VIDEO: Transcatheter Mitral Valve Replacement Planning — Interview with Joao Cavalcante, M.D.

VIDEO: Overview of University of Colorado Structural Heart Program — Interview with John Carroll, M.D., Robert Quaife, M.D., and James Chen, Ph.D.

Advances in Transcatheter Tricuspid Valve Technologies

 

VIDEO: Update of Mitral Valve Repair and Replacement Technologies at TCT 2017 — Interview with Ted Feldman, M.D.,

TAVR Operator and Hospital Requirements Outlined in 2018 AATS/ACC/SCAI/STS Expert Consensus

VIDEO: Tricuspid Device Clinical Trial Overview — Interview with Ori Ben-Yehuda, M.D.

Recent Advances in Transcatheter Valve Technology

 

VIDEO: Tricuspid Valve Imaging and Interventions Developing Hand-in-hand at ASE 2018— Interview with Rebecca Hahn, M.D.

Hospital Consolidation May Increase Access to TAVR, New Cardiac Technologies

VIDEO: TAVR for Degenerated Surgical Valves - 2017 Update— Valve-in-Valve TAVR Procedures — Interview with Sammy Elmariah, M.D.

How to Perform Transcaval TAVR Access

 

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

Advances in Heart Valve Technology in 2017

VIDEO: TAVR For Asymptomatic Severe Aortic Stenosis — Interview with Philippe Genereux, M.D.

VIDEO: Conscious Sedation for TAVR Procedures — Interview with Mario Goessl, M.D.

 

VIDEO: Overview of the Henry Ford Hospital Structural Heart Program

Advances and Future Directions for Transcatheter Valves

Transcatheter Mitral Valve Replacement Devices in Development

 

 

 

 

Antiplatelet and Anticoagulation Therapies | October 08, 2019

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

 

TCT | October 04, 2019

Chandan Devireddy, M.D., offers insights about what he saw as the top take aways from the 2019 Transcatheter Cardiovascular Therapeutics (TCT) annual meeting. He is cath lab director at Emory University Hospital Midtown, associate professor of medicine of interventional cardiology at Emory University, and chairperson for the Society of Cardiovascular Angiography and Interventions (SCAI) Communications Committee. 

Devireddy said his key take aways from TCT 2019 were:

   • The poor results of the Boston Scientific Acurate Neo self-explaining TAVR system compared to the current devices on the U.S. market;

   • Results of the Abbott Portico TAVR system;

   • Levant Trial shows no increased mortality due to use of a paclitaxel-coated balloon; and

   • CT study of TAVR valve leaflet thrombosis.

 

Find more TCT late-breaking news and video

 

Hemodynamic Support Devices | September 22, 2019

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)

Hemodynamic Support Devices | September 12, 2019

A discussion with William O'Neill, M.D., director of the structural heart program, Henry Ford Hospital, and Michele Voeltz, M.D., fellowship program director, interventional cardiology, explaining their process for selecting various levels of hemodynamic support.

Henry Ford Hospital also helped spearhead the Detroit Cardiogenic Shock Initiative that morphed into the National Cardiogenic Shock Initiative using these same protocols. Watch an interview with O'Neill explaining the national initiative.

Additional articles and videos on Henry Ford Hospital 

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

 

 

Advanced Visualization | August 09, 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

CT Angiography (CTA) | August 08, 2019

This is a quick video example of a cardiac computed tomography (CT) exam showing a Medtronic CoreValve transcatheter aortic valve replacement (TAVR) device implanted. The image was reconstructed using Canon Medical’s Global Illumination photo-realistic rendering advanced visualization post-processing software. 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. 

 

 

 

CT Angiography (CTA) | August 08, 2019

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.

 

 

Computed Tomography (CT) | August 07, 2019

This is an example of in-stent restenosis shown using spectral CT imaging. This example was demonstrated by Philips Healthcare at the 2019 meeting of the Society Of Cardiovascular Computed Tomography (SCCT). It can sometimes be difficult to determine if showing inside a stent of CT is artifact or real. Spectral CT can definitely help make a diagnosis. This example shows Philips’ Effective Z visualization, where the image is created based on the atomic number of the elements present in the image. After removal of iodine from the image, it shows the shadow in the stent has the same atomic composition as the vessel intima.  

This example is from a Philips IQon dual-energy CT scanner. This system has spectral imaging always on without any need to change protocols. This allows the spectral to be used when needed for additional information without need to rescan a patient.

Read more on this CT system.

VIDEO: Applications of Spectral CT — Interview with Suhny Abbara, M.D.